Although its findings are considered preliminary, a new study out of Iraq found a distinct connection between use of nonsteroidal antiinflammatory drugs (NSAIDs) and infertility in women. Presented at the European League Against Rheumatism Congress in Rome in June 2015, these findings may provide proof that NSAIDs disrupt ovulation, something previously hinted at in animal studies.
The study conducted at Baghdad Hospital involved 39 women of child-bearing age who suffered from minor back pain. They were randomized to 1 of 4 groups—a control group that received no pain relief and 1 group each for the following NSAIDs: diclofenac 100 mg once daily, naproxen 500 mg twice daily, and etoricoxib (a COX-2 selective inhibitor not presently available in the United States) 90 mg once daily. Participants took their assigned medication for 10 days starting on day 10 of the onset of their menstrual cycles to ensure that a follicle developed in preparation for releasing an egg. At baseline, participant blood samples were evaluated for progesterone level and each woman underwent an ultrasound to assess the size of the dominant follicle on the affected ovary. After 10 days of treatment, the participants repeated these assessments.
The results? Women treated with NSAIDs demonstrated a significant inhibition of ovulation compared with controls. In fact, ovulation was reduced by a 93% in the diclofenac group and by about 75% in both the naproxen and etoricoxib groups. All 3 treatment groups saw profound decreases in progesterone level, and about one-third of the women developed cysts due to unruptured follicles. Ovulation returned to normal once the women stopped taking their NSAID doses.
NSAIDs are used worldwide to relieve pain and are often sold over the counter, so these findings are alarming especially for women who want to get pregnant but who are also using NSAID medications to relieve pain. Physicians would do well to keep these findings in mind when treating patients who experience chronic pain and are also battling infertility.
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Salman S, Sherif B, Al-Zohyri A. Effects of Some non steroidal anti-Inflammatory drugs on ovulation in women with mild musculoskeletal pain. Ann Rheum Dis. 2015;74:Suppl 2 117-118

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