Which drug should be held in male patients with fertility concerns?

• A. Sulfasalazine
• B. Methotrexate
• C. Hydroxychloroquine
• D. Leflunomide

Answer: (A)

Sulfasalazine is the DMARD most consistently linked to reversible impairment of male fertility, reducing sperm count and motility. The effect is related to its sulfapyridine component and typically reverses after stopping the drug, with semen parameters returning to normal over a few months. Because fertility goals are a concern, holding sulfasalazine and switching to another agent is the prudent choice. Other drugs listed don’t have as clear and direct a impact on paternal fertility, though Leflunomide has teratogenic concerns and a long washout period if conception is planned, and hydroxychloroquine and methotrexate are generally considered compatible with paternal fertility considerations in practice.