mercaptopurine and Infertility--Female

Topics: Adaptation, Psychological; Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Azathioprine; Female; Humans; Immunosuppressive Agents; Infertility, Female; Infertility, Male; Inflammatory Bowel Diseases; Male; Mercaptopurine; Mesalamine; Pregnancy; Pregnancy Complications; Reproductive Behavior; Stress, Psychological; Sulfasalazine

Young women with inflammatory bowel disease (IBD) pose a unique set of challenges. These women and their treating physicians must make difficult choices in matters regarding conception, pregnancy, and breastfeeding. This review highlights recent evidence and management issues that arise when taking care of women with IBD in terms of fertility, outcomes, and medication safety in pregnancy and breastfeeding. Ultimately, treatment must be individualized for each patient based on the available evidence and the woman's preferences.

Topics: Animals; Azathioprine; Breast Feeding; Drug Therapy, Combination; Evidence-Based Medicine; Female; Fertility; Gastrointestinal Agents; Glucocorticoids; Humans; Immunosuppressive Agents; Infertility, Female; Inflammatory Bowel Diseases; Mercaptopurine; Meta-Analysis as Topic; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Risk Factors

Topics: Abnormalities, Drug-Induced; Adrenal Cortex Hormones; Animals; Azathioprine; Chlorambucil; Cyclophosphamide; Cyclosporine; Female; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Infertility, Female; Mercaptopurine; Methotrexate; Mice; Pregnancy; Pregnancy Complications; Rheumatic Diseases

Cytotoxic drugs, which are widely used as immunosuppressive and antiinflammatory agents in patients with neoplastic conditions, and cancer chemotherapy preparations, are of long-range concern due to the problem of cumulative organ toxicity which is not manifested until damage is extensive. These considerations have arisen because of their widespread use in recent years. Those involved in hepatic toxicity are the antimetabolites methotrexate and 6-mercaptopurine. Bisulfin, bleomycin, and methotrexate have been linked to pulmonary toxicity. Daunomycin and adriamycin, used as anticarcinogens, are examined for their cardiac toxicity. Cyclophosphamide and streptozotocin affect the urinary tract. These drugs have specific toxic effects on fertility in both males, through its disruption of the testicular function, and in females, for ovarian disruptions. Antifolics, 6-mercaptopurine, azathioprine, and alkylating agents, used for therapy in pregnant women, particularly in the first 4 months, are linked to the appearance of fetal abnormalities. The process of carcinogenesis is examined for clues to possible chemotherapy-related 2nd tumors, which appear during the course of treatment.

Topics: Alkylating Agents; Antineoplastic Agents; Azathioprine; Bleomycin; Busulfan; Carcinogens; Chemical and Drug Induced Liver Injury; Daunorubicin; Doxorubicin; Female; Fetus; Folic Acid Antagonists; Follow-Up Studies; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Infertility, Female; Infertility, Male; Liver; Lung Diseases; Male; Mercaptopurine; Methotrexate; Myocarditis; Neoplasms; Ovary; Pregnancy; Procarbazine; Streptozocin; Testis; Urologic Diseases

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Azathioprine; Colitis, Ulcerative; Crohn Disease; Female; Fetal Diseases; Humans; Infertility, Female; Infertility, Male; Male; Mercaptopurine; Metronidazole; Pregnancy; Pregnancy Complications; Risk; Sulfasalazine

The immunosuppressive drug 6-mercaptopurine is embryotoxic in mice. Of the surviving female offspring of mice treated with low doses of 6-mercaptopurine during pregnancy, despite normal body weight and general appearance, many were either sterile or, if they became pregnant, had smaller litters and more dead fetuses as compared to offspring of mothers that had not received the drug.

Topics: Animals; Dose-Response Relationship, Drug; Female; Fetal Death; Fetus; Germ Cells; Infertility, Female; Litter Size; Mercaptopurine; Mice; Ovary; Pregnancy; Pregnancy, Animal