Which medication can disrupt spermogenesis?

• A. Methotrexate
• B. TNF inhibitors
• C. Hydroxychloroquine
• D. Sulfasalazine

Answer: (B)

Some medications used for inflammatory conditions can affect how sperm are produced, but the one most reliably linked to disrupting spermatogenesis is sulfasalazine. In men taking sulfasalazine, sperm count and motility can drop, leading to infertility, and this effect is usually reversible after stopping the drug, with recovery happening over a few months as new sperm are produced. The mechanism is thought to involve the drug or its metabolites impairing spermatogenic cells and possibly folate metabolism in the testes. Because of this, men who plan to conceive are often advised to discontinue sulfasalazine for a period before trying.

Methotrexate and hydroxychloroquine are not as strongly associated with lasting effects on sperm production, and anti-TNF agents generally do not show a significant impact on male fertility based on available data.