Aspirin,
NSAIDS & Infertility
Doctors may not mention this to women who are trying to get pregnant, but the use of
non-steroidal anti-inflammatory drugs, including Advil and Aleve, and aspirin cause
ovulation problems. Specifically, the use of these medications can cause a failure of the
follicles to burst and release eggs -- called luteinizing unruptured follicle syndrome
(LUF or LUFS). Below are some abstracts on the subject. Full journal articles may be
ordered through Medline or found at medical libraries. I've included the link and here is
the url as well: http://www.fertilityplus.org/faq/nsaids.html
for you to go right to the source. NSAIDS,
Aspirin & Infertility - Journal Abstracts
Citation: Smith G, Roberts R, Hall C, Nuki G, Reversible
ovulatory failure associated with the development of luteinized unruptured follicles in
women with inflammatory arthritis taking non-steroidal anti-inflammatory drugs., Br J
Rheumatol 35: 5, 458-62, May, 1996. Address: Rheumatic Diseases Unit Western General
Hospital Edinburgh.
Abstract
The case histories of three young women with ankylosing spondylitis,
rheumatoid arthritis and a seronegative inflammatory polyarthritis undergoing
investigations for infertility are presented. In each, non-steroidal anti-inflammatory
drug (NSAID) therapy was associated with the recurrent development of luteinized
unruptured ovarian follicles and normal ovulation following drug withdrawal. It is
suggested that NSAID therapy may be an important and frequently overlooked cause of
anovulation and infertility.
Citation: Akil M, Amos RS, Stewart P, Infertility may sometimes be associated with
NSAID consumption., Br J Rheumatol 35: 1, 76-8, Jan, 1996. Address: Department of
Rheumatology Leicester Royal Infirmary UK.
Abstract
Non-steroidal anti-inflammatory drugs are widely used in the
treatment of inflammatory joint diseases. Many patients suffering from these disorders are
young women during their childbearing years. We report three cases of infertility where
the cause may have been NSAID-induced 'luteinized unruptured follicle' syndrome. This
phenomenon is well recognized in obstetric circles, and we would like to bring it to the
attention of rheumatologists since it is not documented in the rheumatological literature.
Zanagnolo V, Dharmarajan AM, Endo K, Wallach EE, Effects of
acetylsalicylic acid (aspirin) and naproxen sodium (naproxen) on ovulation, prostaglandin,
and progesterone production in the rabbit., Fertil Steril 65: 5, 1036-43, May, 1996.
Address: Department of Gynecology and Obstetrics Johns Hopkins University School of
Medicine Baltimore Maryland USA.
Abstract
OBJECTIVE: To determine the effects of acetylsalicylic acid
(aspirin) and naproxen sodium (naproxen) on ovulation, ovarian prostaglandins (PG), and P
production in the rabbit via in vivo and in vitro studies.
DESIGN: Aspirin and naproxen were administered i.v.
6.5 and 7 hours, respectively, after hCG administration to New Zealand White adult female
rabbits. Laparotomy was performed 24 hours after hCG administration. For in vitro
experiments, control animals underwent laparotomy 6.5 (aspirin) and 7 hours (naproxen)
after hCG administration. The treated animal received aspirin and naproxen; laparotomy was
performed 1 hour later. One ovary was perfused for 6 hours with aspirin or naproxen
whereas the contralateral ovary served as a control and was perfused with control medium
(M199; GIBCO, Grand Island, New York). Perfusate samples were collected at 1-hour
intervals for PG and P determination. SETTING: A conventional laboratory setting.
INTERVENTIONS: In vivo experiments used i.v. administration of 100 mg/kg aspirin and 10
and 50 mg/kg naproxen. In vitro perfusion was also carried out with 100 micrograms/mL
aspirin and 10 and 50 micrograms/mL naproxen added to the perfusate. MAIN OUTCOME MEASURES:
Ovulatory efficiency (no. of ovulations/no mature follicles) and ovarian vein PG and P
concentration were determined.
RESULTS: Ovulatory efficiency was 88% for control, 41% for in vivo
aspirin-treated, and 40% (10 mg/kg) and 0% (50 mg/kg) for naproxen-treated rabbits.
Aspirin and naproxen were associated with decreased ovulatory efficiency when administered
in vitro to both in vivo control and in vivo treated ovaries (control-medium = 70%;
control-aspirin = 14%; aspirin-medium = 34%; aspirin-aspirin = 0%; control-naproxen = 25%;
naproxen-medium = 38%; naproxen = 0% with 10 microgram/mL, and control-naproxen = 13%;
naproxen-medium = 0%; naproxen = 0% with 50 micrograms/mL). Prostaglandin F2 alpha was
undetectable in the perfusate of those ovaries perfused of those ovaries perfused either
with aspirin or naproxen. Ovarian venous concentration of P in the perfusate was similar
in all groups.
CONCLUSIONS: Aspirin and naproxen significantly
reduced ovulatory efficiency and PG production both in vivo and in vitro in hCG-treated
rabbits. A critical period of 6.5 and 7 hours after hCG administration was established.
Espey LL. Kohda H. Mori T. Okamura H. Rat
ovarian prostaglandin levels and ovulation as indicators of the strength of non-steroidal
anti-inflammatory drugs., Source Prostaglandins. 36(6):875-9, 1988 Dec. Address:
Institution Biology Department, Trinity University, San Antonio, Texas 78284.
Abstract
Immature Wistar rats were treated with pregnant
mare's serum gonadotropin and human chorionic gonadotropin to induce ovulation. The
non-steroidal anti-inflammatory drugs indomethacin, diclofenac, flurbiprofen, and
phenylbutazone inhibited both the ovulation rate and the normal increase in ovarian
prostaglandin E during ovulation. Tolmetin, ibuprofen, and aspirin did not have any
significant effect. There was a significant correlation between the ovulation rate and the
level of ovarian prostaglandin E following treatment with these drugs. When indomethacin
was given in graded doses, there was also a correlation between ovulation rate and the
dose-dependent inhibition
of ovarian prostaglandin E.
