[Reversible infertility from nonsteroidal anti-inflammatory drugs].
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.
Skomsvoll
Johan Fredrik
JF
Klinikk for ortopedi og revmatologi, Revmatologisk avdeling, St. Olavs Hospital, 7006 Trondheim. johan.skomsvoll@medisin.ntnu.no
Rødevand
Erik
E
Koksvik
Hege Svean
HS
Salvesen
Kjell Asmund
KA
von Düring
Vidar
V
Rygnestad
Tarjei
T
Østensen
Monika
M
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
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors