6 MP and pregnancy

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Mike W
Regular Member


Date Joined Aug 2006
Total Posts : 89
   Posted 4/6/2008 8:18 PM (GMT -7)   
Hello. I'm a 31 y/o male with CD for 8 years. My apologies if this topic has been covered ad-nauseum but I did a search and didn't get much.

I stopped taking my 50mg of 6MP 6 months ago as my wife and I decided to try to get pregnant. Unfortunately pregnancy hasn't happened yet and I'm starting to feel worse. I have a regular appt with my GI in one month, but I think I'm going to start on the 50 again, and I've started 3mg of some Entocort I had from a few years ago. I was basically in remission from the 6MP (I was on as much as 125mg for a while) but things have started up again I believe.

What are the thoughts on males taking 6MP when trying to conceive? My GI doesn't think it was necessary that I stopped but I was trying to play it safe. Thanks for your thoughts.
Diagnosed in 1999.
No surgeries.
Age : 30
Currently on 50 mg 6MP.


Stef17
Veteran Member


Date Joined Feb 2003
Total Posts : 1811
   Posted 4/7/2008 7:37 AM (GMT -7)   
Wow, heavy question. I wish I had some good data for you. I'm not sure how 6mp might affect sperm (if at all). I know that studies show that women who take 6mp while pregnant (steady flow through the blood stream to the placenta) have no greater incidence of complications/abnormalities/etc than women who DON'T take 6mp. So, GI's are starting to keep patients on 6mp while pregnant. That being said, I don't know if sperm quality is a completely different can of worms. If your GI didn't think it was necessary to stop, I would ask him what data he used to come to his decision and if necessary, get a 2nd opinion. One thing is for sure - you need to be well so that you can produce healthy "boys". I might consider starting the 6mp again and put a call in to the doc so he can reassure you.

Mike W
Regular Member


Date Joined Aug 2006
Total Posts : 89
   Posted 4/7/2008 3:18 PM (GMT -7)   
Thanks.  Ya the impressison I got when I researched this last year was that it was more of a risk for a woman than a man, so I was being over cautious I guess.  Thanks for the reply!
Diagnosed in 1999.
No surgeries.

Age : 31

Currently on no meds. Just probiotics.


MandyGirl
New Member


Date Joined Apr 2008
Total Posts : 5
   Posted 4/7/2008 5:16 PM (GMT -7)   
Mike -
First post here, but your question brought me out of hiding as a long-time lurker. Hubby has had Crohn's since his late teens and is now 34. On 6-MP (75 mg/day), Pentasa, and Remicade. (Remi for over 4 years now, 6-MP and Pentasa even longer, and resection a little over 4 years ago). We had QUITE the surprise when we found out we were preggo as I had not missed a single pill and was very cautious about taking it same time each day (and adjusting timezones when traveling so still taking around the same time as back home).  We have a very healthy, active, intelligent 19-month old.  :)  I will admit when we found out we were preggo, we were initially excited, then scared to death. By the time we both made it home from work that day, we knew each other had been researching the internet as reality had set in.  Our plan had been like your's --- go off meds for 3 months, start trying, and if no conception after 2 months we had already spoken with hubby's urologist about intervening so that hubby would not be off his meds for too terribly long. (Hubby gets to fight kidney stones as a side effect of Chron's... so I asked the Uro while there with him one day which is how I learned about 3 months to "clear out" the bad swimmers.) 
 
I researched everything I possibly could about 6-MP, visited with a couple of our regular pharmacists, etc.  We were seeing my regular OB, and she sent me to a perinatologist for further screening (a high-risk OB --- she sent me not just for his meds but I had very recently dealt with cervical pre-cancer cell removal which made a weaker cervix for me -- something to be aware of with pregnancy). Even though I was only 31, we did the round of bloodtests they give women over 35, so we got to see all the extra cool ultrasounds, and all the other higher risk pregnancy tests. We briefly spoke with the genetic specialist there in the practice and she was familiar with 6-MP.  She said "men always get lucky". I know she was putting our minds at ease, but her point she was making was that if it had been ME, the female, on 6-MP, then we might be having a different conversation. I could really only find 1-2 studies of 6-MP taken by males at time of conception. The miscarriage rates were not really any higher than the general population. I just made sure to take extra care of my body.  (We were 8 weeks preggo when we found out because my first preggo test at the OB office was a FALSE negative and I hadn't missed a pill, so she said my body might be reacting to a recent procedure I had had done.) Luckily for us, when finding out we were pregnant, we had the normal first-time OB checkup a week later, and the heart was already beating. Nice we didn't have to go through the extra stress of "we're pregnant, waiting for the heartbeat to start" which is usually several weeks later around 5+ weeks. We found out at 8 weeks we were preggo.
 
Okay - I'll quit rambling - but YES - you CAN have a very healthy pregnancy and baby with the male taking these meds continuously prior to conception.  We are so very blessed.   I will admit I am terrified to actually "try" for #2 -- I think we have a blessing and am afraid to press our luck -- but that's just me.  Sorry if I pulled in TMI, but I definitely remember how scared/worried/paranoid I was with all the meds issue, particularly 6-MP. So little info and past research is available, so I hope this post helps share HOPE that YES... men on 6-MP can produce healthy babies.  :)   Heck, hubby must have super-swimmers with me on the pill and him on his 6-MP at time of conception!!  ;)
 
Take care of yourself, get your wife on prenatal pills (or Juice Plus or BOTH), and go get busy!!!   :)
 
~ Mandy

Mike W
Regular Member


Date Joined Aug 2006
Total Posts : 89
   Posted 4/8/2008 8:58 AM (GMT -7)   
That wasn't TMI at all Mandy! Thanks for the very informative reply, I really appreciate it. Congratulations!
Diagnosed in 1999.
No surgeries.

Age : 31

Currently on no meds. Just probiotics.


MandyGirl
New Member


Date Joined Apr 2008
Total Posts : 5
   Posted 12/20/2008 4:21 PM (GMT -7)   
Just updating this thread on getting pregnant while the male is on 6-mp, pentasa, and Remicade...

Our 27-month old is quite the typical handful for this age! She is counting to almost 20, can sing the alphabet song (although some not understandable!), and perfectly fine healthwise. I had read one article online a while back that was about long-term breastfeeding and lower incidence of Crohn's... so yes, I am still providing breastmilk twice a day (morning/night) with that study in the back of my mind since hubby has CD. LaLeche League has great online resources and support groups - highly recommend breastfeeding if able. Our daughter is low on the weight percentages, but I attribute that to still providing breastmilk which helps the body metabolize better (they actually have different weight charts for breastfed babies versus "national averages" weight charts). She is not so low that our pediatrician is concerned in any way. She is very rarely ever sick - just whatever she might catch at daycare, but I have only had to leave school once due to her being sick --- and that was when she was running a slight fever due to a tooth cutting through!! All those milestones they look at with children (social/emotiona/academic/verbal/physical/etc) are all right on target as of her 2-year old appointment. (And I'm a teacher, so I keep up with it on my own as well.)

So yes... getting pregnant with the male on 6-mp can provide a healthy pregnancy, healthy baby. Hope this helps put others minds at ease since there is such little research out there! :)

Chronicallyill
Regular Member


Date Joined Apr 2008
Total Posts : 195
   Posted 12/20/2008 5:54 PM (GMT -7)   
Hello. This is interesting because when I started researching 6mp and pregnancy, all I found was info that said 6mp caused infertility. It really scared me and I haven't went back to researching it since. My bf and I were unsafe for over a year and a half and no baby. Then bam we got pregnant. I was stunned, excited, and scared all at once. I didn't take 6mp majorly for the whole pregnancy except for one month when my doctor pressured me into taking it, but couldn't back it up so I stopped taking it.

I now refuse to take it again and started taking Methotrexate for the time being. Crossing my fingers, i get well enough and my body permitting, that we can get pregnant again.

MikeW I hope you can have some peace of mind with these other posts giving some insight to you.

Nessa
Age:22/6"1'/146lb - Diagnosed: 2001 @ age 15 now 22
First time mom as of March 8th 2008
Past drugs: Pentasa, Flagyl, Budesonide, Prednisone, tons of Antibiotics, Didrocal, 6mp
Past herbal remedies and vitamins:Probiotics, Omega 3&6, Prenatal vitamins, B12, Calcium, iron, vit C, vit D, vit E, Selenium, mineral drops
Current drugs: Valtrex, Methotrexate as of October 2008
Problems:Fissure and Tags on rectum, blood clots, Chronic UTI's, Osteopenia, Ulcers in my decending Colon
No surgeries....yet. Gone through 5 G.I.'s found a 6th G.I. crossing my fingers
Procedures: 4 colonoscopies, 1 upper endoscopy, 2 barium swallows, 1 biopsy of the fissure and tag (chron's affected)


MandyGirl
New Member


Date Joined Apr 2008
Total Posts : 5
   Posted 12/20/2008 7:15 PM (GMT -7)   
For us, it was reading phrases like this regarding the male using the medication:

"Purinethol and Pregnancy: There is a possibility of birth defect if either the male or female is using Purinethol at the time of conception, or if it is taken during pregnancy. It may harm the baby if used during pregnancy. Effective birth control should be practiced while using this medication. Tell the doctor immediately if you become pregnant while using this drug. It should only be used during pregnancy if potential benefits clearly outweigh risks. "
http://www.77canadapharmacy.com/purinethol.php

Same type of info regarding males here: http://www.chemocare.com/bio/purinethol.asp

Our surprise pregnancy turned out fine with no birth defects.

justjenjen
Veteran Member


Date Joined Nov 2003
Total Posts : 518
   Posted 12/20/2008 8:32 PM (GMT -7)   
I was on 75mg all through my pregnancy and all went well....that was over 7yrs. ago.

Mike W
Regular Member


Date Joined Aug 2006
Total Posts : 89
   Posted 12/20/2008 9:24 PM (GMT -7)   
Thanks for the update Mandy! Sounds like things are going great! Well my wife got pregnant 14 weeks ago while I was taking 75mg of 6MP with my GI's approval. I've had some times of definite anxiety over this, especially when I start surfing the net about it, so it's great to hear your story.

We went to our first OB appt two weeks ago and the doctor wasn't concerned about the 6MP and we got to hear the heartbeat. I pray everyday for a healthy child, that's all I care about right now. My wife is very healthy and she's doing all the right things so that makes me feel better. Yes, she plans to breastfeed for a year as she read the same thing.

Thanks again for updating, I need the re-assurance.
Diagnosed in 1999.
No surgeries.

Age : 31

Currently on 75mg 6mp , 20mg prednisone and probiotics.


Osprey101
Regular Member


Date Joined Apr 2008
Total Posts : 227
   Posted 12/21/2008 12:05 PM (GMT -7)   
6-mercaptopurine (6-MP) is considered to be a Pregnancy Category D drug, meaning it is potentially hazardous to the fetus.

"# Purinethol may be hazardous to the fetus. Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
# For both men and women: Do not conceive a child (get pregnant) while taking Purinethol. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy."

You may wish to consult with your pharmacist to determine the precise type of damage 6-MP may cause.

Mike W
Regular Member


Date Joined Aug 2006
Total Posts : 89
   Posted 12/21/2008 12:41 PM (GMT -7)   
Why would I do that? She's already pregnant, my GI said it's no problem, and the OB said it's no problem. So what difference would it make to determine what 'precise type of damage 6MP may cause'?

Based on the scarcity of studies done I doubt the pharmacist would be able to tell me anything anyway, other than that it's a type D drug. Especially since I'm not using 6MP at the dosage for it's indicated use, cancer.
Diagnosed in 1999.
No surgeries.

Age : 31

Currently on 75mg 6mp , 20mg prednisone and probiotics.


Mike W
Regular Member


Date Joined Aug 2006
Total Posts : 89
   Posted 12/21/2008 1:15 PM (GMT -7)   
Just found this.

http://www.medscape.com/viewarticle/561856_4

Immunosuppressants have a well-defined role in refractory IBD. The use of mercaptopurine (MP) and azathioprine (AZA) in men of child-bearing age is controversial. The use of MP in male mice has been associated with a significant reduction in fertility.[17] Rajapakse et al.[18] showed an increased incidence of congenital malformations, particularly congenital limb abnormalities and gestational complications in offsprings of men exposed to MP within 3 months of conception. However, it was a small study (only 13 men were exposed to MP within 3 months of conception) and several statistical flaws have been outlined.[19] Furthermore, MP has not been shown to have any deleterious effect on sperm quality nor quantity.[20] More importantly, Francella et al.[21] in a large case-control study with 76 males failed to corroborate the above findings. Data from the transplant literature would also support the safe use of MP in prospective fathers.[22] As MP is an inhibitor of de novo purine synthesis, some authors have mentioned the possibility of occult sperm damage.[17,18] However DNA damage due to MP at doses used in IBD has not been demonstrated. It is therefore inappropriate to stop immunosuppressive therapy in males desiring feritility.[23]
Diagnosed in 1999.
No surgeries.

Age : 31

Currently on 75mg 6mp , 20mg prednisone and probiotics.


MandyGirl
New Member


Date Joined Apr 2008
Total Posts : 5
   Posted 12/21/2008 1:49 PM (GMT -7)   
Congrats Mike!!! Yea!!! Things are going to be just fine! And it sounds like she has passed that critical first-trimester milestone! I was hoping the update would help someone out there... I know how hard it was finding info about males on 6mp. I had found one small study, but that was about it. And like you said - you are on a low dosage (same dosage my hubby was on). Now it might be a different story had he been on "big" doses of it as in for cancer, but not the lower doses used for CD.

If your insurance covers it, you could ask your OB about a perinatologist referral. Our's wasn't sure about the 6mp, but with my borderline blood pressure, she sent us on to a perinatologist anyway. We had "big" sonograms at 12, 16, and 20 weeks. It was at 16 weeks where we found out the gender. They have better sonogram equipment so we were able to see things sooner, like at 12 weeks they were measuring the fluid behind her neck for some sort of test. If anything, it calmed my fears and worries. Well, for both of us. We had not found anyone out there where the male had been on 6mp at time of conception. After 20 weeks, we were turned back over to our OB. She had 2-3 more sonograms at her office due to my family history of pre-eclampsyia, so we got later peaks of our little one. :)

You guys are going to be just fine. :) We followed the Mayo pregnancy timeline, and loved feeling those first kicks, hiccups, and stretches when waking up from naps in the womb! Hubby would even rub part of my tummy in the last trimester, and she would arch her back. We think it was her rear she was poking out so she could get more rubbing - it was so cute. Enjoy all those special moments!!

SallyC
Regular Member


Date Joined Nov 2004
Total Posts : 158
   Posted 12/21/2008 3:43 PM (GMT -7)   
Hi Mike,
I take 6mp and although some on here would have a fit I even nursed my twins for 13 months while taking 100mg. I highly doubt my pharmacist, OB, 3 different pediatricians, my GI, my lactation cosultant would say it was ok if it wasn't and cause harm to my babies. I usually took it before bed where we had the longest stretch of not nursing.
I get a professional journal sent to me and 6mp was not on the list of things to not nurse while taking. I never knew the issue of fertility and taking it. Obviously you didn't have a problem. Yay! I didn't take it while pregnant but only because I for some odd reason was getting migraines from of it. I never had in the 6-8 months before getting pregnant. I started it back up when the twins were about 2 months old.

And I had a much much more healthy first year with these two than I did with my first 2 when I was not on the 6mp. For me it has been a wonder drug and we really don't take even close to what someone might take for say a kidney transplant.

I was hoping to get see that you and your wife are expecting after I read your post from a while ago. I am happy for you and wish you a happy healthy baby.

Sally
Sally
 
Diagnosed with UC in July of 2003 then diagnosed with Crohns in August of 2006.


SallyC
Regular Member


Date Joined Nov 2004
Total Posts : 158
   Posted 12/21/2008 3:52 PM (GMT -7)   
Just wanted to add that I do not do my medication research on the internet but with my doctors and pharmacists. The internet can be a very scary place.
Try to relax and have your wife work with the doctor as much as you both need to ease your fears. I agree with Mandy that everything will be fine in regards to your 6mp. Any time something is not right with our children whether it be physical or mental we will always think it is something we did or didn't do.
Sally
 
Diagnosed with UC in July of 2003 then diagnosed with Crohns in August of 2006.


Mike W
Regular Member


Date Joined Aug 2006
Total Posts : 89
   Posted 12/21/2008 8:24 PM (GMT -7)   
Thanks guys!!!
cool
Diagnosed in 1999.
No surgeries.

Age : 31

Currently on 75mg 6mp , 20mg prednisone and probiotics.


Dave123
Regular Member


Date Joined Feb 2005
Total Posts : 223
   Posted 12/22/2008 1:01 PM (GMT -7)   
For what it's worth, I'm like you and went off 6mp for 4 months for my first child (now 5) based on doc's recommendation, but stayed on 6mp during second and third kids conception (a second doc's recommendation). Happy to say all three are healthy!

Mike W
Regular Member


Date Joined Aug 2006
Total Posts : 89
   Posted 12/22/2008 4:17 PM (GMT -7)   
Dave, that is music to my ears, thanks so much for posting.
 
Mike
Diagnosed in 1999.
No surgeries.

Age : 31

Currently on 75mg 6mp , 20mg prednisone and probiotics.

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