As pharmacists, our primary aim would be to look at the drugs. Recall the lady has conceived before, therefore something went wrong along the line, and it is the NSAIDs.Let’s look at this holistically.
Ovulation, the release of matured ovum from the ovary into the Fallopian tube, constitutes a central event in the ovarian cycle and a woman’s ability to conceive.Ovulatory disfunction is a relevant cause of female infertility.
Non-steroidal anti-inflammatory drugs (NSAIDs), widely used due to their analgesic and anti-inflammatory properties, consistently inhibit ovulation in all mammalian species. The pharmacological target of NSAIDs is cyclo-oxygenase (COX), which catalyses the first rate-limiting step in the production of prostaglandins. COX-2, one of two isoenzymes, is active in the ovaries during follicular development. Its inhibition by NSAIDs is thought to cause luteinised unruptured follicle (LUF) syndrome, an anovulatory condition characterised by clinical signs of ovulation but in the absence of follicular rupture and ovum release. COX-2 inhibition has major effects on ovulation, fertilization and implantation, and NSAID therapy is likely implicated in human infertility and could be an important, frequently overlooked, cause of ovulatory disfunction in women.
If you look at this case, you will realise that the lady has been on NSAIDs for the past six months, this further emphasises the that the pharmacist is an important link in patient care.
We are of the opinion that if a woman who presents with infertility is found to be taking a NSAID, the role of the drug should be considered before launching costly, invasive investigations or starting medically assisted reproduction.
If you missed the question click the infertility
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1. Bata MS, Al-Ramahi M, Salhab AS, Gharaibeh MN, Schwartz J. Delay of ovulation by meloxicam in healthy cycling volunteers: A placebo-controlled, double-blind, crossover study. J Clin Pharmacol. 2006 Aug;46(8):925-32. Address: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Jordan, Amman
2. Gaytan, M; Morales, C; Bellido, C; Sanchez-Criado, J E; Gaytan, F Title Non-steroidal anti-inflammatory drugs (NSAIDs) and ovulation: lessons from morphology. Histology and Histopathology. vol. 21, no. 5 (2006 May): 541-56.
3. Skomsvoll, Johan Fredrik; Rodevand, Erik; Koksvik, Hege Svean; Salvesen, Kjell Asmund; von During, Vidar; Rygnestad, Tarjei; Ostensen, Monika Reversible infertility from nonsteroidal anti-inflammatory drugs Tidsskrift for Den Norske Laegeforening. vol. 125, no. 11 (2005 Jun 2): 1476-8.