As we all know very well that nonsteroidal anti-inflammatory drugs are the most commonly prescribed and used over the counter medication for analgesic and anti-inflammatory purposes. We all have awareness about the adverse effects of NSAID associated with gastrointestinal tract (dyspepsia, erosion of lining, heart burn, perforation of lining, ulcer, bleeding), cardiovascular (myocardial infarction, stroke, heart failure, elevation of blood pressure venous thromboembolism and atrial fibrillation) and renal (acute interstitial nephritis, acute kidney injury, electrolyte imbalance, acid-base imbalance and nephrotic syndrome) systems. Beside these adverse effects, there is also awareness about the fact that in near term pregnancy use of NSAID causes prolongation of labor, Increases the risk of postpartum bleeding and premature closure of the fetal duct arteriosclerosis BUT the awareness about the adverse effect of NSAID related to reversible infertility is very much less.
Here, I will discuss HOW THE LONG TERM OR CHRONIC USE OF NSAID CAUSES REVERSIBLE INFERTILITY IN WOMEN?
NSAID like (naproxen, piroxicam, diclofenac) are frequently used by women during child bearing age in dysmenorrhea and arthritis. NSAID causes female infertility via ovulatory dysfunction through proteinoid (group of local hormones especially prostaglandin) synthesis inhibition. Let’s try to understand how physiological process in the ovaries and pharmacological action of NSAID causes reversible infertility in women.
NSAID shows its potential therapeutic effects via prostaglandin synthesis inhibitions that block COX-1and COX-2 enzyme system.
COX-2 inhibition has significant impact on ovulation, fertilization and implantation. During follicular development COX-2 is supposed to be active in the ovaries. COX-2 deficiency is supposed to be responsible for compromised ovulation despite apparently normal follicular development. COX-2 ENZYME induced prostanoid especially prostaglandin which is essential for rupturing of mature follicles. It is an ovulatory condition in which there is ovulation without release of ovum due to un rupture follicles and it is known as LUTEINIZED UN RUPTURED FOLLICLE SYNDROME.
HOW NSAID CAUSES INFERTILITY IN MEN?
NSAID like aspirin, paracetamol and ibuprofen showed their anti-androgenic effects by affecting semen quality and sperm parameters. There is abnormal sperm parameters analysis which includes motility, size and shape of sperm, decrease sperm count and DNA integrity.
It has been observed that ibuprofen inhibit FSH and LH hormones production from the pituitary gland which is responsible for the release of testosterone (main male sex hormone) from testicles and sperm production. Other possible mechanism of action for this compensated hypogonadism besides decrease testosterone synthesis exhibits by NSAID (mainly by paracetamol and ibuprofen) includes oxidative stress, reduce nitric oxide and prostaglandin production, chelation of Zn ions and death of spermatocyte. This hormonal imbalance caused by NSAID is chiefly considered for impaired infertility in men. However, extensive research is required for establishing the relationship between NSAID and infertility in men. NSAID use for short duration causes reversible infertility in men. The impact of chronic use of NSAID or if taken for long duration and at which dose this adverse effect has been observed still unclear.
CONCLUSION
With out the need of expensive fertility investigation, just by simply stopping the use of NSAID Unexplained infertility issue can be resolved which is mainly due to apparent ovulation without the release of ovum. With drawl of NSAID is prove to be significant for the women who want to conceive. Impaired infertility in men is also reversible by stopping irrational NSAID intake.
