The age group with the highest incidence of ankylosing spondylitis is young people between the ages of 18 and 30, just in the reproductive years, and thus fertility issues are of great concern. Here are a few common concerns for patients: Does having ankylosing spondylitis affect fertility? Because ankylosing spondylitis seems to be seen more often in men, the disease is not exclusive to men, but can also affect women. Men are more concerned about whether it affects their reproductive function, while some women are concerned about whether they will have difficulty giving birth because of the lesions in their pelvis. Men: Recent studies have shown that sperm quality in patients with ankylosing spondylitis during the active phase of the disease is not significantly different from that of healthy individuals Women: Studies as early as 1948 Ann rheum Dis and 1988 Clin Exp Rheumatol have mentioned that although ankylosing spondylitis affects the skeletal structure, it does not affect pregnancy, and the majority of patients with AS have the same fertility, pregnancy and birth process as the general population. The majority of AS patients have the same fertility rate, pregnancy and birth process as the general population. Are there any adverse consequences of taking anti-inflammatory and analgesic medications during pregnancy when I have ankylosing spondylitis? In 2012, the journal J Rheumatol published a meta-analysis focusing on the safety of pain management in inflammatory arthritis during pregnancy and lactation. A total of 204 of these malformed children were confirmed to have been taken by their mothers during pregnancy. The incidence of cardiac malformations was higher than expected with the use of anti-inflammatory analgesics. The anti-inflammatory analgesics that caused malformations were not that a certain drug might cause malformations and some would not, but rather nonspecifically, naproxen was used in five of the six cleft lip and palate cases and ibuprofen in one case. In this way, the use of anti-inflammatory and analgesic drugs during pregnancy may really have adverse consequences. Will oral medication for ankylosing spondylitis affect fertility? The types of oral medications used to treat ankylosing spondylitis are approximately anti-inflammatory and analgesic drugs, glucocorticoids, lorazepam, and some to flumetide, thalidomide, and methotrexate. These drugs should be handled with great care if you are preparing to have a child. Anti-inflammatory and analgesic drugs are usually stopped for 2-3 months. Glucocorticoids are generally rarely used, but once used in pregnant women, prednisone in small doses can be safe. Sulfasalazine can affect sperm motility and can be gradually restored after discontinuation. Methotrexate should be discontinued for about six months before preparing for pregnancy. Thalidomide should be discontinued for at least six months before pregnancy, and this drug may be teratogenic. Leflunomide is very slow to clear and should be discontinued for at least 1 year before pregnancy. If treated with biologics, will it affect male sperm quality? The main biologic agents available in China for the treatment of ankylosing spondylitis are the tumor necrosis factor alpha inhibitors, usually adalimumab (Xumel), infliximab (classical), etanercept (Enzyme), and the domestic Ixepro, etc. Both the Joint Bone Spine and Rheumatology (Oxford) journals have reported in the last two years on biologic agents for the treatment of ankylosing spondylitis. Studies on the effect of ankylosing spondylitis on male fertility have shown that in patients with ankylosing spondylitis, both short-term and long-term tumor necrosis factor alpha inhibitor therapy have no negative impact on sperm quality. Is it safe to use biologics in female patients with onset of pregnancy? Almost all the instructions state that no reproductive toxicity or teratogenicity has been found in animal studies, but the safety of use in pregnant women has not been established. It is not recommended for use in pregnant women and women of childbearing age are advised not to become pregnant during treatment and to use it only when clearly needed in pregnant women. There are some study data to share in patients treated with tumor necrosis factor alpha inhibitors when clearly needed. For example, in 2014 the journal Reprod Toxicol reported a prospective controlled observational study entitled Pregnancy outcome following gestational exposure to TNF-alpha-inhibitors: a prospective. comparative, observational study, The study included 83 patients treated with tumor necrosis factor-alpha inhibitors (35 with infliximab-classic, 25 with etanercept-enilide, and 23 with adalimumab-xumil), 97.6% of whom were treated in the first trimester of pregnancy and then continuously observed. Two comparison groups were set up for this study. One was a group of 86 patients with disease similar to autoimmune disease, which included those treated but treated neither with biologics nor with methotrexate; it also included those who were not treated. Another group of 341 without chronic disease served as a control group for non-teratogenic exposures. The study found no significant difference in the rate of major congenital malformations between the three groups. The study concluded that tumor necrosis factor treatment did not pose a significant teratogenic risk. In addition, in 2014, Expert Opin Drug Saf reported a meta-analysis that analyzed data from more than 100 articles and showed that biologic agents are safe to use during pregnancy. In conclusion, even if you have ankylosing spondylitis, you can still have children, and you can have healthy children!