TTC in difficult circumstances.

I always knew I wanted 2 children; my husband didn't initially, but after a few months said he'd love another. We tried in June, when our first daughter was 14 months, but we quickly decided we wanted to wait until she was about 2 for various reasons - all seem quite trivial now, but at the time they were quite significant. So we stopped trying and in early October (5 weeks ago today) I had the mirena coil in (I'd had one for 4 years previously and conceived first month trying 3 months after I had it out, and have no issues with it really).

My husband had been having a few aches and pains in a few joints and had his hospital appt on 27th October. He was diagnosed with psoriatic arthritis and told he will have to start methotrexate as soon as he's had an appt to see a specialist nurse. That appt hasn't come through yet, but it will quite soon as once it's diagnosed they like to treat asap to stop progression of the illness. We assume he will get the appt for some time in December so will need to start it some time after that and the initial tests (so around new year - 8 weeks' time or so). He can delay starting it, but he wouldn't want to delay more than a few weeks after the appt, so we are looking at the start of feb maximum really.

You should NOT conceive whilst EITHER partner is on methotrexate or has taken it within the last 3-6 months, as it works by preventing cell-division which can lead to poor fetal growth/no fetal growth and any number of birth defects. Not only that, but it reduces fertility enormously. So we are on a ticking time bomb as there is no way I would be selfish enough to actively try for a baby when there are those odds, no matter how many anecdotes say that people have done it and the baby been fine and healthy. It's just not a chance I am willing to purposely take - accidents happen but I will do everything I can to prevent. Most treatments for his illness are similar and conception not advised whilst on them, and once he starts treatment he will always need it because this is a progressive disease that could eventually disable him.

So, don't ask me why it has taken me nearly 3 weeks to get this done - I suppose it's been sinking in for both of us and we just brushed it under the carpet until about Sat last week when I had a sudden breakdown about it all - I cried solidly for about 4 hours. I just couldn't see reason. I know I should be grateful and thankful for the one baby I have, but my male GP (who I saw yesterday but didn't remove the coil) said I am grieving for the baby I planned and may never have and for the life we'd planned for both of us. I had my coil removed today and we are going to start trying immediately.

I realises the chances of conceiving straight away are very slim, and even if I do there is a high chance of miscarriage early on. I breastfed for 16 months, but my periods returned 7 months post-partum and were regular (every 27-29 days) from then until I had the coil last month, since when I have had on and off bleeding (which is normal). I have now had the coil for 5 weeks, and I am also overweight. However, we don't drink or smoke, eat reasonably well, are reasonably active, get plenty of sleep and are young (28 and 37). We are both taking pre-conception vitamins. So we are doing what we can.

I won't be temping. I won't be charting. I won't be symptom-spotting. I won't be doing anything that will stress me out. Our time is short and I need to give myself the best chance possible, which means NO stress.

So that's me and why I'm here in this forum (which I never used last time as I was an annoying one who went straight from wtt to pregnant!). Let's hope I'm pregnant by February!!

 

We have been told by his consultant and two GPs that we must not conceive while he is on it because of even a small chance of problems. I have read lots of anecdotes like yours, and a lot of papers (from America) which state there is no real evidence to say the man taking the drug will affect anything; the only evidence links to the female taking it. However, when I said to a GP the other day 'would it be OK as he is only on a very low dose to start with' she replied with 'no it is NOT ok.' She then went on to list many of the birth defects that could occur because of this. I have done a lot of reading about this too, as I am desperate to find another answer, and it seems to be linked to the fact that mtx is a folic acid (essential to healthy fetal growth) antagonist.

HOWEVER, I have also read that there are no reported cases of any birth defects linked to the male taking this drug.

The temptation is there to continue to ttc once he starts it, as we get good midwife care here and I'd get extra scans. Believe me. But I just can't settle it in my mind that I would not know til about 20 weeks pregnant whether there may be problems, and then I'd face all kinds of horrendous decisions.

We will speak to the specialist nurse when his appt comes through, and ask to chat it through with his consultant again, but thank you for sharing your experience.

https://qjmed.oxfordjournals.org/content/92/10/551.full
Scroll down to Methotrexate in malignant conditions (para between tables 2 and 3). OK so these people were on higher doses than my husband will be, and it will take about 3 months for the drug to get into his system, and on the scheme of the amount of pregnancy recorded there were few cases of problems, but even the few there are is enough to scare me into not doing this.

If you scroll down to the next paragraph about low dose mtx, it does state that they think the threshold is about 10mg weekly (my husband won't be on that for a while as they will build it up) and that the vulnerable time for the fetus is 6-8 weeks. All cases they talk about are in women.

It does say this about sperm:
"There is a theoretical risk of sperm mutation in males treated with MTX. However, a study looking at men with rheumatoid arthritis on low-dose MTX found no significant chromosomal breakage.53 Green et al. report two children with birthmarks (no further details given) and one with a skin tag out of 35 children born to 25 males who had received single and multiple chemotherapy in childhood or adolescence. Two of the abnormal children were born to the 11 men who had received MTX (possibly among other agents).54 There is a case report of a 34-year-old man with Reiter's syndrome who had received intermittent MTX for 5 years, and continuous MTX for 5 months prior to conception, who fathered a normal child.55 As the duration of individual spermatogenesis is approximately 74 days, it would seem sensible to add this figure to the (minimum) 4 months needed for MTX excretion before attempting conception."
So the jury is out on it - risk seems to be small and unproven.

I think I need to do lots more research and talk to a few different people about this.x

 

It might be due to the lady being in America where the literature on the subject seems a bit more liberal. Here in the UK, even the NHS literature states to never get pregnant while either partner is taking this drug.

 

Thanks for your replies.

We are keeping everything crossed but also looking into adoption now as well.xxx