Sulphasalazine and male infertility: reversibility and possible mechanism.
Open accessAbstract
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 Semen quality improved after sulphasalazine had been withdrawn for more than two months and 10 pregnancies are reported after sulphasalazine withdrawal.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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The effect of sulfasalazine can be temporary and semen may return to normal after cessation of use.
“The effect of the latter can be temporary and semen may return to normal after cessation of use (61).”
From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [61]
The Conclusion reports that semen quality improves after sulphasalazine withdrawal, supporting the claim that the effect can be temporary. In the Results passage under HORMONE STUDIES, 11 of 14 patients had normal sperm density after at least two months off the drug, but mean motility remained below normal and morphology did not improve. The paper therefore supports recovery, not a general return of semen quality to normal. (LLM, conf=0.88)
Experimental — accuracy not yet measuredExposure to polychlorinated biphenyls, dibenzofurans, and sulfasalazine correlates with abnormal sperm morphology.
“Some other chemicals that correlate with abnormal sperm morphology include exposure to polychlorinated biphenyls, dibenzofurans, and sulfasalazine (60,61).”
From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [61]
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Research works printed but not linked: 19
- 'Levi AJ, Fisher AM, Hughes L, Hendry WF. Male infertility due to sulphasalazine. Lancet 1979; 2: 276-8.
- 2Grieve J. Male infertility due to sulphasalazine. (Letter) Lancet 1979; 2:464.
- 3Traub AI, Thompson W, Carville J. Male infertility due to sulphasalazine. (Letter) Lancet 1979; 2: 639-40.
- 4Toth A. Reversible toxic effect of salicylazosulpha- pyridine on semen quality. Fertil Steril 1979; 31(5): 538-40.
- 5Jarnerot G. Manlig Intertilitet Orsakad av Salazo- sulfapyridin (Swe). Lakartidningen 1980; 77:1444. ;
- Schroder H. Simplified method for determining the acetylator phenotype. Brit Med J 1972; 3:506-7.
- 7Collins WP, Mansfield MD, Allandina NS, Somer- ville IF. Radioimmunoassay of plasma testosterone. J Steroid Biochem 1972; 3:333-48. on July 10, 2023 by guest. Protected by copyright. http://gut.bmj.com/ Gut: first published as 10.1136/gut.22.6.445 on 1 June 1981. Downloaded from 8Mansfield MD, Johnson MN. The determination of testosterone and five related steroids in human plasma. Proceedings of the Fourth International Congress on Human Steroids, Mexico City. J Steroid Biochem 1973; 5:305.
- 9Svartz N. Salazopyrin, a new sulfanilamide prep- aration. Acta Med Scand 1942; 110:577-98.
- 10Misiewicz JJ, Lennard-Jones JE, Connell AM, Baron JH, Jones FA. Controlled trial of sulpha- salazine in maintenance therapy for ulcerative colitis. Lancet 1965; 1:185-8. "The National Co-operative Crohn's disease study. Gastroenterology 1979; 77:825-944.
- 12Heller CG, Clermant Y. Kinetics of the germinal epithelium in man. Recent Prog Horm Res 1964; 20:545.
- '3Schroder H, Gustafsson BE. Azo-reduction of salicylazosulfapyridine by germ free and conven- tional rat. Xenobiotica 1973; 3:225-31.
- t4Van Hees DAM, Tuinte JHM, Van Rossum JM, Van Tangeren JHM. Influence of intestinal transit time of azo reduction of salicyazosulphapyridine (Salazopyrin). Gut 1979; 20:300-4.
- '5Das KM, Eastwood MA, McManus JPA, Sircus W. The metabolism of salicylazosulphapyridine in ulcerative colitis. I The response to treatment in patients. Gut 1973; 14:631-6.
- '6Das KM, Eastwood MA, McManus JPA, Sircus W. The metabolism of salicylazosulphapyridine in ulcerative colitis. II The relationship between metabolites and the progress of disease studied in out-patients. Gut 1973; 14:637-41.
- '7Schroder H, Lewkonia M, Price-Evans DA. Metab- olism of salicylazosulphapyridfine in healthy sub- jects and in-patients with ulcerative colitis. Clin Pharmacol Ther 1973; 14(5):802-9.
- 18Schroder H, Price-Evans DA. The polymorphic acetylation of sulphapyridine in man. J Med Genet 1971; 9:168-71.
- 'Pepperform MA, Goldman P. The role of intestinal bacteria in metabolism of salicylazosulfapyridine. J Pharmocol Exp Ther 1972; 181:555-62.
- 20Murdia A, Mathur V, Kothari LK, Singh KP. Sulpha-Trimethoprim combinations and male in- fertility. (Letter) Lancet 1978; 2:375-6.
- 21Jaubert A, Motz C. Action inhibitrice de certains derives sulfo-conjugues des amines aromatiques sur la spermatogenese de l'homme (Fre). Presse Med 1938; 46:237. on July 10, 2023 by guest. Protected by copyright. http://gut.bmj.com/ Gut: first published as 10.1136/gut.22.6.445 on 1 June 1981. Downloaded from
Cited by
Sorted by citations
The Effects of Sulfasalazine on Human Male Fertility Potential and Seminal Prostaglandins
Cosentino, M. J., Chey, W. Y., Takihara, H., & Cockett, A. T. K. (1984) · Journal of Urology · doi:10.1016/s0022-5347(17)49824-7 · Cited by 68 · see citing works
Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review
Atmoko, W., Savira, M., Shah, R., Chung, E., & Agarwal, A. (2024) · Translational Andrology and Urology · doi:10.21037/tau-23-397 · Cited by 23 · see citing works
“The effect of the latter can be temporary and semen may return to normal after cessation of use (61).”
- Authors
- Toovey, S., Hudson, E., Hendry, W. F., & Levi, A. J.
- Affiliations
- Northwick Park Hospital (GB)
- Venue
- Gut
- Publisher
- BMJ
- Published
- 1981-06
- Volume
- 22
- Issue
- 6
- Pages
- 445-451
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC1419267
- OpenAlex
- W2114988327
- Cited by
- 205
- References
- 0
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 5 · 2023: 4 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 4 · 2018: 3 · 2017: 12 · 2016: 7 · 2015: 4 · 2014: 9 · 2013: 7 · 2012: 5
- FWCI
- 12.16
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gut (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Keywords
- sulfasalazine, male infertility, drug-induced infertility, semen quality, inflammatory bowel disease, sulfapyridine, sperm toxicity, drug withdrawal, reversibility, acetylator phenotype
- MeSH terms
- Adult, Colitis, Ulcerative, Crohn Disease, Female, Humans, Infertility, Male, Male, Middle Aged, Pregnancy, Sulfasalazine, Semen, Sperm Count, Sperm Motility, Spermatozoa
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