title: [Reversible infertility from nonsteroidal anti-inflammatory drugs].
abstract: BACKGROUND
  Nonsteroidal anti-inflammatory drugs (NSAIDs) and selective cyclooxygenase-2 inhibitors may interfere with ovulation and the rupture of the follicle, causing reversible infertility.
  
  
  METHODS
  Literature review.
  
  
  RESULTS
  Reversible infertility is shown both in animal and human studies of these drugs. As determined by ultrasound, the drugs may delay or inhibit ovulation. These findings are also confirmed by a few randomized controlled studies showing an increase in time from the luteinizing hormone surge to rupture of the follicle and an increased size of the unruptured follicle. Most of the hormone analyses show values in accordance with the ovulation/menstrual cycle. Also, two epidemiological studies have shown an association between NSAID use and spontaneous abortion. These studies have methodological weaknesses and their findings have to be elucidated in future studies.
  
  
  CONCLUSIONS
  Women with fertility problems should avoid not only the selective cyclooxygenase-2 inhibitors, but also the traditional NSAIDs. However, women with rheumatic disease responding well to therapy should consult their physicians before stopping treatment. Reduced dose of a NSAID and temporary stop of drug treatment early in the menstrual cycle, or alternative drug treatment, may be a solution. NSAIDs should not be used in the last eight weeks of pregnancy.
authors.affiliation: Klinikk for ortopedi og revmatologi, Revmatologisk avdeling, St. Olavs Hospital, 7006 Trondheim. johan.skomsvoll@medisin.ntnu.no
authors.forename: Johan Fredrik
authors.initials: JF
authors.lastname: Skomsvoll
authors.forename: Erik
authors.initials: E
authors.lastname: Rødevand
authors.forename: Hege Svean
authors.initials: HS
authors.lastname: Koksvik
authors.forename: Kjell Asmund
authors.initials: KA
authors.lastname: Salvesen
authors.forename: Vidar
authors.initials: V
authors.lastname: von Düring
authors.forename: Tarjei
authors.initials: T
authors.lastname: Rygnestad
authors.forename: Monika
authors.initials: M
authors.lastname: Østensen
mesh_terms: D000022:Abortion, Spontaneous / Q000139:chemically induced; D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000139:chemically induced*; D006080:Ovarian Follicle / Q000187:drug effects; D034445:Ovulation Inhibition / Q000187:drug effects*; D011247:Pregnancy; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors