SLE Lupus Nephritis (Status post Cyclophosphamide).

Hi there, My cousin who is a 27-year-old male, was diagnosed with lupus when 22 years old.  It was an acute onset then 5 years ago, was admitted to ICU with kidney failure, hepatitis, multiple organ failure, CNS vasculitis/complications, GI tract manifestations with a 40-day hospital stay.  The docs were not sure about his survival during the first 10 days of admission, but he recovered.  During that stay, he was recommended by rheumatologist to get cyclophosphamide therapy over 6 months, 500 mg every month.

He is now on hydroxychloroquine daily, azathioprine 50 mg b.i.d., and calcium and iron supplements.  He is on prednisolone 2.5 mg alternate days.  He was able to reduce to 5 mg daily within 1 year after discharge, but now he is not being able to reduce prednisolone further, as he gets flare-ups if he tries to reduce any further.

He was informed about the infertility that comes with cyclophosphamide.  He was told that about the limited quality of life he will be having thereafter and the kidney failure that might happen after he crosses 50 years of age.  and that he could not have a married life.

He is very young now, and disheartened and depressed about it.

I would like to know how cyclophospamide affects his fertility. Is it related to erectile dysfunction or reduction in sperm count.  He states now he has normal sexual health after 5 years, but what are his chances of having a child.

Regarding the tapering of prednisolone, is there any way to stop this steroid.

Please help him out.