This comprehensive review examines the challenges faced by women of reproductive age who have inflammatory bowel disease (IBD). It focuses on the management of IBD during the periconceptional, gestational, and postpartum periods, as well as its effects on fertility and pregnancy outcomes. The review emphasizes the impact of disease activity, surgical interventions, and medications on fertility and pregnancy, underscoring the importance of achieving disease remission prior to conception to improve outcomes. Preconception counseling is identified as essential in reducing disease flares and complications during pregnancy. Most IBD medications—excluding methotrexate, thalidomide, JAK inhibitors, and S1P modulators—are deemed safe for use during pregnancy and lactation. The article also stresses the need for the timely resumption of treatment after delivery and highlights the increased risk of postpartum disease flare, particularly in cases of ulcerative colitis. Additionally, it offers guidance for male IBD patients, emphasizing the importance of medication adjustments to address fertility concerns. A multidisciplinary approach, involving gastroenterologists, obstetricians, and surgeons, is recommended to ensure optimal care and favorable outcomes for both mother and child.