Received an email from Kay, which I'm sharing with her permission:
"My partner has been taking Methotrexate (Methoblastin) for Psoriasis for an extended period of time. I believe that the dose is 20mg per week.
Are you aware of any referenced evidence or trials relating to birth defects where the male partner has been taking Methotrexate at the point of conception?
I am having a lot of trouble finding any detailed information about this topic though I did find one forum where there was a broad indication that there is no real evidence in this situation and claims by some women that they have given birth to babies with no defects despite their partners treatment.
I really can't see my partner being able to come off the drug for the three months that the pharmaceutical manufacturers recommend as he suffers a lot of pain within about two weeks of stopping.
We have been very conscious about the potential side effects and so have been very careful to not get pregnant - unfortunately, not careful enough."
She's obviously quite concerned by the situation, which is fair enough, given the general recommendation is to cease Methotrexate in both females, and males, prior to trying to conceive.
I think it's clearly accepted that the prospective mother should cease Methotrexate, usually for a period of 3 months, prior to falling pregnant. The situation with males should be different, given their obviously different role in pregnancy.
My response to Kay was:
"I am not aware of any known case where a male patient continued on Methotrexate and then this led to a birth detect. Please do understand that birth defects do occur at a background rate in people not on medications as well.
I do know that the recommendation is for the male to cease Methotrexate prior to attempting conception but I do not think this is based on any scientific evidence. Rather it is based on avoiding litigation from distraught parents.
I have not insisted that my male patients stop their Methotrexate and have been privy to patients conceiving healthy babies while the male patient continued on Methotrexate.
Hopefully, this helps you. You and your husband should discuss this in much more detail with the treating rheumatologist."
Kay also highlighted 2 very useful fact sheets from OTIS (Organization of Teratology Information Specialists):
I thought it worth opening up this topic for discussion here.
What are your experiences with this issue, either as a patient, a partner, or a health care professional?Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here. Arthritis requires an integrated approach. We call this, Connected Care. Contact us.