Fertility: Can a man or woman with epilepsy have a baby?

This is an article from the Safe Pregnancy in Epilepsy patient guide.

Epilepsy does not decrease fertility. But Epilepsy medications can affect fertility.

Epilepsy medications can affect the reproductive system in women. Some medications like valproate can cause PCOD.  Epilepsy medications can cause temporary problems in getting pregnant.

Some epilepsy medications can decrease sperm counts. However, epilepsy medications usually do not decrease fertility of males.

Can a woman with Epilepsy have a baby?

Yes!

Certainly and definetely!

A woman with Epilepsy can get pregnant. A woman with Epilepsy can have a baby. Many women with epilepsy have babies every year.

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Many women with epilepsy have succesful pregnancies.

So no, neither epilepsy nor epilepsy medications decrease fertility in women drastically!

You need to be well informed about pregnancy in epilepsy. Also, there are some extra things to take care of.

These articles cover almost everything you need to know about pregnancy in Epilepsy.

Does Epilepsy affect the reproductive system?

No.

There is some controversy about this topic. But, recent research shows that Epilepsy does not affect fertility.

For example:
A recent US study looked at women who were trying to get pregnant. They studied both women with epilepsy, and women without epilepsy.

Most women became pregnant in less than 1 year. Women with epilepsy were equally likely to become pregnant.

So, what is the controversy?

Older research shows that Epilepsy patients may have trouble getting pregnant. There is a simple reason for the difference between newer and older studies.

Patients in earlier studies were on older medications like Phenobarbital. Older epilepsy medications can decrease fertility (see below).

Medications
In some patients, seizure medications / epilepsy medications can decrease fertility.

In summary, Epilepsy itself does not affect fertility. But in some cases, older epilepsy medications decrease fertility. Read more below.

Do epilepsy medications affect fertility in women?

Yes. Some medications can.

Please note that these epilepsy medications decrease fertility. They do not abolish it. Many women get pregnant while taking these medications.

Epilepsy medications decrease fertility in women in 2 different ways:

(1) Valproate:

Valproate is one of the older seizure medications. It can disrupt a female’s reproductive cycle. Valproate may cause a condition called Polycystic Ovarian Disease (PCOD).

PCOD causes irregular cycles. PCOD can prevent the female’s eggs from developing normally. As a result, patients with PCOD find it more difficult to become pregnant.

ovary, utero, uterus
PCOD is a common condition in which there are too many cysts in the ovaries.

(2) “Enzyme Inducing seizure medications”:

The liver gradually inactivates hormones floating in the blood. This gives the hormones some time to act on various body parts.

Some seizure medications are called “Enzyme Inducers“. They can cause your liver to go into overdrive. It starts inactivating hormones rapidly! The hormones include estrogen & progesterone. These sexual hormones are important for becoming pregnant.

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The liver neutralizes many chemicals, including hormones.

These “Enzyme Inducing” medications include:
– Phenobarbital
– Phenytoin
– Carbamazepine
– Oxcarbazepine

Phenobarbital really pushes the liver into overdrive! This decimates hormones. Thus, phenobarbital may produce temporary infertility.

The other medications push the liver less hard. But according to some studies, in some cases these epilepsy medications decrease fertility. In my own practice, I find this to be uncommon.

These medications may also disturb child growth during pregnancy. This problem is called teratogenicity. It is described in another article (see below).

Can a man with Epilepsy have a baby?

Yes!

Certainly and defintely and quite easily!

A man with Epilepsy can have a baby. Many men with Epilepsy have babies every year. Just like women, there are a few extra things to keep track of.

Does epilepsy or epilepsy medications affect fertility in men?

As explained below, epilepsy medications can decrease sperm count.

But because men produce so much sperm, usually epilepsy medications do not affect fertility in males.

There are very few described cases of epilespy medications causing infertility in males. These cases are temporary. After changing medications, sexual function, sperm count and sperm function all improve.

Does Epilepsy affect sperm count?

Epilepsy may decrease sperm production. But this usually does not affect chances of pregnancy.

Usually, men produce a lot of sperm. Every time a male ejaculates, he releases about 40 million or more sperm!

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Sperms under the microscope

Epilepsy may produce mild hormonal changes in men, like it does in women. This may reduce sperm production and may cause slightly higher abnormal sperms.

But due to the huge number of sperm produced, the net effect is usually insignificant.

Do epilepsy medications affect sperm count?

Yes.

This effect is more significant.

Both kinds of medications described above can have this effect.

(1) Valproate:

It is unclear how valproate reduces male fertility. It may cause hormonal changes. It may also decrease energy production in the testes (mitochondrial dysfunction).

Males treated with Valproate produce fewer sperm. They can get a low sperm count. They also produce higher numbers of abnormal sperm.

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Some seizure medications can reduce sperm production.

Higher doses of Valproate are more likely to produce male infertility. The problem is less marked at lower doses.

(2) “Enzyme inducing seizure medications”

As listed before, these medications include:
– Phenobarbital
– Phenytoin
– Carbamazepine
– Oxcarbazepine

As explained before, these medications put the liver into overdrive. In males, this causes the liver to decrease testosterone in the blood. This can lead to reduced and less speedy sperms.

This effect is less dramatic than the effect of valproate. In my practice, decreased male fertility due to these medications is uncommon.

Newer epilepsy medications are less likely to affect male fertility.

For example:
Levetiracetam is a newer seizure medication. It does not affect sex hormone levels and decreases sperm count only by 10-20%.

So the chance that levetiracetam and newer epilepsy medications decrease fertility in males is very small.

Can epilepsy medications cause impotence?

Yes.

Some epilepsy medications may decrease sexual hormones. This may decrease your sexual desire (libido).

This is one obvious way in which epilepsy medications decrease fertility. Decreased sex certainly decreases the chances of you becoming pregnant.

Sexual function is commonly affected in males. Males with epilepsy can have trouble maintaining erections. They may have premature ejaculation.

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Impotence & decreased libido are treatable.

These problems are treatable!

  1. You can be shifted to alternative (newer) seizure medications. Most new epilepsy medications do not decrease fertility.
  2. However, this decision needs to be careful. You can lose control of your epilepsy with a different medication.
  3. Medications such as sildenafil (Viagra) can help cure impotence.
  4. Depression is common in Epilepsy. Depression is very treatable. Sexual dysfunction caused by depression goes away, after depression is treated.

Summary

  1. Epilepsy does not drastically reduce chances of pregnancy. In some patients, epilespy medications affect fertility.
  2. Valproate may cause PCOD. PCOD makes decrease fertility.
  3. Phenobarbital may cause problems getting pregnant. It does this by over-driving the liver, which decreases sexual hormones.
  4. Phenytoin, Carbamazepine & Oxcarbazepine can also affect fertility. However, this is less common.
  5. Epilepsy, seizure medications & depression can decrease sexual desire (libido). They may cause impotence & premature ejaculation.
  6. Talk to your doctor if you have difficulty getting pregnant. Options include changing to newer medications or taking other treatments.
  7. Be sure to read the “Safe Pregnancy in Epilepsy Checklist”.

 

Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

Call 022-4897-1800

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