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Fertility in Rheumatic Disease Patients Needs Priority

Authors review reasons for impaired fertility, role of practitioner in helping preserve it

TUESDAY, Dec. 28 (HealthDay News) -- Reduced fertility is not uncommon in both male and female patients being treated for rheumatic diseases; therefore, family planning should be discussed with all patients requiring therapy with drugs that may impair fertility, according to a review published in the December issue of Arthritis Care & Research.

Clovis A. Silva, Ph.D., from the Universidade de Sao Paulo in Brazil, and colleagues reviewed literature from 1966 to 2009 regarding fertility, rheumatic diseases, gonadal toxicity, nonsteroidal anti-inflammatory drugs (NSAIDs), and immunosuppressive drugs. They reviewed 78 articles in an attempt to determine the best way to retain fertility in this patient population.

The researchers found that the reasons for impaired fertility in these patients were multifactorial, with drug treatment being the main factor in gonadal dysfunction. Certain drugs, such as NSAIDs in women and sulfasalazine in men, can cause reversible infertility. Irreversible infertility was observed exclusively in male and female patients treated with alkylating agents such as cyclophosphamide. It was determined that, in cases where alkylating agents are necessary, the lowest possible doses and alternative therapies need to be considered. The authors write that family planning needs to be discussed with any patient who requires therapy with drugs that can result in infertility.

"The rheumatologist should inform the patient about methods for preservation of fertility and refer the patient to a gynecologist or urologist for necessary assessments of gonadal function," the authors conclude.

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