When a couple is planning pregnancy, it is easy to just
focus on women's health. However, there are drugs that
can affect both the woman and the man.
In women, some
drugs can reduce the chance of getting pregnant and
increase the risk of fetal damage. In the man, such
drugs can reduce the number of sperm and thus the chance
of the woman becoming pregnant, but some preparations
can also lead to miscarriage or congenital malformations
in the child.
Drugs that affect the woman and man in this way are
first and foremost drugs used in the treatment of
rheumatic diseases - DMARDs, disease-modifying
anti-rheumatic drugs. However, the preparations are also
used in other chronic inflammatory diseases. If you use
such drugs, you should be aware of the risks associated
with them in pregnancy and breastfeeding.
Methotrexate affects both eggs and sperm. It can also
lead to miscarriage or congenital malformations, such as
spinal bifida (spina bifida) in the unborn child. Use of
safe prevention is therefore important when using
methotrexate - whether you are male or female.
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Treatment with methotrexate should be discontinued
for at least three months (some doctors recommend up to
six months) before attempting to have children as a man
or woman. Some believe that it is enough to take eight
weeks off for a woman who has used methotrexate before
trying to get pregnant. When it comes to men, there are
some professionals who recommend waiting at least four
months before trying to have children. The
recommendations are based on this literature.
If you become pregnant while taking methotrexate,
talk to your doctor as soon as possible.
This preparation can reduce the number of sperm in
men, and can also affect the woman's eggs. However, it
seems that women who use azathioprine give birth to
normal children and there does not appear to be an
increased risk of congenital malformations. However, it
is recommended that you do not use azathioprine during
pregnancy or while breastfeeding.
Ciclosporin is often used among people who have
undergone transplants and it is not an uncommon agent in
the treatment of gout (arthritis). Many women who have
used this drug during pregnancy have had successful
pregnancies. However, the drug goes into breast milk and
it is therefore recommended that the child receive
breast milk replacement.
Cyclophosphamide and chlorambucil
Both of these preparations can cause sterility in
both men and women. Men who use this drug are advised to
freeze their sperm before starting treatment to use them
for future conception. Use of such drugs should be
discontinued for at least three months before attempting
to become pregnant. The drugs should also be avoided
during pregnancy as they can be harmful. Breast milk
replacement is recommended if you take this preparation
after the baby is born.
This preparation is relatively new in the treatment
of arthritis. Leflunomide can cause congenital
malformations and should be avoided both before and
during pregnancy. Safe contraceptives should be used as
long as you are eating this medicine. Leflunomide stays
in the body for a long time and women who want to become
pregnant should wait at least two years after stopping
the drug before attempting to become pregnant. For this
reason, there are doctors who avoid prescribing the drug
to women who may want to become pregnant in the future.
The waiting time can be reduced to three months if you
undergo a special treatment that flushes the drug out of
Men should stop taking the preparation, undergo a
cleansing treatment and then wait three months before
trying to have children.
Leflunomide should not be used during breast-feeding.
Many women have had successful pregnancies when using
penicillamine. However, there is a risk that problems
will occur if taken in high doses, early in pregnancy
and this is therefore not recommended.
This preparation reduces the number of sperm, but the
number increases again when treatment ceases. If a
couple is having a difficult time having a child, it may
be good if the man changes the drug type. Many women
have used this preparation during pregnancy and
breastfeeding without this causing any problems.
The biological treatments include adalimumab,
anakinra, etanercept and infliximab. They are relatively
new drugs used in the treatment of arthritis, psoriasis,
multiple sclerosis, chronic infectious diseases of the
gut, and more. Experience with the effects of these
drugs during pregnancy and lactation is still limited.
It is recommended that both men and women cease
treatment five to six months before attempting to have
children. Medicines can pass into breast milk and the
effect on the baby is not known.