Epilepsy May Be Linked to Infertility Risk
Study Shows Women Taking Multiple Epilepsy Drugs Are at Greatest Risk for Fertility Problems
Prepregnancy Counseling for Women With Epilepsy
Kimford Meador, MD, a professor of neurology at Emory University in Atlanta, says there have been studies with similar findings in England, but other studies have not found an increased risk for infertility among women with epilepsy. Meador is also on the advisory board of the Epilepsy Foundation.
"Women of childbearing age with epilepsy should have a conversation with their doctor even before they are contemplating pregnancy as half of all pregnancies are unplanned," he says. "You want to make sure you are on the right drug or drugs and that your seizures are controlled before you get pregnant," he says.
If your epilepsy is under control before pregnancy, you are less likely to have seizures during pregnancy, Meador says. "You don't need to see a fertility specialist right off the bat," he says. "Most women with epilepsy still can get pregnant even without fertility help, and the majority of babies are normal."
Talk to Your Neurologist
"Women with epilepsy are at increased risk for infertility," says Alison M. Pack, MD, a neurologist at Columbia University, who wrote an editorial accompanying the new study. "This study suggests that one potentially modifiable factor is being on multiple drugs, and avoiding the drug phenobarbital.”
In the new study, women taking phenobarbital were at greater risk for fertility issues. This drug is no longer widely used in the U.S.
"Women with epilepsy should be counseled that they are at risk for infertility," she says. "Should they all be sent to fertility specialists right away? No."
Pack recommends talking to your epilepsy doctor if you are thinking about becoming pregnant and working with your doctor to simplify your medication regimen as much as possible. "If it is taking longer than six months to conceive, it's not unreasonable to seek an evaluation from a fertility expert -- especially if you also have other risk factors for infertility such as advancing age."
Dileep Nair, MD, a neurologist at the Epilepsy Center at Cleveland Clinic in Ohio, agrees with Pack. "This study shows that if women with epilepsy are going to get pregnant, it tends to happen in the first two years of trying," he says.
This helps further identify a high-risk group of women. Don't waste time, he says. "If you have epilepsy and want to get pregnant, go to your neurologist and discuss your medications, so he or she can counsel you on the effects of these medications on your fertility and birth defects." Some epilepsy medications have been linked to birth defects.