A 35yr old male taking methotrexate 7.5mg/wk. His wife with no significant past medical history is on oral contraceptive pills. Now the couple wanted to conceive. What isur advice?

Methotrexate should be stopped before 3months in males with effective contraception till then Methotrexate can cause birth defects and should be stopped before trying to conceive. It is also recommended by the manufacturers that TNF inhibitors are also discontinued prior to conception but the evidence that these drugs cause birth defects is not anywhere near as strong. People taking methotrexate, both male and female, are advised to discontinue taking the drug at least three months prior to conception because there is a chance that the drug may cause birth defects. The period of time off the drug used to be six months but has recently been reduced to three, much to our relief. In people who have arthritis some other way of controlling the disease must be found during this period. For men, once pregnancy is confirmed they can go straight back on to methotrexate. Women, however, are advised to stay off the drug throughout pregnancy. Fortunately the pregnancy itself often helps rheumatoid arthritis but not until about 12 weeks. In the period of time between stopping the methotrexate and the pregnancy associated relief some other 'safer' drug is used or a short period of time on steroids is recommended