Azathioprine, glucocorticoids, mesalazine, anticalcineurins such as cyclosporine and tacrolimus, ß-interferon, glatiramer-acetate and chloroquine can be used during pregnancy, bearing in mind however that side effects may still occur.

Cancer Res. Transplantation.

Transplantation.

Expert Rev Clin Immunol. All rights reserved. 2004;99:656–61.Hoeltzenbein M, Weber-Schoendorfer C, Borisch C, Allignol A, Meister R, Schaefer C. Pregnancy outcome after paternal exposure to azathioprine/6-mercaptopurine. 2014;82:674–80.Soleimani R, Heytens E, Oktay K. Enhancement of neoangiogenesis and follicle survival by sphingosine-1-phosphate in human ovarian tissue xenotransplants. Transplantation. Liver diseases in pregnancy: liver transplantation in pregnancy.

2007;20:305–11.Krämer BK, Neumayer H-H, Stahl R, Pietrzyk M, Krüger B, Pfalzer B, et al. Impact of mTOR-I on fertility and pregnancy: state of the art and review of the literature. The safety of 6-mercaptopurine for childbearing patients with inflammatory bowel disease: a retrospective cohort study. Anti-TNF-alpha and mTOR-inhibitors are to be used cautiously if pregnancy is desired, since experience using these drugs is still relatively scarce.

Arthritis& Rheumatol. The diagnosis of these complications is made upon the medical history (transplantation, rheumatoid arthritis, lupus, bowel inflammatory diseases, multiple sclerosis…) and the analysis of the previous treatment courses both in mother and father before and during the pregnancy. BMC Neurol. 2008;8:1471–9.Rovira J, Diekmann F, Ramírez-Bajo MJ, Bañón-Maneus E, Moya-Rull D, Campistol JM. Male fertility in cyclosporine-treated renal transplant patients.

Current recommendations for multiple sclerosis treatment in pregnancy and puerperium. The recommendations for use are established with a rather low level of proof, which needs to be taken into account in the patient management. Andrologia. CNS Drugs. 2003;124:9–17.Moskovitz DN, Bodian C, Chapman ML, Marion JF, Rubin PH, Scherl E, et al. Clin Rheumatol. Int J Cardiology.

Clin Rheumatol. Fertil Steril. In addition, immunosuppressive drugs pose a substantial maternal-foetal infectious risk (bacterial or opportunistic infections especially cytomegalovirus or BK reactivation). 2013;149:1274–80.Schatz M, Zeiger RS, Harden K, Hoffman CC, Chilingar L, Petitti D. The safety of asthma and allergy medications during pregnancy.

2012;16:346–9.Cil AP, Leventoğlu A, Sönmezer M, Soylukoç R, Oktay K. Assessment of ovarian reserve and Doppler characteristics in patients with multiple sclerosis using immunomodulating drugs. 2001;15:483–6.Riley SA, Lecarpentier J, Mani V, Goodman MJ, Mandal BK, Turnberg LA. 2012;64:2085–94.Warnke C, Stüve O, Kieseier BC. 2005;37:1601–4.Kaczmarek I, Groetzner J, Adamidis I, Landwehr P, Mueller M, Vogeser M, et al. It must be anticipated very far in advance, before the prescription of the immunosuppressants, in order to preserve fertility, and then before conception in order to adjust the immunosuppressive treatment. Am J Gastroenterol. 2005;5:197.Huyghe E, Zairi A, Nohra J, Kamar N, Plante P, Rostaing L. Gonadal impact of target of rapamycin inhibitors (sirolimus and everolimus) in male patients: an overview. NOVP chemotherapy for Hodgkin’s disease transiently induces sperm aneuploidies associated with the major clinical aneuploidy syndromes involving chromosomes X, Y, 18, and 21. Outcomes of pregnancies fathered by solid-organ transplant recipients exposed to mycophenolic acid products. 2005;4:111–5.Ojeda-Uribe M, Afif N, Dahan E, Sparsa L, Haby C, Sibilia J, et al.

Autoimmune diseases have become the 3rd leading cause of morbidity and mortality following cardiovascular disease and cancer.The present review is based on a comprehensive PubMed search between the dates of January 1, 1960, to October 1, 2014, using the search term fertility and pregnancy combined with the different immunosuppressive drugs and discussed according to the multidisciplinary clinical experience of the authors.

After liver or kidney transplantation, the rates of miscarriage range from 15 to 27 % [Most of the time, the intensity of immuno-suppression In transplanted male patients, there is a dose-dependent decrease in plasma concentrations of testosterone, an increase of gonadotrophins and an alteration of spermatogenesis compared to the values of the general population.

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