# Enbrel while trying to concieve



## Jaime (Aug 25, 2009)

Hi my name is Jaime, I have severe ankylosing spondilitis and used to be on Enbrel anti tnf treatment but was advised by my rheumy to come off it whilst trying to conceive my 2nd child.  Unfortunately we have since found out we have some fertility issues and I have now been off this treatment for over a year during which time my rheumy prescribed diclofenac.  During some recent internet research I came across a few articles stating that long term use of NSAIDS can infact stop you conceiving so my doctor took me off diclofenac and put me on tramacet with paracetamol.  In the 2 weeks I have been off diclofenac my condition has deteriorated rapidly and I am in constant pain.  After looking on this website it is apparent that anti tnf is actually used for fertility treatment, I understand this is only available at ARGC in London and have left a message to book an appointment but understand there is a long waiting list.  My questions to you (which I understand you may not be able to answer, but just your opinion would be great!) are,  have you heard of the link between diclofeanc and infertility?, why do you think my rheumy wont let me be on enbrel whilst trying to conceive if it is used as fertility treatment? Do you know how much enbrel/humira is administered when using for fertility treatment and how long the patient would be on it?.  Finally what actually is tramacet? (as to me its like popping smarties).  Many thanks for listening
Regards
Jaime x


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## mazv (Jul 31, 2006)

Hi Jamie,

I would advise you to speak to your rhuematologist about these issues as you need to discuss all the complicating factors of both your underlying condition and your fertility issues.

There is some evidence that long term use of NSAIDs can delay or prevent ovulation in women, however it is not a common problem and is reversible on discontinuation of the NSAID. Were tests undertaken to determine if ovulation occurs before you stopped the diclofenac? If you are ovulating then there is no need to stop an effective pain controlling treatment.

Neither Enbrel nor Humira are licensed in fertility treatment nor are they licensed in pregnancy and there is no evidence of use on pregnancy to determine whether they are safe or not. There is a school of thought that certain causes of fertility problems are linked to imbalance in the immune system and some clinics advocate the use of immunological therapies during assisted reproduction to overcome implantation problems and early miscarriage. At present there is no robust evidence base from any clinical trials to support this theory. Although there are a select number of clinics offering this type of therapy. My understanding of the protocols is that Humira is used prior to starting an assisted cycle in order to reduce abnormally high levels of certain immune markers; it is generally given once or twice in the weeks prior to starting IVF/ICSI. As far as I'm aware it is not used during cycles nor after a positive result.

Tramacet is a combination drug that contains tramadol (an opioid like pain killer) plus paracetamol. Are you taking this with paracetamol just now as well? You should not take any more than a total of 4 grams of paracetamol in 24 hours. I would check with your Doctor exactly what doses of these drugs you are taking to ensure you aren't;t exceeding maximum doses. Opioid are generally not as effective as anti-inflammatory drugs for the treatment of your condition so not surprised that the tramacet isn't;t doing anything. Again you really need to speak to your Doctor to find the right balance between treating your condition and optimising your chances of conceiving.

Best wishes for everything
Maz x


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