Authors: Jerome H Check, Diane L Check, Brooke Neumann.
Rationale: Treatment with dopaminergic drugs e.g., dextroamphetamine sulfate (DS) has provided marked relief of abdominal pain and diarrhea in patients with Crohn's disease who failed to respond to other therapies e.g., corticosteroids and biologic monoclonal antibody therapy directed against pro- inflammatory cytokines e.g., tumor necrosis factor-alpha treatment with DS has provided marked amelioration of Crohn’s disease and dysmenorrhea thus relieving excessive bowel inflammation and pelvic inflammation with subsequent successful conception. The likely mechanism of action is through stimulating the release of dopamine from sympathetic nerve fibers leading to diminished cellular permeability thus limiting absorption of toxic elements into those tissues. There are reports of DS improving fecundity i.e. aiding conception and inhibiting miscarriage.
Objective: To see if DS combined with luteal phase progesterone in a woman with Crohn’s disease but no pelvic pain suffering with infertility with diminished oocyte reserve can help her to conceive naturally despite failure with other therapies including in vitro fertilization.
Findings: Not only did the DS markedly ameliorate her inflammatory bowel symptoms but she also conceived naturally and has passed the first trimester with a live fetus.
Conclusion: At her last consultation with her previous fertility specialist, she was advised that she should proceed with donor oocytes. She probably had excessive endometrial inflammation despite the absence of dysmenorrhea. Thus, inflammation may have also caused damage to her ovarian egg supply. Dopaminergic drugs should be considered to help infertile women to conceive when there is evidence of other autoimmune disorders even with no apparent pelvic pain. DS is much safer to take during pregnancy than corticosteroids or biologics even with monoclonal antibodies especially in the last trimester.
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