There are no studies that show a negative effect of IBD drugs on female fertility.8 More data are available on subfertility and IBD medication use in male patients. We therefore describe current knowledge on the effect on male fertility of the IBD drugs that are most often prescribed.
Sulphasalazine causes a reversible, dose-related decrease in both sperm count and motility.18,19 Sulphasalazine should therefore be switched to a different 5-ASA drug if the patient wishes to reproduce.
Corticosteroids can cause a reversible decrease in sperm motility and concentration; however, there seems to be no link between steroid use and infertility.20,21
Methotrexate causes oligospermia, which improves within a few months of stopping it.22 Methotrexate is, however, teratogenic and contraindicated in both men and women wishing to procreate.23 It has been advised that methotrexate should be stopped 4–6 months before conception.24
Azathioprine does not reduce semen quality and, therefore, does not affect fertility in male IBD patients.25 A large prospective study including 115 pregnancies fathered by males using thiopurines (azathioprine or 6-mercaptopurine) during conception showed no statistically signiﬁcant increase in the rate of major congenital anomalies.26 In addition, a meta-analysis published in 2013 showed no association between congenital abnormalities and thiopurine use by the father at the time of conception.27
The effect of anti-tumour necrosis factor (TNF) drugs on male fertility has not been extensively examined. Infliximab seems to affect semen quality by reducing motility,28 but the data are conflicting because men with spondylarthropathies who received anti-TNF therapy were found to have a tendancy for better sperm quality than those who did not.29 There have been no studies on the effect of adalimumab on male fertility. Few studies have investigated the effect of male infliximab use during conception on the foetus, but the existing studies found no evidence that they increased the risk of adverse birth outcomes.30-32 Therefore it is not recommended that male patients stop infliximab treatment before conception.
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