Methotrexate and Surrogate Pregnancies

[Sparda29]

We have a patient who is on Methotrexate and Enbrel for rheumatoid arthritis. She wants to have a baby, but because of the methotrexate, pregnancy is contraindicated. Thus, she wants to have a surrogate pregnancy.

Question is, how long does she have to wait before having the egg removed to be inseminated in implanted into the surrogate mother? Or does she even have to wait or be taken off the methotrexate at all?

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[PharmDstudent]

All About Abortion says, "Since the medication works on dividing cells and a woman’s eggs do not divide until they are fertilized, future pregnancies should not be affected. However, to be extra-safe, women should avoid getting pregnant by using birth control for at least three months after receiving Methotrexate."

 

[All4MyDaughter]

Hard to imagine that her REI specialist wouldn't know the answer to the better than any of us. I wouldn't want to mess around with this one!

 

[Sparda29]

Hard to imagine that her REI specialist wouldn't know the answer to the better than any of us. I wouldn't want to mess around with this one!

Her doc told her to call us.

 

[All4MyDaughter]

Her doc told her to call us.

What kind of doctor? Rheum? Family doc?

 

[rxlea]

I've heard twelve weeks .

 

[PharmDstudent]

Is there a such thing as egg washing like sperm washing in HIV+ patients? I would imagine that the fluid surrounding the egg would need to be cleaned of any residual methotrexate.

 

[rxlea]

Not sure but men are told to use protection too because methotrexate is teratogenic to sperm. The only difference is that the sperm are continually being produced and the ova are already produced. I don't think I'd want to take the chance either way.

Washing would be expensive. I'm only a student, but I would say the patient should just wait to be on the safe side.

 

[PharmDstudent]

I've heard twelve weeks .

Conception is twelve weeks... http://www.ncbi.nlm.nih.gov/pubmed/21044438

Not sure but men are told to use protection too because methotrexate is teratogenic to sperm. The only difference is that the sperm are continually being produced and the ova are already produced. I don't think I'd want to take the chance either way.

Washing would be expensive. I'm only a student, but I would say the patient should just wait to be on the safe side.

I'm not so sure about that...

http://www.jrheum.org/content/38/4/628.abstract

http://qjmed.oxfordjournals.org/content/92/10/551.full


I'm only a simpleton retailer and a whimpy prn LTACer, so what do I know?

 

[rxlea]

That second article is slightly outdated, don't you think? It seems to me that there isa risk, albeit small ; so, considering how expensive using a surrogate is, I think waiting is a reasonable safety measure.

I don't know...I guess I like to err on the side of caution.

 

[PharmDstudent]

That second article is slightly outdated, don't you think? It seems to me that there isa risk, albeit small ; so, considering how expensive using a surrogate is, I think waiting is a reasonable safety measure.

I don't know...I guess I like to err on the side of caution.

Sure. It's quite old, but it's specific to the topic.

I don't know if waiting will change the eggs' condition. Eggs are there for life, you know? What if the woman gets in a car accident tomorrow or is dieing of cancer? What if the in vitro clinic is running a special?

...but waiting is your professional opinion. Congrats! You have one of those, too, and you should protect it.

Pharmacy practice can be pretty gray at times.

 

[rxlea]

Sure. It's quite old, but it's specific to the topic.

I don't know if waiting will change the eggs' condition. Eggs are there for life, you know? What if the woman gets in a car accident tomorrow or is dieing of cancer? What if the in vitro clinic is running a special?

...but waiting is your professional opinion. Congrats! You have one of those, too, and you should protect it.

Pharmacy practice can be pretty gray at times.

Those are certainly factors to consider which is why the patient should be given all the information and be a part of the decision making process. You're right. It's gray. I would just be hesitant to make that kind of recommendation and then something goes wrong with the fetus after all the effort, money, and what the surrogate will go through.

 

[rph3664]

I don't think methotrexate would affect an unfertilized egg. I'm pretty sure it's only dangerous after the embryo has implanted, because it attacks placental tissue. That's why it's used for some ectopic pregnancies and is so effective against choriocarcinoma.

 

[CUpharmD2013]

We have a patient who is on Methotrexate and Enbrel for rheumatoid arthritis. She wants to have a baby, but because of the methotrexate, pregnancy is contraindicated. Thus, she wants to have a surrogate pregnancy.

Question is, how long does she have to wait before having the egg removed to be inseminated in implanted into the surrogate mother? Or does she even have to wait or be taken off the methotrexate at all?

Just a student, but we just had our RA section and this question was on our test. Sulfasalazine is pregnancy category B. Would it be appropriate to try to switch her regimen so that she can give birth? Or do you stick with MTX/Enbrel since it's obviously working for her. And since she's currently on combo therapy, does she always need to be on combo therapy? It may be safe for her to be on sulfasalazine/Enbrel.