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. 1981 Jun;22(6):445–451. doi: 10.1136/gut.22.6.445

Sulphasalazine and male infertility: reversibility and possible mechanism.

S Toovey, E Hudson, W F Hendry, A J Levi
PMCID: PMC1419267  PMID: 6114897

Abstract

Earlier observations on infertility related to sulphasalazine treatment were extended and semen samples obtained from 28 patients with inflammatory bowel disease on treatment with sulphasalazine at 2-4 g per day. Semen was examined for changes in density, motility, and morphology before, during, and after withdrawal of sulphasalazine. Gross semen abnormalities were seen in 18 patients on this drug for more than two months. Semen quality improved after sulphasalazine had been withdrawn for more than two months and 10 pregnancies are reported after sulphasalazine withdrawal. Preliminary endocrine and acetylator phenotype studies do not elucidate the mechanism of this important new side-effect of this drug. The time course of the drug's effect on semen quality is consistent with the hypothesis that sulphasalazine or a metabolite, possibly sulphapyridine, is directly toxic to developing spermatozoa. These studies confirmed the preliminary report and suggest that prolonged treatment with sulphasalazine may universally depress semen quality and cause reversible infertility.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Collins W. P., Mansfield M. D., Alladina N. S., Sommerville I. F. Radioimmunoassay of plasma testosterone. J Steroid Biochem. 1972 Apr;3(3):333–348. doi: 10.1016/0022-4731(72)90080-5. [DOI] [PubMed] [Google Scholar]
  2. Das K. M., Eastwood M. A., McManus J. P., Sircus W. The metabolism of salicylazosulphapyridine in ulcerative colitis. I. The relationship between metabolites and the response to treatment in inpatients. Gut. 1973 Aug;14(8):631–641. doi: 10.1136/gut.14.8.631. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Grieve J. Male infertility due to sulphasalazine. Lancet. 1979 Sep 1;2(8140):464–464. doi: 10.1016/s0140-6736(79)91512-5. [DOI] [PubMed] [Google Scholar]
  4. HELLER C. H., CLERMONT Y. KINETICS OF THE GERMINAL EPITHELIUM IN MAN. Recent Prog Horm Res. 1964;20:545–575. [PubMed] [Google Scholar]
  5. Levi A. J., Fisher A. M., Hughes L., Hendry W. F. Male infertility due to sulphasalazine. Lancet. 1979 Aug 11;2(8137):276–278. doi: 10.1016/s0140-6736(79)90292-7. [DOI] [PubMed] [Google Scholar]
  6. Murdia A., Mathur V., Kothari L. K., Singh K. P. Sulpha-trimethoprim combinations and male fertility. Lancet. 1978 Aug 12;2(8085):375–376. doi: 10.1016/s0140-6736(78)92975-6. [DOI] [PubMed] [Google Scholar]
  7. Peppercorn M. A., Goldman P. The role of intestinal bacteria in the metabolism of salicylazosulfapyridine. J Pharmacol Exp Ther. 1972 Jun;181(3):555–562. [PubMed] [Google Scholar]
  8. Schröder H., Evans D. A. The polymorphic acetylation of sulphapyridine in man. J Med Genet. 1972 Jun;9(2):168–171. doi: 10.1136/jmg.9.2.168. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Schröder H., Gustafsson B. E. Azo reduction of salicyl-azo-sulphapyridine in germ-free and conventional rats. Xenobiotica. 1973 Apr;3(4):225–231. doi: 10.3109/00498257309151518. [DOI] [PubMed] [Google Scholar]
  10. Schröder H., Lewkonia R. M., Price Evans D. A. Metabolism of salicylazosulfapyridine in healthy subjects and in patients with ulcerative colitis. Effects of colectomy and of phenobarbital. Clin Pharmacol Ther. 1973 Sep-Oct;14(5):802–809. doi: 10.1002/cpt1973145802. [DOI] [PubMed] [Google Scholar]
  11. Schröder H. Simplified method for determining acetylator phenotype. Br Med J. 1972 Aug 26;3(5825):506–507. doi: 10.1136/bmj.3.5825.506. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. The metabolism of salicylazosulphapyridine in ulcerative colitis: II The relationship between metabolites and the progress of the disease studied in outpatients. Gut. 1973 Aug;14(8):637–641. doi: 10.1136/gut.14.8.637. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Toth A. Reversible toxic effect of salicylazosulfapyridine on semen quality. Fertil Steril. 1979 May;31(5):538–540. doi: 10.1016/s0015-0282(16)44000-8. [DOI] [PubMed] [Google Scholar]
  14. Traub A. I., Thompson W., Carville J. Male infertility due to sulphasalazine. Lancet. 1979 Sep 22;2(8143):639–640. doi: 10.1016/s0140-6736(79)91702-1. [DOI] [PubMed] [Google Scholar]
  15. van Hees P. A., Tuinte J. H., van Rossum J. M., van Tongeren J. H. Influence of intestinal transit time on azo-reduction of salicylazosulphapyridine (Salazopyrin). Gut. 1979 Apr;20(4):300–304. doi: 10.1136/gut.20.4.300. [DOI] [PMC free article] [PubMed] [Google Scholar]

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