Medications that can impair sperm quality and fertility

One of the routine questions that patients get asked when they submit a semen sample for analysis is “Have you taken any medications in the last 60 days?” The 60 days is relevant because it takes around 60-70 days for a sperm cell to be produced and so exposures that occurred two months earlier may effect your semen quality today.

Each sperm arises from a spermatogenic stem cell which produces a group of sperm that go through a set program of cellular development to produce the final sperm cell with its distinctive shape and fertilizing ability. Since some new sperm are started on their two month journey every day, the testicle is filled with sperm at various stages of development. Normally, only mature sperm cells end up in the ejaculate in about 70 days. For those of you who are interested in learning more about the genetic and cellular transformation sperm cells undergo during their two months in the testicular production line, you will find a description of spermatogenesis (cellular division and replication) and spermiogenesis (maturation and structural remodeling  of sperm cells from round cells to a cell specialized for fertilization)  from this link.

During this long production period, the medications men take may have a negative effect on sperm quality. The University of Iowa Urology Department website has an informative page listing some of the medications that have been shown to cause problems

Anabolic steroids are testosterone and other synthetically produced variants of testosterone which are most often abused by body builders and other athletes who want to increase muscle mass and sports performance dramatically. Anabolic steroid abuse is something that most of us have heard about but you may not be aware that testosterone prescribed for you may be the culprit in a poor semen analysis result. According to my andrology list-serve discussion, more men are being given prescription testosterone supplements by their primary doctor because they are diagnosed with low testosterone levels and are complaining of erectile dysfunction, low libido and low energy. Not all primary care doctors are aware of either the effect of these testosterone supplements on sperm quantity and quality or they don’t realize that their patient is actively trying to conceive.

Urologists who specialize in infertility treatments can use other drugs instead of testosterone such as clomiphene citrate (brand name Clomid), aromatase inhibitors that block the formation of estradiol from androgens and hCG (a hormone with LH-like activity to stimulate the steroid sensitive cells in the brain and testes) to correct low levels of testosterone without damaging sperm production. The good news is that for most men when testosterone supplementation is discontinued, sperm production can recover although it will take 4-6 months so advance planning for fertility is required. Unfortunately, it is not always reversible so it is important to let your primary care doctor know that you are concerned about protecting your fertility.

Antibiotics including Gentamycin, Erythromycin,  Tetracycline and Nitrofurantoin have been implicated in reducing sperm quality and quantity by several mechanisms. Nitrofurantoin, erythromycin and gentamycin have direct toxic effects on the testicular cells, killing the cells that produce sperm or regulate the production of sperm. Nitrofurantoin also has been shown to interefere with the normal hormonal signalling between the testis and the brain ( the hypothalamic-pituitary-gonadal (HPG) axis). Tetracylcines have been shown to negatively effect the fertilizing ability of sperm. Be sure to ask your doctor about the potential effects of using any antibiotic, especially if it will be prescribed for long term use, on fertility.

Antihypertensives used to control high blood pressure can also negatively affect fertility.?Spironolactone affects the hypothalamic-pituitary-gonadal (HPG) axis). Calcium channel blockers have been shown to block fertilization by interfering with calcium sensitive receptors on sperm cells. Beta-blockers interfere with fertility by decreasing libido and negatively affecting sexual function, instead of by directly affecting sperm quality. Alpha-adrenergic blockers and thiazide diuretics can cause erectile dysfunction. When your doctor prescribes antihypertensives, ask about any known reproductive side effects.

Mark  Sigman,  MD , Associate Professor of Surgery at Brown Medical School has summarized the effects of a large number of medications on sperm quality in his paper,  Medications that impair male fertility, published in  Vol. 5, No. 2 , May 2007  of Sexuality, Reproduction and Menopause. I have copied his table summary below, but you should check out his  entire on-line article (also available as a downloadable pdf  which you can print and take with you to the doctor’s office).

Agents Proposed to Adversely Affect Male Fertility

Medication Gonadotoxic Altered HPG Axis Decreased Libido Erectile Dysfunction Fertilization Potential
Recreational/Illicit drugs
??Alcohol + + + + -
??Cigarettes + - - + -
??Marijuana + + - - -
??Opiates - + + - -
??Cocaine + - - + -
Antihypertensives
??Thiazide diuretics - - - + -
??Spironolactone - + + + -
??Beta-blockers - - + + -
??Calcium channel blockers - - - - +
??Alpha-adrenergic blockers - - - + -
Psychotherapeutic agents
??Antipsychotics - + + + -
??Tricyclic antidepressants - + + + -
??MAOIs - - - + -
??Phenothiazines - + - - -
??Lithium - - + + -
Chemotherapeutic agents
??Alkylating agents + - - - -
??Antimetabolites + - - - -
??Vinca alkaloids + - - - -
Hormones
??Anabolic steroids - + - + -
??Testosterone - + - + -
??Antiandrogens - + + - -
??Progesterone derivatives - + + + -
??Estrogens - + + + -
Antibiotics
??Nitrofurantoin + + - - -
??Erythromycin + - - - -
??Tetracyclines - - - - +
??Gentamycin + - - - -
Miscellaneous medications
??Cimetidine - + - - -
??Cyclosporine - + - - -
??Colchicine - - - - +
??Allopurinol - - - - +
??Sulfasalazine + + - - -
HPG, hypothalamic-pituitary-gonadal; MAOIs, monoamine oxidase inhibitors.
Modified from Nudell DM, et al. Urol Clin North Am. 2002;29:965-973.

I have focused on prescription medications for this post, but you should be aware that other drugs associated with infertility include: alcohol, tobacco, excessive caffeine, marijuana, heroin, and methadone.  Even vitamin supplements or other non-prescription medications have the potential to cause problems with fertility so it is really important to disclose everything you are taking or using with your doctor to be sure that you are not sabotaging your own fertility without realizing it.

© 2011, Fertility Lab Insider. All rights reserved.

©2011 Fertility Lab Insider. All Rights Reserved.

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