We all know that most drugs must be avoided during pregnancy, and many women avoid drugs while they are actively trying to get pregnant, too.
That is a smart strategy. Your doctor should advise you about any medications (or herbs or supplements) you take that could be harmful to a developing embryo. But you should also know that certain prescription and over-the-counter medications can impair your fertility as well. This goes for both men and women. Giving up a medication may not always be the answer, depending on why and how you are using it. But if you take any of the following and want to get pregnant, you need to have a serious discussion with your doctor about your options.
• Antibiotics. Although antibiotics are often the key to solving fertility problems (by clearing up the infections that are causing infertility or miscarriages), some hamper sperm production. Be cautious with aminoglycosides, Minocin, nitrofurantoin, and sulfasalazine. In addition, certain broad-spectrum antibiotics, such as Augmentin, Keflex, ampicillin, and amoxicillin, can provoke an overgrowth of vaginal yeast, which can make fertile cervical mucus hostile to sperm. And even if a yeast infection doesn’t do that, it can make timing intercourse more difficult, since it will be hard to detect when you are having fertile cervical mucus.
• Antidepressants. Selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft, can depress libido in both men and women and cause erectile or ejaculatory dysfunction. People taking antidepressants may experience an effect on their hormone balance, but it is difficult to say whether the depression or the drug is at fault. There’s evidence that antidepressants can affect semen quality, too, and lead to lower sperm count. SSRIs may also reduce the number of days of fertile cervical mucus. Older antidepressant drugs, the tricyclics, can impede fertility by increasing prolactin levels, which can suppress ovulation.The decision about whether to use an antidepressant while trying to get pregnant is a difficult one, and you should never discontinue one without consulting your doctor. For some people, extreme stress (including depression) plays a major role in their fertility problems, and in those cases an antidepressant can actually be useful.
• Antihistamines. Some antihistamines, such as Chlor-Trimeton, Allegra, Benadryl, Claritin, and Zyrtec, can dry up fertile cervical mucus, so it is important to avoid them around ovulation.
• Anti-inflammatories. Heavy use of anti-inflammatories, including nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, Advil, Motrin, and Aleve, and COX-2 inhibitors, such as Vioxx and Celebrex, can stop ovulation. They can lead to luteinized unruptured follicle syndrome (LUFS), the failure of the follicle to release the egg. They can also reduce the amount of fertile cervical mucus produced.
• Blood pressure medications. Calcium channel blockers, such as Plendil, Cardene, Procardia, Cardil, Cardizem, and verapamil, can lower sperm count. (Look for generic names ending in “dipine.”) Some blood pressure drugs can cause erectile or ejaculatory dysfunction. Verapamil and ACE inhibitors have been associated with increased prolactin, which can suppress ovulation.
• Cough medicines and decongestants. These can dry up fertile cervical mucus just as they do any other mucus. Be wary of pseudoephedrine and phenylephrine. (In some cases, thinning the cervical mucus benefits fertility.)
• Diuretics. These can cause dehydration, leading to poor cervical mucus or low semen volume.
• Painkillers. These can inhibit prostaglandin release and delay ovulation, decrease libido, and cause ejaculatory dysfunction.
• Sleeping pills. These can decrease libido and cause ED in men, and they can decrease libido and arousal in women. It is important to note, however, that insomnia can cause low FSH, and therefore ovulation problems. So for some women, sleeping aids may be necessary; be sure to consult your doctor.
• Steroids. At high doses, steroids can affect the pituitary gland and interfere with testosterone, FSH, and LH production. Anabolic steroids and testosterone can lower sperm count.
• Drugs for peptic ulcer. Cimetidine can lower sperm count in men and cause increased prolactin in men and women. Increased prolactin stops ovulation and impairs male fertility as well (see page 220).
• Drugs for ulcerative colitis. Sulfasalazine can lower sperm count.
• Drugs for epilepsy. Carbamazepine and valproate can lower sperm count. Dilantin decreases FSH. These drugs can decrease testosterone in men by suppressing LH, and they can suppress LH and estrogen in women.
• Chemotherapy drugs. These can lower sperm count. Talk to your doctor about any alkylating agents you may be taking, including cyclophosphamide, nitrogen mustard, and methotrexate.
• Drugs for urinary function. Nitrofurantoin (Macrodantin) can lower sperm count.
• Antifungal medications. These can lower sperm count. Ketoconazole can inhibit the production of hormones.
• Propecia. This can affect male reproductive hormones enough to weaken sperm production and function, especially in men with sperm counts that are low or borderline to begin with.
• Migraine medications. Ergots can restrict blood flow to the uterus, which can interfere with implantation, and are not safe when you want to get pregnant. While there has been no study of triptans in humans, research in other animals suggests that they carry a moderate increased risk of miscarriage.
• Clomiphene (Clomid). Ironically, this fertility drug acts as an antiestrogen and thus can reduce fertile cervical mucus.
DON’T USE RECREATIONAL DRUGS
In
case there’s anyone out there who can’t answer this for themselves,
recreational drugs must not be used during pregnancy or while trying to get
pregnant. They pose all the problems of pharmaceutical drugs and then some.
Authoritative
studies have long established, for example, that marijuana disrupts the
reproductive hormones. In women, marijuana use decreases FSH and LH and
increases prolactin, thus interfering with the menstrual cycle and ovulation.
In men, it decreases FSH, LH, and testosterone and increases prolactin,
impairing sperm creation, function, and motility. Furthermore, marijuana
affects the placenta and could prevent implantation or proper nourishment of an
embryo or fetus.
Fortunately,
all these effects disappear once there’s no more exposure to marijuana.
However, it is important to note that long-term exposure during
adolescence—just as hormonal patterns are shifting to their permanent adult
form—can be a factor in lasting fertility problems.
Case Study: Meri and DanMeri and Dan had been trying to get pregnant for four years. They had seen a series of good doctors, under whose care Meri had taken some minor fertility drugs and had insemination, but still no dice. It turned out that one key question had been overlooked, and I (Sami) asked it in my basic evaluation on their first visit: do you take a bath or a shower? As it happens, their apartment did not have a shower, and Dan, age 52, enjoyed a nice hot bath every day. I asked him to stick a thermometer in the tub the next time he drew a bath and call me to give me the reading. He phoned the next day: 103°F. At that temperature, he was, in effect, cooking his testicles. From then on, he kept his bath at 98°F, and Meri was pregnant after three months with no further intervention.
You
should also steer clear of electric blankets, which have been linked to
increased risk of miscarriage and male infertility, and heated car seats.
Women
should avoid flying. Long flights early in pregnancy have been shown to
increase the risk of miscarriage. You should not put your entire life on hold
while trying to conceive, but if you can, avoid airplanes for a few months.
Avoid
scented tampons and vaginal douches. Both interfere with the production of
fertile cervical mucus.
Men
need to avoid bike shorts and any other tight pants or undergarments (such as
jockstraps) that pull the testicles in close to the body. Your testicles are
designed to hang away from the body, so that they can maintain a temperature
just a little below your core body temperature to protect the process of sperm
production and storage. Excess heat will kill or damage sperm.
Men
also should avoid placing their laptops on their laps. The heat generated is
enough to disrupt sperm production and fertility. A study of young men sitting
with their legs together in order to balance a laptop showed that the
temperature around the testicles rose 2.1°C before they even turned the
computer on—at which point the temperature increased a total of 2.8°C. It was a
small study, but given what we already know about the negative effects of heat
on sperm count, it’s enough to give us pause. Our advice is to keep your laptop
away from your sperm-making equipment.
Men
should moderate the amount of time they spend on their cell phones as well.
Research presented at an ASRM conference in 2006 found that men who used their
cell phones for four or more hours a day had lower sperm counts and lower sperm
quality than men who weren’t so devoted to their phones. More research is needed
to confirm and explain the risk, but in the meantime, why take a chance? Hang
up your cell phone once in a while or use a landline.
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