So you’re thinking of starting a family

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Will I have problems conceiving?

1 in 6 couples experience difficulty conceiving. This can be as a result of female problems, male factors or a combination of both. Common reasons for failing to conceive include tubal damage, endometriosis, ovarian failure, and low sperm count. In many couples the cause for their infertility is “unexplained”. Most couples will conceive within a year, however if you are experiencing problems you should seek advice from your GP initially who can then refer you on to a Gynecologist if necessary for further investigations and treatment.

Will my fertility be affected if I already have PsA?

PsA itself should not be directly responsible for fertility problems however, sometimes the treatments and drugs used to treat the condition can reduce your fertility. Often the affect of the drugs on your fertility is reversible once the drugs are stopped. If you are thinking of starting a family then you should discuss it with your GP and hospital consultants first.

Is the condition genetic?

If one parent has PsA then they have a 1 in 4 chance of having a child with PsA. If both parents have PA then that risk increases to approximately a 3 in 5 chance of their child developing PsA.

Can I go anywhere for genetic counselling?

Before trying to get pregnant it is advisable to discuss it with both your GP, Dermatologist and Rheumatologist as they will be able to advise you about problems you may face during your pregnancy and the risks to a child of developing the disease. Most large hospitals have a consultant geneticists but it is unlikely that you would need to see them.

Will my PsA become worse or improve during pregnancy?

Approximately 80% of women find that their PsA improves during pregnancy. Often the symptoms re-occur 6-12 weeks following delivery. In some cases the psoriasis or arthritis presents for the first time during pregnancy. During pregnancy hormonal changes cause the ligaments to stretch to allow the pelvis to accommodate the growing baby. This together with the additional weight of the baby can also cause lower back problems in later pregnancy. It is therefore advisable to see a physiotherapist regularly. Aqua-natal classes are also widely available, your midwife should be able to advise you of the classes held in your area. These exercise classes take place in a swimming pool so that the weight of the baby is supported by water.

Will I have to stop any drug therapies prior to conceiving and during my pregnancy?
Before trying to conceive you must discuss your plans with your doctor. Several drugs used to treat PsA are not safe to take whilst pregnant and some of them even need to be stopped several months prior to conceiving as they are harmful to an unborn baby. Some of the drugs are also associated with reduced fertility.

Methotrexate.Reduces sperm count in men and causes ovulatory problems in women. The effect is reversible but should wait 6 months after stopping the drug before conceiving as is associated with fetal abnormalities.

Azathioprine. There is a possible increase in of abnormal birth defects. Small concentrations of the drug have been found in breast milk. Should only be used in pregnancy if the benefits outweigh the risks.

Non-steroidal anti-inflam­matories (NSAID). These can reduce amniotic fluid and are excreted in inflammatory drugs breast milk. Therefore should be avoided in last 3 months of pregnancy or whilst breast feeding.

Gold. Safe use has not been established in pregnancy. Advise to wait 6 months from stopping treatment before trying to conceive.

Sulfasalazine. No data on safety in pregnancy available. Lowers sperm count but this is reversible once drug stopped.

Calcipotriol. Safe use in pregnancy has not been established therefore avoid unless no other alternative available.

Voltarol. Prostaglandin inhibitor, therefore prolonged use of high doses can affect ovulation. Avoid in pregnancy unless no alternative available.

Will my midwife know anything about my condition?

Your community midwife may not know much about PsA so expect to be teaching her! However most large hospital have a specialist unit that cares for women ante-natally that have additional medical problems and they should be able to advise you on your pregnancy, delivery and post­natal period.

Author: by Fiona Pringle
First published 2001: Skin 'n' Bones Connection, issue 14 p7-8