Inflammatory bowel disease in subfertile men and the effect of mesalazine on fertility

Abstract

This study aimed to examine the effect of mesalazine on fertility. In this retrospective analysis of 1,225 male subfertile patients, we reviewed the cases of inflammatory bowel disease (IBD) in the medical records and evaluated the prevalence of the disease in our reproduction center. Specifically, we examined IBD patients who ceased mesalazine during male infertility treatment, and compared the seminogram of these patients before and after discontinuation of mesalazine. We also analyzed pregnancy outcome after discontinuation. The prevalence rate of Crohn's disease and ulcerative colitis in our male infertile patients was 163 per 100,000 men and 490 per 100,000 men, respectively. Seven patients had taken mesalazine and six of them subsequently stopped the medication. The mean values of sperm concentration, sperm motility, percentage of normal formed sperm, semen volume, and total motile sperm count taken before discontinuation increased after discontinuation of mesalazine. Among these parameters, the sperm motility and total motile sperm count were significantly improved (p50.05) after discontinuation. Of the six patients who stopped the drug, four achieved pregnancy with their partners, with two of the four men showing significant improvement not only in the percentage of normal shaped sperm but also sperm motility and total motile sperm count. This study provides further insight into the rarely investigated relationship between male fertility and mesalazine.

Systematic review: safety of mesalazine in ulcerative colitis

“…Six of these seven patients discontinued their mesalazine treatment. Sperm motility and total motile sperm count were significantly improved in all patients after discontinuation, and most were able to conceive successful pregnancy with their partners . Thus, in male patients on mesalazine who experience a decrease in libido, sexual dysfunction, or difficulty conceiving a pregnancy, a trial of mesalazine discontinuation is a reasonable first approach (Table ).…”

Conservative Nonhormonal Options for the Treatment of Male Infertility: Antibiotics, Anti-Inflammatory Drugs, and Antioxidants

“…The negative effect of mesalazine on fertility has been shown in patients with irritable bowel disease that at a certain point requires treatment cessation to achieve fertility. Indeed, the mean sperm concentration, sperm motility, percentage of spermatozoa with normal form, seminal fluid volume, and total motile sperm count increase after mesalazine discontinuation [42]. Another study showed a decrease of sperm count and motility in mice treated with sulfasalazine [43].…”

Review article: the safety of therapeutic drugs in male inflammatory bowel disease patients wishing to conceive

“…This improvement resulted in four of the six patients achieving pregnancy. The authors concluded that mesalazine cessation should only be pursued in patients with stable IBD …”