Male on MMF antirejection drug issues - holding up fertility approval

[Rstar]

My husband is a very lucky man after surviving what turned out to be complex transplant surgery. He is now on MMF and feels well and we would like to start a family. We are at the last stages of our fertility treatment screening and have now been told that the guidance with MMF has changed and this could be problematic for our potential treatment due to potential risks to baby. There is no evidence relating to the risks In males yet it is widely reported writhin females. Has anyone else come across this and if so what was the outcome? Changing my husbands drugs is something we are not happy to do as he is stable and it's been a long road - just seem so hard for us to be told no because of a potential risk that cannot be quantified as there is no evidence and no known association of deformalities in a child when the male is taking the drug. So stressed as it's taken us 8months to get to this point. Would this be the same if we went private? Or is his an NHS thing? Any advise would be appreciated

[DianeArnold Partner Nurse Fertility Network UK]

Hi Rstar. Obviously, we need to realise the importance of your husband continuing on the mycophenolate following a successful transplant. I do, from working with and knowing transplant patients that pregnancy is not advised while being on the drug and for 3 months after finishing it. This goes for men fathering a baby too. However, there are newer forms of fertility treatment known as “IMSI”. Using IMSI, sperm samples are examined under a microscope which is almost 6000 times more powerful than a normal ICSI microscope. This technique enables the embryologist to choose the very best quality sperm, without any defects, to inject into the patient’s eggs, thereby, hopefully, increasing the rate of implantation and pregnancy after fertility treatment. IMSI is usually recommended for couples whose sperm samples are unusually low or highly abnormal, or who have already undergone several IVF treatment cycles without success. This you need to have a serious discussion about with an embryologist and his transplant team, as I doubt this would be available on the NHS, and is very expensive. If you are advised that it is all too risky, you may be geared towards using a sperm donor. I realise that you both want your own genetic child if possible, but as you say, your husband has been through so much to get to the stage he is at. He is the most important person here, and his transplant is most important to him and needs careful looking after. I do wish you both well with whatever you both decide, and for ongoing success with his transplant. Diane

[Rstar in reply to DianeArnold]

Thanks for your response Diane. This is a recent development for us and so we are looking into it and the options. IMSI has not yet been suggested. It's interesting that our renal team never gave any such guidance with regards to MMF and it is only just mentioned to us by the fertility team! Had we been fortunate to have children naturally we could have conceived and been none the wiser with regards to the risks. Do you know of any studies that have taken place to show the risk in percentages for men on MMF? My husbands renal consultant said this is new guidance, he is not aware of any evidence and therefore thinks it's hard to quantify the risk.

It is a minefied!

Thanks for your post x

[DianeArnold Partner Nurse Fertility Network UK in reply to Rstar]

Hi Rstar. I'm afraid I don't. You need to be guided by your embryologist. You could try writing to the transplant team at the Queen Elizabeth Hospital in Birmingham and see whether they have any more information?? Or perhaps write to the manufacturers f Mycophenolate Mofetil. Actavis UK Ltd Whiddon Valley Barnstaple DevonEX32 8NS Might be worth a try. Gd luck! Diane

[Rstar in reply to DianeArnold]

Thank you so much - that's wonderful. Best Wishes

[DianeArnold Partner Nurse Fertility Network UK in reply to Rstar]

Hi. I would love to know how it goes, if you can. My emails are confidential. [e-mail] All the best. Diane

[Dalal19]

hello,

my husband had a kidney transplant on march 2015, we decided to get pregnant 2 months after the surgery, our daughter was born last march and she will be 9 month soon, she is healthy and very alert, at the time we were not aware of the excitence of a potential risk for male using MMF, the pregnancy was spontanious and the baby is healthy.. all the scans were excellent and no abnormalities with the pregnancy. 2 weeks ago we received a letter from the hospital suggesting that MMF can have an effect on the unborn child, i have been researching this as we want a second child ( sooner ) i can't find enough evidence as it is completely based on theoretical evidence and not clinical ones, it s a recent study that has been done in the united states suggesting the potentiel risk. according the same study the survey that has been done on 74 childs born to fathers under the drug are similar to the general population. i got millions of questions and i can't find a satisfying answer, for example is the durations of the treatment an important factor ? i would assume that someone who is under the drug for 10 years has higher risk compered to someone who has been taking the drug for 10 months ?!

[Stesven in reply to Dalal19]

Hi, my partner and I did not know about the potential risks of MMf in sperm. We have a healthy 16 month old boy and we’re pregnant again. I just happened to come across a paragraph in my medication leaflet warning of the risks of feral deformities. We’re very worried that we my have been lucky the first time but might not be in this occasion. I’ve been taking this medication for 3 years now. Fingers crossed we have no issues.

[Hidden in reply to Stesven]

Hi. How is your pregnancy going. Did you get any outcomes from Birmingham or the drug company.