Epilepsy May Be Linked to Infertility Risk
Study Shows Women Taking Multiple Epilepsy Drugs Are at Greatest Risk for Fertility Problems
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.
Infertility Workup and Epilepsy
Eric Flisser, MD, a reproductive endocrinologist at Reproductive Medicine Associates in New York, says that the initial infertility workup is the same for women with epilepsy as it is for women without epilepsy. "We want to see you if you are under 35 and have been trying for a year. If you are older than 35, we recommend an evaluation after six months of trying."
"Everyone is screened in a similar fashion including semen analysis, a hysterosalpingogram or X-ray of uterus and fallopian tubes to check for blockages, and blood tests to measure hormone levels," Flisser tells WebMD.
"Just because a woman has epilepsy does not mean she doesn't also have common infertility problems," he says. "It is not clear why or if women with epilepsy have fertility problems, so we need to make sure we are not missing one of the simple things."
Certain epilepsy medications may affect fertility. "This should be discussed with your doctor before attempting to conceive," he says. In addition, some epilepsy medications also interfere with folic acid, which helps prevent neural tube defects. "You may need extra folic acid during pregnancy."