Medicines and fertility in men with rheumatic disease who are planning a pregnancy

Men with rheumatic disease who are planning a pregnancy with their partner should discuss the medicines they are taking with their doctor. The ability to have children may be affected by inflammatory rheumatic disease, and by the medicines taken by this group of patients.

Fertility in men with rheumatic disease

It is unknown whether male fertility is affected by inflammatory rheumatic disease. Although male infertility has been reported by a few studies, the extent to which it causes infertility has not been established. The reasons can also be varied and complex.

For men, certain medications taken for rheumatic disease can also temporarily affect sperm production. This can make it harder to get their partner pregnant.

Below, you’ll find a brief summary of the most commonly used medicines, and current recommendations about which of them can be taken when planning a pregnancy. The recommendations apply to dosages used in the treatment of rheumatic diseases.

Methotrexate

The recommendations apply to the dosages used in the treatment of rheumatic diseases. There is no evidence to indicate that methotrexate taken by a prospective father increases the risk of birth defects.

Methotrexate may possibly impair sperm production, but the number of men affected by this is not known. This may make it difficult to conceive. If you take a break from your methotrexate therapy, your sperm production will normalise within three months.

It is up to you to decide whether to continue taking methotrexate or to take a break from it while you and your partner are trying for a baby. If you are unsure, consult your specialist for advice.

Biological medicines

There is no evidence that the father’s intake of biological medicines (such as TNF inhibitors and interleukin (IL) inhibitors) increases the risk of birth defects, or affects male fertility. The recommendation is therefore to continue taking these medicines.

JAK inhibitors

JAK inhibitors (e.g. Olumiant®, Xeljanz®, Jyselca®, Rinvoq®) are a relatively new class of disease-modifying drugs for the treatment of rheumatic disease. 

It is unknown whether JAK inhibitors taken by men adversely affect sperm cells and fertility. If you are planning to father a child, you should consult your rheumatologist about taking a JAK inhibitor .

Cyclophosphamide

Cyclophosphamide (Sendoxan®) can cause permanent infertility in men. If you are going to start taking cyclophosphamide, you should consider sperm banking before taking this medicine.

The risk of birth defects if you make your partner pregnant while you are on cyclophosphamide therapy is not known. You should therefore stop taking this medication three months before trying to conceive. Reliable contraception is required during treatment and three months after stopping treatment.

Sulfasalazine

There is no evidence that sulfasalazine (Salazopyrin®) taken by the father increases the risk of birth defects. However, sulfasalazine is known to impair sperm production. This may therefore make it more difficult for some men to make their partner pregnant.

Sperm production normalises within three months after stopping treatment. It is therefore usual for your specialist to recommend taking a break from your sulfasalazine thereapy. If you are unsure, consult your specialist for advice.  

The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases (NKSR)

Monday-Friday from 08:00 to 15:00

Advises both patients and health professionals.

Norsk revmatikerforbund (Norwegian Rheumatism Association)

22 54 76 00

Tuesday from 10:00 to 15:00

Wednesday from 10:00 to 15:00

Thursday from 10:00 to 15:00

Calls are answered by people with a rheumatic disease, who can give you advice and guidance.

Podcast: Revmamas

A podcast (in Norwegian) for women who have a rheumatic disease and are planning a pregnancy or are pregnant. 

You’ll find it where you usually listen to podcasts, like Spotify for example.

Trygg mammamedisin

Get advice from professionals about safe medication use during pregnancy and breastfeeding. The service is free of charge.

Nasjonal kompetansetjeneste for svangerskap og revmatiske sykdommer. Veileder i svangerskap og revmatiske sykdommer.[Internett].Trondheim: St. Olavs hospital [hentet 2021-01-04]. Tilgjengelig fra: https://www.nksr.no/medikament/

Content provided by The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases (NKSR)

The Norwegian National Advisory Unit on Pregnancy and Rheumatic Diseases (NKSR). Medicines and fertility in men with rheumatic disease who are planning a pregnancy. [Internet]. Oslo: The Norwegian Directorate of Health; updated Tuesday, October 10, 2023 [retrieved Friday, March 1, 2024]. Available from: https://www.helsenorge.no/en/pregnancy-and-maternity-care-in-norway/pregnancy-childbirth-family-life-rheumatic-disease/medicines-and-fertility-in-men-with-rheumatic-disease-who-are-planning-pregnancy/

Last updated Tuesday, October 10, 2023