On 09.01.2019, I posted an article about MS medication during pregnancy online. In response, a comment was made by Faxe saying “Good to know, but what about the gentlemen?” He’s completely right – the advice for men often takes a backseat in this topic.
Please forgive me for not thinking of this, but as male pregnancy is still a thing of the future, I didn’t immediately think of men when dealing with the topic of “Medication and Pregnancy”. However, there are indeed a few things for men to consider, although significantly fewer than for women. The primary issue is what needs to be considered when conceiving a child – and furthermore, questions about fertility play a role.
Let’s first touch on the point of fertility: With the exception of Mitoxantrone, there is no evidence that any of the currently approved drugs have an effect on reproductive ability. For Mitoxantrone, it is expressly recommended that due to the risk of irreversible fertility disorder, cryopreservation of sperm should be performed before application.
Although Mitoxantrone was an important medication for treating highly active MS courses in the past, it currently doesn’t play a significant role in my view and should only be applied de novo in selected individual cases. Therefore, it can be expected that Mitoxantrone will no longer appear as a treatment option in the revised guidelines.
So, what’s the situation regarding conceiving a child? For men who were treated with Mitoxantrone, contraception should be used for at least six months after the last dose, as Mitoxantrone can damage genetic material. This should also be considered when treating with Cladribine – for both men and women, safe contraception should be used 6 months after the last dose of Cladribine. Considering the maturation and lifespan of sperm is approximately 3 months, a 6 month interval is generally considered sufficient and safe.
Men don’t really need to consider anything with all other medications. However, a few words should be said about Teriflunomide. When taking Teriflunomide, the active substance can be detected in the seminal fluid, but it is much lower (approx. 100x) than in the blood of an individual exposed to 14 mg. Accordingly, there is a theoretical possibility that minute amounts of the active ingredient could be passed on to the partner during conception. Overall, however, the risk is assessed as low in the technical information.
So – as I’ve already said, men have to consider significantly fewer facts than women. Caution is really only necessary with Mitoxantrone and Cladribine. But since Cladribine is used as an induction therapy and not regularly applied at three-month intervals like Mitoxantrone, this limitation does not pose a significant obstacle for male patients who want to conceive and are to be put on Cladribine – provided you bring a little patience (1.5 years).
