Commonly Used Medications That Can Negatively Impact Male Fertility

Did you know that some medications used to treat chronic medical conditions can negatively impact a male’s fertility status? This is something that is often overlooked; however, a recent review published in Fertility & Sterility (F&S) by authors Armin Ghomeshi, B.S. , Boris Yang, B.S. , and Thomas A. Masterson, M.D. is trying to bring awareness on this topic. Luckily the majority of these effects are reversible, however the lifecycle of the sperm is approximately 3 months. Therefore, it takes at least 3 months for us to see any potential improvement in semen parameters. As many of you know, 3 months can seem like a lifetime when you are already having difficulty conceiving. This is why it is important to discuss your family planning goals with your healthcare provider so that your fertility status can be optimized prior to trying to conceive. Summarized below are a few of the medications reviewed in the F&S article that have the most research supporting a potential impact on the male partner’s fertility status.

Proton Pump Inhibitors (PPIs):

Commonly used to treat: Gastrointestinal disorders like acid reflux (GERD) and H. pylori infections.

How does it affect sperm?: Long-term use of PPIs may be associated with a higher risk of low total motile sperm count. Remember the total motile count (TMC) is measured by multiplying the volume X concentration X motility. It is ideal to have a TMC > 20 million, ideally > 40 million to have the best chance of success with natural conception.

What is the science behind it?: PPIs may affect sperm quality by increasing gastric pH, impairing vitamin B absorption, and interfering with sperm maturation processes.

How convincing is the data?: More long term studies are needed. Currently there is conflicting data in the research.

Antidepressants:

Commonly used to treat: Depression and/or anxiety.

How does it affect sperm?: There are many classes of antidepressants, some with larger known side effect profiles that others. Some antidepressants are known to cause decreased libido or difficulty with erection which can make “performing on demand” more challenging and add another layer of complexity to the trying to conceive journey. Additionally some studies have suggested negative effects of antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs) on semen parameters, including reduced sperm concentration and increased abnormal morphology.

What is the science behind it?: Antidepressants, like SSRIs, can decrease androgen (testosterone) production and increase estrogen levels both of which can negatively effect sperm production.

How convincing is the data?: More long term studies are needed. However, there is consistent evidence in the currently available data demonstrating the negative impact of certain antidepressants on semen parameters and hormone levels.

Hormones/Hormone Antagonists:

Commonly used to treat: Low testosterone, angioedema, benign prostatic hyperplasia (BPH), or male pattern hair loss

How does it affect sperm?: Danazol has been shown to negatively impact sperm parameters and hormone levels, leading to lower sperm counts. Finasteride, used to treat hair loss, can affect semen parameters in healthy men, reducing total sperm count and semen volume. Although it has become more widespread in use, the use of testosterone hormone replacement therapy can have profound negative impact or completely shut off sperm production temporarily.

What is the science behind it?: These hormonal medications negatively effect the complex hormonal pathway that monitor the production of testosterone and sperm.

How convincing is the data?: There is consistent evidence in the research demonstrating the negative impact of exogenous hormones on male fertility potential.

Calcium Channel Blockers (CCBs):

Commonly used to treat: Heart conditions like high blood pressure and angina (chest pain).

How does it affect male fertility?: Some human studies have indicated potential effects of CCBs on hormonal parameters and sperm function. Animal studies have shown that CCBs like nifedipine, verapamil, and diltiazem can decrease sperm counts and motility.

What is the science behind it?: CCBs are thought to have an effect on the molecular level as calcium is important for movement and fertilization. Additionally, some studies have suggested that it can negatively effect the complex hormonal pathway that monitors the production of sperm and testosterone.

How convincing is the data?: More research is needed to fully understand the association between CCBs and male fertility. The available studies do show an association between CCBs and decreased sperm parameters

It is important that before you start any new medications or make changes to your current medications that you discuss your family planning goals with your healthcare provider. Together you can weigh the risks and benefits of taking certain medications and discuss how it may impact your fertility potential. Your healthcare provider may also consider switching to an alternative medication that has fewer known side effects on fertility when you are trying to conceive. Additionally, if the male partner has an abnormal semen analysis it is recommended that he is evaluated by a reproductive urologist (RU) to identify certain risk factors and optimize things from a sperm perspective. Just like with many things, on your path to parenthood it is important to ask questions and lean on reputable sources so that you can have all the necessary information to make an informed decision that align with your values and goals. You can read the full article here.