Sexual and reproductive health in rheumatic disease

The cause of reduced fertility in women and men with rheumatic disease is multifactorial and is related to disease activity, therapy, impaired sexual function and personal choicesAt present, evidence for impairment of fertility is only robust for cyclophosphamide in both genders and for sulfasalazine in men; measurements for preservation of fertility should be initiated in both genders before or during early treatment with cyclophosphamideNSAIDs can delay or temporary inhibit ovulation; the choice of type of NSAID, dosage and timing of NSAID administration can reduce the effect on ovulation.The first step to avoid unintended infertility is to monitor sexual function and family planning routinely in all patients of fertile age to detect problems related to reproductive health.Improvement of reproductive health is achieved by effective treatment of rheumatic disease, comprehensive counselling, and if needed, referral to specialists in sexual medicine and infertility.