Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group NSAIDS + Fertility

Hi,

Just wondering if anyone can help...

I was diagnosed with AS in my early 20's (33 now) and have been taking 75mg of Diclofenac twice a day since.

My husband and I have been trying for a baby for 19 months and are at present undergoing fertility investigations. I have read many articles on the web saying that NSAIDS may cause temporary infertility and have motioned this to my Rheumatologist and the fertility consultant but neither knew anything about it and don’t seem to be taking it seriously.

The articles I have read say that when taken off NSAIDS the women studied become pregnant quite quickly but they do not say what kind of pain relief they were given during this period.

So finally to my question's. Does anyone know anything about this or what kinds of medication are ok to take while trying to get pregnant?

Any help would be much appreciated.

Nicola


Nicola

Hi

It was said to me, if I wanted to conceive, I should come off ALL meds in advance. I did for the 3 months before 'trying', and fell pregnant.
Everyone is different (regardless of the use of meds), so one person could conceive 1st try, while others take a year, 3 years or more
.
None of my Drs were concerned that I might not fall pregnant because of my use of NSAIDS and no one said that they may affect fertility. I've not looked into this myself though.

While pregnant in the 1st trimester your asked not to take anything at all. Not even a painkiller.
Some NSAIDS can then be used (if absolutely needed) for the 2nd trimester, but are not recommended in the 3rd trimester, as they can affect the babies heart.

I'm 32 1/2 weeks pregnant now, and dealing with things as best I can.

I hope you find some answers to your questions, and that all is well after your fertility tests.

Take care, and best wishes for your future.


Amber

Hi Amber,

Thanks for the reply.

I think I am going to try coming of the Diclofenac and just survive on paracetamol and lots of exercises!


Nicola

Hi,
another pregnant here :) 15 weeks.

my docs said anything about the meds, but i knew i shouldnt take any before, basically cause you never know when the miracle happens and i didnt want to hurt the baby before i even knew it was there. in the first trimestr, i managed to do without meds, now, i had to take it ones.

we were trying for 11 months and already went for some bood tests and spermiogram as well. the problem they discovered was i have too much prolactin which can cause fertility problems. by the time the results came, i was pregnant but if i wasnt the doc said she d send me for computer tomography as it could mean a problem on my brain - not serious but important in this case so if we try for another baby in future, she said she would check that.

good luck and dont worry too much, it seems this year is great for having babies, i find out about new pregnancies every other week - yesterday about another one :)

Hana

From medline:

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10952743&dopt=Abstract
Mendonca LL, Khamashta MA, Nelson-Piercy C, Hunt BJ, Hughes GR.
Non-steroidal anti-inflammatory drugs as a possible cause for reversible infertility.
Rheumatology (Oxford). 2000 Aug;39(8):880-2.
PMID: 10952743
"OBJECTIVE: To highlight the possible association between infertility and treatment with long-term non-steroidal anti-inflammatory drug (NSAIDs). NSAIDs act mainly through the inhibition of cyclooxygenase, the enzyme that catalyses the synthesis of prostaglandins, which are essential mediators of ovulation, implantation and placentation of the conceptus. METHODS: Case reports of four women suffering from severe arthritis, on long-term NSAIDs and undergoing extensive investigation and treatment for infertility. RESULTS: During the last 2 yr, four out of five women with severe arthritis and difficulty conceiving were counselled to stop NSAIDs, and they successfully conceived shortly after the withdrawal of NSAIDs. CONCLUSION: NSAIDs, used largely for the treatment of rheumatological conditions, may be responsible for some cases of infertility. "

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11425807&dopt=Abstract
Pall M, Friden BE, Brannstrom M.
Induction of delayed follicular rupture in the human by the selective COX-2 inhibitor rofecoxib: a randomized double-blind study.
Hum Reprod. 2001 Jul;16(7):1323-8.
PMID: 11425807
"…RESULTS: Four ofthe six women who received rofecoxib demonstrated delayed follicle rupture, >48h after the LH peak, when compared with the placebo group, who all had follicular rupture >36 h after the detected LH peak. No differences in peripheral serum concentrations of progesterone, oestradiol, LH and FSH wereobserved between placebo and rofecoxib groups, when analysed at specified timeintervals. CONCLUSIONS: This study suggests that selective COX-2 inhibition has a negative, local effect on human ovulation, resulting in delayed follicular rupture, without affecting peripheral hormonal cyclicity.""

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8646437&dopt=Abstract
Smith G, Roberts R, Hall C, Nuki G.
Reversible ovulatory failure associated with the development of luteinized unruptured follicles in women with inflammatory arthritis taking non-steroidal anti-inflammatory drugs.
Br J Rheumatol. 1996 May;35(5):458-62.
PMID: 8646437
"The case histories of three young women with ankylosing spondylitis, rheumatoid arthritis and a seronegative inflammatory polyarthritis undergoing investigations for infertility are presented. In each, non-steroidal anti-inflammatory drug (NSAID) therapy was associated with the recurrent development of luteinized unruptured ovarian follicles and normal ovulation following drug withdrawal. It is suggested that NSAID therapy may be an important and frequently overlooked cause of anovulation and infertility."

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8624628&dopt=Abstract
Akil M, Amos RS, Stewart P.
Infertility may sometimes be associated with NSAID consumption.
Br J Rheumatol. 1996 Jan;35(1):76-8.
PMID: 8624628
"Non-steroidal anti-inflammatory drugs are widely used in the treatment of inflammatory joint diseases. Many patients suffering from these disorders are young women during their childbearing years. We report three cases of infertility where the cause may have been NSAID-induced 'luteinized unruptured follicle' syndrome."

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11425807&dopt=Abstract
Pall M, Friden BE, Brannstrom M.
Induction of delayed follicular rupture in the human by the selective COX-2 inhibitor rofecoxib: a randomized double-blind study.
Hum Reprod. 2001 Jul;16(7):1323-8.
PMID: 11425807
"…CONCLUSIONS: This study suggests that selective COX-2 inhibition has a negative, local effect on human ovulation, resulting in delayed follicular rupture, without affecting peripheral hormonal cyclicity. "

http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12113640
Stone S, Khamashta MA, Nelson-Piercy C.
Nonsteroidal anti-inflammatory drugs and reversible female infertility: is
there a link?
Drug Saf. 2002;25(8):545-51. Review.
PMID: 12113640
"Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently prescribed to women of child-bearing age. Three case series highlight the possibility of a link between NSAIDs and reversible infertility. The pharmacological target of NSAIDs is cyclo-oxygenase (COX), which catalyses the first rate-limiting step in the production of prostaglandins. COX-2, one of two isoenzymes, is active in the ovaries during follicular development. Its inhibition is thought to cause luteinised unruptured follicle (LUF) syndrome, an anovulatory condition characterised by clinical signs of ovulation but in the absence of follicular rupture and ovum release. The evidence linking regular NSAID use to reversible LUF syndrome comes from animal studies and three clinical studies. COX-2-deficient mice have severely compromised ovulation in the presence of apparently normal follicular development. Experimental administration of prostaglandins induced ovulation in rabbits and this was blocked by the administration of indomethacin. The three clinical studies demonstrated the induction of delayed follicular rupture or LUF in previously ovulating women by the administration of NSAIDs. A link can therefore be identified between NSAID use and reversible female infertility and NSAID withdrawal should be considered prior to or concurrent with fertility investigations."


http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15013926
OStensen ME, Skomsvoll JF.
Anti-inflammatory pharmacotherapy during pregnancy.
Expert Opin Pharmacother. 2004 Mar;5(3):571-80.
PMID: 15013926
"…The ability of NSAIDs to compromise reproductive function by inhibition of ovulation and as causative agents for miscarriage is still under debate..."

Edited by Evelyn on 03/18/04 10:44 AM (server time).

Edited by Evelyn on 03/18/04 10:59 AM (server time).

Edited by Evelyn on 03/18/04 11:11 AM (server time).

Thank you all for your quick replies.

They are very helpful.



Nicola

I actually got pregnant while taking an NSAID. I was on meloxicam or Mobic. It didn't cause any problems with my child, however, I stopped taking them as soon as we found out I was pregnant. In my experience, my AS went into a temporary remission while I was pregnant. I had a few tuff days, but for the most part, I felt fine. I did have my daughter premature because the doctors said that my body would not expand any further, which may have been due in part to my frame size. I am only 5'1" tall and of a smaller build. When I found out I was pregnant, I looked for information from lots of places, and the best source I found was WebMD.

I hope this helps.
Misty

PS: good luck with trying for a baby. they truely are a blessing to have.