Patients with ankylosing spondylitis who have not had children are often encountered in outpatient clinics, and the number of such patients is large. How do these patients use their medications? Is it possible to adopt a “treatment guideline”? We know that many immunosuppressive drugs have unpredictable effects on the reproductive system and can cause congenital malformations in the fetus, or fetal failure, or even a high incidence of fetal malignancy if immunosuppressive drugs are not used properly. Therefore, we should avoid the use of immunosuppressive or immunomodulatory drugs that may damage the reproductive system in young men and women with fertility requirements. For such patients, we should choose hydroxychloroquine, leucovorin, and other drugs that have little effect on the reproductive system, supplemented with Chinese herbal medicine. From the experience of treating thousands of patients, I believe that we must be careful with medication, not to blindly pursue clinical remission, but to weigh the pros and cons and minimize the side effects of medication. I wish all young men and women with fertility requirements a speedy recovery!