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

If you have a rheumatic disease and want to become pregnant, you should plan your pregnancy together with your specialist. The goal is to provide the best possible care for you without harm to your unborn child.

Reviewing your current medication

You will have to stop taking certain medicines before trying for a baby, while other medicines are important to continue taking throughout pregnancy. It is therefore important to review the medication you are taking with your doctor before you become pregnant.

Medication during pregnancy poses a particular challenge because consideration must be given to your unborn child as well as you. Taking medicines may be absolutely essential for your own health and that of the unborn child, while some medicines may also be directly or indirectly harmful to your baby.

This is precisely why it is important to plan the pregnancy and review the medicines you are taking before you get pregnant. The goal is to provide the best possible care for you without harm to your unborn child.

Medicines and fertility

Some medicines taken to treat rheumatic disease affect fertility.

Methotrexate

If you have taken methotrexate before, this will not affect your ability to have children. However, you should stop taking methotrexate three months before you plan to become pregnant. This is because taking methotrexate while you are pregnant carries an increased risk of birth defects and miscarriage.

Anti-inflammatory drugs

If you have problems getting pregnant, you should be cautious about taking common anti-inflammatory drugs (also known as NSAIDS). These drugs may affect ovulation in some women. This may make it harder to get pregnant. It is not a huge effect, and most women who take NSAIDs will not experience any problems conceiving.

Cyclophosphamide

Cyclophosphamide (Sendoxan®) is a powerful immunosuppressive drug that is sometimes used to treat severe rheumatic disease. Treatment with cyclophosphamide may result in reduced ability to become pregnant. The risk of this depends on your age and the size of the doses you have been prescribed.

When you start taking cyclophosphamide you should always discuss future pregnancy with your doctor. 

Does the rheumatic disease affect fertility?

Fertility, meaning the ability to get pregnant, is influenced by many factors. Some studies have found that women with rheumatic arthritis diseases take a little longer to get pregnant compared to healthy women of the same age. The reason for this is complex and not fully known.  If you have a very active disease, it is likely to affect your ability to get pregnant.

Many factors may be involved:

  • Physical factors
  • Psychological factors
  • Hormonal factors
  • Immunological factors
  • Medical factors 

The most common cause of fertility problems in women with rheumatic disease is the same as for healthy women, namely advanced age.

If you want to get pregnant, you should talk to your rheumatologist at an early stage. If you experience problems getting pregnant, your GP should refer you for fertility assessment. Usually this is done after one year of trying to get pregnant, but in women with rheumatic disease the doctor may decide to refer you after only 6 months of trying, especially if there are other factors that might make it more difficult to conceive. Talk to your doctor about this.  

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.

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 women 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-women-with-rheumatic-disease-who-are-planning-a-pregnancy/

Last updated Tuesday, October 10, 2023