How Medications Can Affect Your Fertility
Your body is an important vessel—one you want to keep in tip-top shape if you're considering a pregnancy. Women who are planning a family may already know that sexually transmitted diseases, fibroids, excessive weight, and thyroid conditions (among other things) can all impact conception. But less familiar is the fact that certain over-the-counter and prescription medications may also affect fertility.
"Because a woman's menstrual cycle is tightly controlled by the interaction between the brain, ovaries, and uterus, any health problem or medication that disrupts this communication could adversely affect ovulation and make it challenging for women to achieve a pregnancy," explains Alan Copperman, M.D., director of reproductive endocrinology at the Icahn School of Medicine at Mount Sinai in New York City.
But some medications are necessary to treat certain conditions, leaving women to grapple with both the possible inability to conceive and the difficult feelings, including sadness, isolation, frustration, and anger, that can accompany it. "Women with infertility issues have equivalent levels of anxiety and depression to those with cancer, HIV, or heart disease," notes Alice Domar, Ph.D., executive director of the Domar Centers for Mind/Body Health and director of integrative care at Boston IVF and coauthor of the book Finding Calm for the Expectant Mom.
Close consultation with your doctor is paramount when it comes to the medications you take and your fertility. In some cases, there may be alternatives that are just as effective as prescriptions and OTC medications. Here's what you need to know for the healthiest conception:
How medicines affect fertility
There are three main ways medication can interfere with fertility, and two of them pertain directly to women, according to Jason Griffith, M.D., an ob-gyn and specialist in reproductive endocrinology at the Houston Fertility Institute. Medicines can alter ovulation, and endometrial or uterine receptivity to a pregnancy, he says. (The third way medicines play a role is the possible change they can cause in sperm production)
"A medication may affect the ability of a woman's body to ovulate (release an egg) or a man's sperm count by affecting the production of follicle stimulating hormone (FSH) or luteinizing hormone (LH) by the pituitary gland," expands Valerie Baker, M.D., chief of the division of reproductive endocrinology and infertility at the Stanford University School of Medicine.
The duration of impact
Once a medication is stopped, it take some time for the body to recover, though the exact span varies from drug to drug. "Most medications are out of the system within days, but some can interfere with normal egg production for months," says Dr. Copperman. For example, women on the chemotherapy agent methotrexate should wait three months before attempting conception. It may also take your body a month or two to get back to its optimal fertility after stopping some forms of birth control.
"This is most likely because the uterine lining is recovering after a long time of suppression," adds Richard Paulson, M.D., president-elect of the American Society for Reproductive Medicine and an ob-gyn professor at the Keck School of Medicine of University of Southern California. Depo-provera (a contraceptive injection), for example, can take a particularly long time to clear the system, lingering in the body for up to 10 months after the last shot.
Clear answers regarding fertility and medicines aren't always apparent. "There are thousands of medications out there and for many, if not most of them, the effect on fertility has not been well-studied," points out Dr. Baker. "There are also many untested over-the-counter remedies that are purported to improve fertility, but convincing scientific data is lacking," adds Dr. Griffith. Fortunately, most OTCs don't interfere with fertility, but it's always a good idea to check with your doctor first, and be cautious when it comes to the following categories:
- NSAIDs (non-steroidal anti-inflammatory drugs) Some reports have suggested that NSAIDs like Motrin or Advil could have a minor impact, says Dr. Copperman. "These can interfere with ovulation, particularly the ability of the egg to be released by the ovary," explains Dr. Griffith.
- Natural or herbal remedies The concern with this group is that there's little to no data nor regulation of content. "So-called 'natural 'herbs sometimes contain substances that can act like hormones (estrogens or progestins), including animal products made from the adrenal, testes or ovaries," says Dr. Paulson.
If you are currently taking any of the following drugs, discuss their impact as it relates to your desire to become pregnant with your health care provider.
- Psychiatric medications such as anti-depressants and some anti-psychotics can interfere with the hormonal regulation of ovulation and may also elevate associated hormone levels such as prolactin. "A recent study showed that women who were taking an SSRIs (selective serotonin reuptake inhibitors) took significantly longer to conceive; these may also reduce the efficacy of infertility treatment and are associated with miscarriage and preterm birth," reports Dr. Domar. "¨
- Prescription NSAIDS The risks here are similar to OTC NSAIDS (see above). "¨
- Steroids This class, including anabolic steroids and corticosteroids (cortisone, prednisone) used to treat asthma and lupus, are made from testosterone and could have a serious affect on fertility. In particular, steroids may prevent the release of hormones needed for ovulation and menstruation.
- Antiepileptic (phenytoin, carbamazepine, and valproate) medications may impact fertility. "¨
- Antipsychotics such as risperidone may increase levels of the hormone prolactin and lead to lack of ovulation. "¨
- Thyroid medications If the dose isn't well-regulated (too high or too low), prolactin levels may be affected. "¨
- Skin products with hormones Avoid those with estrogen or progesterone, which may alter ovulation. "¨
- Chemotherapy, especially alkylating agents, can be toxic to the ovary, potentially resulting in permanent infertility. "¨
In some cases, like asthma, prescriptions are usually unavoidable. But some conditions may have equally effective alternative approaches that can work well during the conception stage. "I strongly urge women who are taking an SSRI to review the pro/con list of remaining on it and to try other options, such as cognitive behavior therapy, which can be just as effective in most cases but with no side effects," says Dr. Domar. Acupuncture, a complementary medicine used to treat pain, is another alternative therapy example.
Most physicians would prefer that women be on as few medications as possible when trying to conceive or while pregnant. "It's a good idea to sit down with your doctor before you get pregnant to discuss the safety of each one, and to attempt to either switch to safer ones or try non-pharmaceutical approaches," recommends Dr. Domar. And if a regimen is necessary (chemotherapy for cancer), discuss the possibility of freezing eggs prior to beginning the course.