Methotrexate: pregnancy and fertility

One of the most common concerns in patients treated with methotrexate (MTX) is the potential risks in case of a future pregnancy. In this regard the following considerations may be of help:

  • A patient with arthritis who takes MTX can get pregnant if desired, although, pregnancy is not recommended when treated with this medication. To prevent possible teratogenicity, a careful pregnancy planning should be reached by consensus between doctor and patient before conception. Pregnancy should only be considered if arthritis activity is under a good control, preferably, under remission. In this case, MTX must be withdrawn 2-3 months before conception switching to a substitute less harmful in order to prevent possible flares.
  • If arthritis does not allow MTX withdrawal or patient got fortuitously pregnant while taking MTX: What are mother and fetus risks? For those rheumatoid arthritis patients that got pregnant while being treated with low-dose MTX (<25 mg), up to 66% of pregnancies reached successfully term and rate of abortions or fetal malformations in these patients were similar to those found in healthy patients [Clin Exp Rheumatol. 2009, 27 (4): 678-84]
  • Fertility of males with arthritis treated with low doses of MTX (<25mg) is still debated. Some authors have published some isolated cases of reversible oligospermia (less sperm). However this finding has not been supported by others. To date, there is no evidence that supports that low-dose of MTX in rheumatoid arthritis patients may cause male infertility or fetal growth abnormalities. [Can Fam Physician. 2003, 49 (5): 577-78]. However, a number of doctors recommend MTX withdrawal also in men 2-3 months before conception.

Leave a Reply

Your email address will not be published. Required fields are marked *