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

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

Answer: (D)

In this situation, the main idea is that some drugs used for inflammatory conditions can directly affect male fertility by altering sperm production. Sulfasalazine is well known to cause reversible decreases in sperm count and motility. This effect is usually noticeable enough to impact fertility, and it typically improves after stopping the medication. Because of that, it’s the one you would hold if a patient is actively trying to conceive. The sulfapyridine component in sulfasalazine is largely responsible for the impact on spermatogenesis, and the change is generally reversible with discontinuation.

Other options don’t have the same proven association with reduced sperm production. Hydroxychloroquine is considered safe for male fertility; methotrexate is primarily a concern for pregnancy in women, though it’s teratogenic, and leflunomide has a long elimination time and requires a separate washout process if fertility is desired, but sulfasalazine is the classic, direct issue for male fertility.