Can colchicine or azathioprine cause defective sperm heads?/nA 40-year-old man with familial Medite

Fråga: Can colchicine or azathioprine cause defective sperm heads? A 40-year-old man with familial Mediterranean fever and a successful kidney transplantation is treated with Imurel (azathioprine) 200 mg, prednisolone 10 mg and colchicine 0.5 mg three times daily. He now wants to become a father but an analysis at the andrologic clinic showed that 100 per cent of his sperms have defective heads and the probability for him to father a child is therefore very low.

Sammanfattning: Colchicine has in a few studies been associated with azoospermia or sperm penetration defects but no description of defect spermheads could be found. Azathioprine in ordinary doses is normally not associated with male infertility.

Svar: Questions about the effect of colchicine on male fertility has previously been answered in Drugline. Colchicine inhibits the cell division and has anti-inflammatory properties (1). Results from studies on the effects of colchicine on the spermatogenesis are contradictory. Some studies have not shown any effect and some studies have shown effects on the spermatogenesis (2).

One of these studies (including 19 male patients) described four cases of infertility during colchicine treatment, one case of azoospermia and three cases where the sperm count and sperm motility were normal but the sperms had a penetration defect, making the sperms infertile (3).

A case report from 1972 describes a man who got azoospermia after treatment with 1.3 mg colchicine. The azoospermia was reversible on withdrawal and reoccurred on rechallenge (4).

An updated Medline search gave one study from 1995. In this study 62 men were treated with colchicine for Behcets disease. Prior to treatment all the men had had a successful sexual life and children. 25 of the men showed adverse effects of colchicine on the spermatogenesis and the longer the use the more serious the adverse effects on sperm count. However, nothing was written about the doses used (5).

Azathioprine has in most studies not been associated with effect on male fertility (6,7). An updated Medline search gave no further information.

If it is considered safe, colchicine treatment may be discontinued and the sperm count and morphology examined. In case the sperm morphology improves, thereby suggesting a detrimental effect of colchicine, the case should be reported to SADRAC (The Swedish Adverse Reactions Advisory Committee).