# psoriatic arthritis and ttc



## lottie14 (Jul 7, 2014)

Hello, I'm new on here and was just looking for advice! 

My partner has psoriatic arthritis and has been on infliximab and methotrexate for the last 10 years. He came off his treatment over 12 months ago so that we could try for baby number 2 and we haven't been able to conceive. We already have a 7 year old. His arthritis has gotten really bad so we asked for gp to do semen analysis and they both came back zero sperm - azoospermia! 

We have been to see urologist and blood test results and testicular ultrasound both came back OK. According to all doctors we've spoken to - GP, rheumatologist the drugs he was on do not cause infertility nor does the psoriatic arthritis itself. I have searched high and low on the internet and just can't find any information apart from methotrexate can cause infertility but only while on the drug and fertility returns once the drug is stopped.

We just can't understand how he can have no sperm at all when we conceived so quickly the first time.

Is there anyone in a similar situation or any advice?


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## Sheilaweb (Mar 21, 2006)

Lottie, my hubby was diagnosed azoospermic - but his infertility was blamed on long term use of anti convulsants for his epilepsy as it effects the pituitary gland in the brain which is where sperm or the making of sperm stems.

We did conceive after 8 years of trying, but it was thought that the effects of the drugs have had hubbys potency on a downward trend for years, but was never investigated when we first went to our gp's after 3 years ttc.  Consultants wanted hubby to come off the drugs to see if it made any difference, but he'd have had to have given up his driving licence, probably lost his job - so for us it wasn't worth the gamble.

There is no 'proven' medical link or warning given to boys who are prescribed drugs as to the 'potential risk to their fertility in later life' but our consultant was adamant it was down to this despite this being refuted by other dr's and gp's - but I have found quite a few research papers associating infertility with epilepsy drugs. 

I suppose it's like all things medical - if the asked the same question to 100 dr's, you'd potentially get up to 100 different answers!

Soo sorry you're in this position.
Sheila


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## lottie14 (Jul 7, 2014)

Hi Sheila,

Thank you very much for replying and for sharing your sharing your story. I'm very glad to hear you were able to conceive eventually.

My partner had to come off the treatment because they don't advise you to conceive while taking the drugs because of adverse effects on the baby.
The doctors all seem so sure that the infertility isn't linked to the drugs or the arthritis but I just find it hard to believe. Although the GP did say that they would 'yellow card' methotrexate and infertility. (basically they issue a yellow card for the side effect and then if other doctors do the same thing eventually they will see a link)  

I'm holding on to the hope that the cause is 'fixable' 

I think the next stage for us is to check for blockages, but I'm not sure how they do this. In the meantime my partner's arthritis is getting worse and he really needs to go back on his treatment, we're trying to decide where to draw the line and 'give up' so that he can go back on treatment. Although from what I've read ICSI can be an option for azoospermia, as we already have a child we would have to go private and at £4000 I just can't see it being possible. But it's really hard to think we wont ever have another baby  

I do have a question for you if you don't mind me asking, I've tried to find the info online and I can't. 
I'm trying to find out if azoospermia is caused by drugs, would this be reflected in the any of the test results or would they just not find any cause of the azoospermia. For example would some of the blood test results be abnormal because the body isn't producing sperm.

Lottie


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## Loopyttc (Aug 4, 2013)

Hi Lottie

OMG I had to respond! Don't always trust what the doctors says! 

My husband has an autoimmune disease called Behchets (it's very rare), and he was put on an anti-inflammatory drug called colchicine. We were assured repeatedly by the immune specialist and even our fertility specialists told us it would have no impact on my husbands sperm. Their advice was completely wrong - it is actually well known that the drug he was put on can put an absolute stop to sperm production and take times to come out of your system. Zita West's book specifically names it as a drug that impacts sperm. 

My DH's immune disease only started about 4 years ago, and his original SA 5 years ago were all fine. After the immune disease came on, his count, mobility and morphology went down hill drastically.  I have struggled with the doctors who all say that his immune disease is unlikely to have an impact on his SA - however, logic says that before the immune disease he was fine, and since the immune disease he is not. 

So, we went to see a specialist urologist (Dr Ramsay), who is fabulous, and he confirmed that the disease was the most likely cause of the problem and that flare-ups are likely to co-inside with poor sperm. My husband suffers particularly when he is stressed, which as a teacher happens quite often. As it takes 3 months for sperm production, we have decided to freeze some sperm at the end of the summer holidays (he has 2 months off) and hope that it might be a better result.  

Also, I used the "email Robert Winston" service that the Guardian reported on recently and asked him for a second opinion - he said that DH's immune disease is very likely causing more widespread inflamation (i.e. not just that you can see!) and that its very likely impacting his sperm production. 

We are now on an anti-inflamatory diet, not drinking, no hot baths and he is taking supplements - we've gone for the Zita West ones and I am researching whether we should go for some additional supplements that are specifically designed for inflamatory responses. 

The doctors have been very dismissive of this - we've been told that there is no research to say that supplements help sperm production - but that's missing the point in my view. We're not trying to improve sperm production, we are trying to control an immune response naturally knowing that the immune response damages sperm production.

Hopefully by the start of September we should know if this is going to work - and I will let people know if it does, but for 3 months it's worth trying anything if it means we can have our own child - and it's all natural so it can't do any harm. 

One final point (sorry this is so long!) we have been told that it takes a while after a flare-up of the immune disease and after taking the medicine for things to return to "normal" - DH's SA have improved SLOWLY since the onset of the disease (which was the biggest flare-up of symptoms and inflammation) and him coming off his drugs. Hopefully this will happen with you too. 

I hope this helps, sorry for the rant but it's taken us 5 years to get to this point and so I feel I should share what we have learnt so others don't have to go through everything like us.


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## lottie14 (Jul 7, 2014)

Hi Loopy,

Thank you so much for replying, don't apologize at all this information is great, I really appreciate it, although I am sorry to hear you're going through this.

I have long suspected that the inflammation going on in his body is having an effect on sperm production, but the doctors who specialise in the arthritis are so quick to dismiss any link. His ESR and CRP levels are really high. 
When we conceived our first child it wasn't planned and he was on his infliximab treatment at the time - but thankfully everything was ok. The treatment has always kept his arthritis under control and ESR and CRP levels low. (normal range)

The problem we have is unless he goes on drugs we wont be able to reduce the inflammation and the drugs themselves aren't recommended while ttc! The rheumatologist hasn't suggested any alternative treatments he could try in the meantime other than steroids, tbh I get the feeling he isn't interested - it's like because he has decided to stop the treatment to have a baby he is on his own until he decides to go back on the drugs he was on before. Which is really frustrating.

After hearing about your situation I feel even more sure that the inflammation must be playing a part and we will research what our options are for reducing the inflammation. 
I am very interested to hear if there have been any improvements for you in September - I hope there is!!


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## Sheilaweb (Mar 21, 2006)

Lottie, in my own very personal and somewhat limited experience, dr's do close ranks and do not want to place any blame whatsoever on the drugs they prescribe for our men or for any subsequent male factor fertility problems further down the line.  But is seems very co-incidental certainly from my own personal research that there seems to be a growing number of research papers and investigations concerning male epilepsy sufferers and their subsequent inability to father children naturally after long term use of anti convulsants.... maybe they do not want to warn young boys (or their already worried Mothers) that by taking long used (and effective) treatments - this might hamper their chances of becoming Dads, OR, more worryingly, passing on a possibility that any son conceived, may also in turn have problems.

I am glad that we conceived a daughter, why?, because I know that I may pass on problems with fibroids in her later life.  Yes they're not nice to deal with, but from my own experience, they can be dealt with - I won't therefore have a son and daughter in law going through years of limbo and what if's trying as we did to have a family.

But in answer to your question, I don't think there is any hard and fast 'rule' where blood test results can give a definitive indication of azoospermia or it's root cause....simply because there are soo many parts of the body that are used within the whole sperm production cycle from the pituitary gland in the brain that kick starts it all - with the FSH and LH and other hormones driving the process, to the tubes and other bodily parts that this liquid travels before becoming the 'finished article' - bit like a conveyor belt of bits being added as it get nearer the end of the production line!  Something somewhere can go wrong at any point of the 'sperm production process' - blood tests and scans can only give an indication -  or where a problem may (or in the case of non obstructive azoospermia), may not exist...if that makes sense.

Doctors are also sceptical of the impact of vitamins and supplements - but again, I can only go on my own personal experience, after 5 SA's all coming back with zero, 9 months on Multivitamins, my hubby had a million swimmers, more than enough for our ICSI...so for us, so for us, vitamins made a life changing impact.

I really hope that your hubbies / partners can be pain free and find the holy grail that will help.... I think luck played a major part in our success.  But sadly, I think that it'll take a huge increase in infertile couples asking the same questions to medical experts, before these people a) admit a link, b) investigate, c) find a cure that wont impact of their ability to procreate.

Hugs
Sheila


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