Increasing amounts of research, literature and scientific discussion are now preliminarily warning that women who are looking to conceive or become pregnant should avoid taking or consuming NSAIDs (aka: non-steroidal anti-inflammatory drugs) due to the potential link between taking NSAIDs and interference of these drugs with, and sometimes the prevention of, ovulation in females. 

For a drug that is taken by so many people globally, this is a pretty huge claim so in today’s article we are going to go deeper into NSAIDs, what they are, the specifics of how they may interfere with ovulation, as well as looking deeper into a study of 39 women of childbearing age with minor back pain and how, ultimately, the study concluded that these NSAIDs are likely to impact ovulation and the ovulation cycle of up to 75% of participants.

Ok, back to basics. First up, what are NSAIDs?

The term ‘NSAIDs’ stands for Non-Steroidal Anti Inflammatory Drugs and they are over the counter (and sometimes prescription) medications to help with managing pain (particularly for headaches, migraines, back pain, etc). The most common NSAIDs are ibuprofen, aspirin & naproxen.

TThese NSAIDs are absolutely everywhere and there is no doubt you will have seen, heard of, or even used NSAIDs at some point in your life. And, on the very small chance that you haven’t? It is highly likely that someone close to you will have, or are taking these drugs day-in day-out now on an ongoing basis. 

Take the USA as an example, in 2012, a report published in the Holistic Primary Care Journal reported that between 20-30% of the entire population of the USA take NSAIDs daily (yes, *daily*), with 70 million NSAID prescriptions being given out each year by medical doctors, and 30 billion (yes, billion) of over the counter NSAIDs being purchased by Americans to self medicate.

It’s a lot - particularly when you start to understand the potential side effects of these drugs, not only on fertility but also on the body as a whole.

For a long time, there have been rumors that these NSAIDs have unpleasant side effects - particularly in terms of stomach upset and digestive issues but in the holistic health community, it is now well understood that these NSAIDs go one step further - throwing off the bacterial imbalance of the gut (we call this gut dysbiosis), driving leaky gut, as well as causing digestive discomfort, heartburn, gastrointestinal ulcers and more.

Up until now, however, fertility has not been explored as a side effect so this new study is very eye-opening. 

Let’s get into it. How would NSAIDs impact fertility?

Good question. Let’s look at this through the vehicle of a research study.

The most interesting (albeit small scale) study on this topic came out of the work of a rheumatologist at the University of Baghdad called Dr. Sami Salman Shihab.

Dr. Sami recruited 49 fertile women who suffered from back pain and decided to monitor how their bodies reacted to taking these NSAIDs, he gave:

• 16 of them a drug called diclofenac;
• 12 of them a drug called naproxen;
• 11 a drug called etoricoxib;
• and 10 of them a placebo drug. 

Before starting the trial, each woman underwent an ultrasound scan of her reproductive system, specifically measuring the diameter of dominant follicles, her ovary size, and the thickness of her endothelial cells (in the reproductive system).

In addition to this, a critical part of the study was testing the progesterone levels of each woman before, during, and after the studies.

Why progesterone?

Progesterone is a hormone that is mainly secreted from inside of the ovary during the second half of the menstrual cycle and it plays a critical role in reproductive health, fertility, and maintaining the early stages of pregnancy.

By monitoring progesterone, Dr. Sami Salman Shihab could effectively look at the fertility levels of each woman in terms of likelihood to conceive, etc.

And the study - what did it involve?

After testing, each participant in the study was treated with their selected NSAIDs and after taking their specific drug for 10 consecutive days, testing happened again - looking at whether there had been any changes since taking the NSAIDs.

And?

The results were crazy.

First up, every woman who was given the placebo drug ovulated in the 10 days, as they were meant to - suggesting that there was no interference with the cycle due to no NSAIDs being consumed.

However, those women on the NSAIDs saw major changes in their ovulation and ovulated at a far lower frequency.

Specifically:

• 75% of the study who took the drug called diclofenac did not ovulate at all;
• 33% of people taking etoricoxib didn’t either; and
• 25% of those taking naproxen did not.

In addition to the marker of ‘ovulation’ or ‘no ovulation’ it was the progesterone testing that became particularly interesting here as it showed that, no matter which NSAID drug the women took, all of them had much lower levels of progesterone during the trial than any of the women on the placebo.

Even Dr. Sami was shocked by his findings, saying that he was not expecting the results and the effect of taking NSAIDs to be as dramatic as it seemed to be.

What does this mean in practice? What are the implications of lowered progesterone levels?

Good question. As well as interfering and even inhibiting the ovulation cycle (a critical part of the puzzle in conceiving), lowered progesterone levels can lead to a reduced likelihood of successful implantation of a fertilized egg, and, going one step further, Dr. Sami also said that if implantation was likely to happen, it would be unlikely to be a healthy egg and would ‘probably lead to an early miscarriage. 

In short, lowered progesterone levels reflect lower fertility and a lower likelihood of conception.

How would this drug interfere with my progesterone levels?

Ok - let’s get into the science.

Whilst we acknowledge that the study size was small, and so more research into this is required, the study allowed the research team to speculatively suggest that these NSAIDs are having impacts on ovulation through the following mechanism:

1. These NSAID drugs work by inhibiting an enzyme called cyclooxygenase in the body;
2. The reduction in cyclooxygenase then reduces the production of something called prostaglandins;
3. Prostaglandins are a group of lipids that have many important functions but, in this context, they most importantly control ovulation, changes in the menstrual cycle - and even the induction of a woman into the labor state.

So, disruption to the creation of prostaglandins, or reduction in the creation of them, could be the way that NSAIDs interfere with and ultimately inhibit ovulation.

I’ve taken these drugs before - should I be worried?

The good news is, no!

The other fascinating thing that came out of the study was that the impact of these NSAIDs seems to be temporary and reversible. This was confirmed by the study when the entire cohort was also monitored on their next menstrual cycle - during which they took no NSAIDs whatsoever. At this point, all participants started ovulating again.

What we can take from this is that a reduction in fertility can occur after even just 10 days of regular NSAID use butthis reduction is not permanent.

Despite this, we can’t undermine how important this finding is, with Dr. Sami advising that a woman is going to struggle to conceive if she continues to take NSAIDs.

Takeaway thoughts

This is a very small study, and more extensive research is needed - particularly into the use of ibuprofen which was not incorporated into this study (and this is a medication taken by millions worldwide) but, initial findings suggest that these drugs may reduce fertility.

So, if you are struggling to conceive, and take NSAIDs regularly then it may be the sign you need to talk with your Doctor about alternate ways to manage your pain that may not interfere with your fertility.

Ultimately, whether or not you are trying to conceive, at Agent, we feel passionate about exploring more holistic and arguably, less damaging, ways to manage pain in the body, rather than through the use of pharmaceutical drugs, so, maybe this is the sign you need to kick the NSAIDs once and for all! 

References
[1] Salman S, Sherif B & Al-Zohyri A. Effects of some non-steroidal anti-inflammatory drugs on ovulation in women with mild musculoskeletal pain. Annual European Congress of Rheumatology. 11 June 2015. doi: 10.1136/annrheumdis-2015-eular.1062.

[2 ]Harrison, P. (2015, June 16). NSAIDs Dramatically Reduce Ovulation With Consistent Use. Medscape. Retrieved 6/30/15 from http://www.medscape.com/viewarticle/846552?nlid=83026_2042.

***THESE STATEMENTS HAVE NOT BEEN APPROVED OR REGULATED BY THE FDA.  WE ARE NOT DOCTORS, THEREFORE ALWAYS CONSULT WITH YOUR DOCTOR FIRST.