Can Medications Affect Male Fertility?

Male fertility and questions regarding factors that can affect male fertility have started to become popular as awareness about male infertility has been raised. There are several questions about male fertility and what can affect it, and one popular question among men and women is if any medications can have an effect on male fertility.

 

What is Male Fertility?

Male fertility is defined as a complex process where spermatozoa are produced every day via an intricate process known as spermatogenesis. This results in the production of sperm and the amount of sperm per millilitre or ejaculation will determine the fertility of a man. It can be considered as a man’s ability to fertilise a woman’s ovum resulting in conception. 

 

How the Male Reproductive System Functions

Two important biological products are synthesised via the testes that form part of a male’s reproductive system, testosterone and sperm. Testosterone is responsible for various physiological functions while sperm is needed for fertility. The synthesis of these products is regulated via the endocrine system cascade that originates in the hypothalamus, leading to the pituitary gland and then to the testis.

Balanced levels of testosterone and Follicle-Stimulating Hormone (FSH) are necessary for testicular development and also play a role in optimal sperm production. However, if there are any interferences within the cascade, it can affect the production of testosterone and have an impact on fertility.

 

Medications That Can Affect Male Fertility

Certain medications can affect the male reproductive system negatively resulting in low fertility or infertility.

 

Selective Serotonin Reuptake Inhibitors (SSRIs)

Medications known as  Selective Serotonin Reuptake Inhibitors (SSRIs), such as Citalopram and Paroxetine, are frequently used as the first-line treatment for depression. Although these medications do not pose a risk to sperm parameters, they do affect erectile function and can cause delayed ejaculation resulting in the inability to conceive.

 

Opioids

Pain medications such as opioids that are used on a long-term basis at a high dose can lead to sexual dysfunction or infertility. Thus it is important to discuss with a healthcare provider to provide close monitoring of a male’s fertility when they have to be on a high dose of opioids for a long period of time, especially when the male and their partner still want to conceive.

 

Acne Agents

Topical agents commonly used for warts, such as podophyllin, and for acne, such as benzoyl peroxide, have minimal systemic absorption via the transdermal route and are generally safe to use in males in their conceiving years. Spironolactone is an agent that can be used for moderate acne due to its anti-androgenic effects and it can affect male fertility by causing a decrease in testosterone levels that can lead to impotence.

 

Anti-bacterial Agents

Certain oral anti-bacterial agents such as metronidazole can cause infertility when used for a period of longer than six weeks at the maximum dose. Studies have shown that fertility has been restored after ceasing metronidazole for 8 weeks. Long-term use of co-trimoxazole has also been associated with a decrease in sperm concentration.

 

Hair Growth Agents and Anabolic Steroids

Agents such as Finasteride that are commonly used for androgenic alopecia can affect male fertility in various manners including lower libido, ejaculatory disorders and poor seminal quality. The inappropriate use of anabolic steroids causes a cessation in the biological production of testosterone and can cause infertility in men.

 

Risks vs. Benefits

It is recommended that patients consult their healthcare professional if they are struggling to conceive and are currently taking any medication that can affect their fertility. It is important to note that it is not advised to just stop your treatment before consulting your General Practitioner.

 

When to Test Your Fertility

If partners under the age of 35 have been unable to conceive after regular intercourse without any form of contraception for longer than 12 months, it is recommended to consult their GP and if necessary test their fertility via a blood test and or a semen monster.

 

Sperm Preservation

As some men have to undergo chemotherapy or start on a course of medication such as methotrexate which can have teratogenic effects and influence a man’s fertility, the option of preserving sperm is available. Sperm can be preserved to be donated or used at a later stage for conception. Sperm can be banked at a fertility clinic. It is recommended to consult your healthcare provider and talk about possible considerations regarding sperm preservation.