Medications that can impair sperm quality and fertility

October 17, 2011Carole 45 Comments »

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, Carole. All rights reserved.

45 Responses to this entry

  • Carole Says:

    A related blog post about diagnosing anabolic steroid abuse and it’s negative impact on male health, including infertility, http://www.kevinmd.com/blog/2011/10/mksap-25yearold-man-evaluated-infertility.html

  • Medications that affect sperm quality? Says:

    […] you very much! Dear Purple Dream, I blogged on the effect of some medications on sperm quality Medications that can impair sperm quality and fertility | Fertility Lab Insider but I am not sure the medications you mention were in the article I reviewed. The best approach […]

  • Chris Says:

    Is it known if having an flu vaccination has an impact on sperm production or quality? This is an induced immune response, but as the active component of the virus is removed, does this have any negative outcomes?

  • Carole Says:

    Dear Chris,
    I am unaware of any effect of flu vaccine on sperm production or quality. Best Wishes, Carole

  • prakash Says:

    hai, is there any effect of antipyretics on sperm quality and fertlization? if so how?

    thank u

  • Carole Says:

    Hi Prakesh,

    In this article http://onlinelibrary.wiley.com/doi/10.1002/j.1939-4640.2003.tb02719.x/full, I found this Therefore, one way of optimizing sperm quality would be to maintain scrotal temperature at physiological levels by avoiding occupational exposure to heat, treating episodes of fever with antipyretics, or performing varicocelectomy in cases of varicocele, eg, grades II or III, especially in adolescents in whom the presence of a varicocele could significantly compromise their long-term testicular function (Romeo et al, 2003). Thanks for your question. Carole

  • aija Says:

    My husband is using some antibiotics because of his tooth infection..Is it ok if we are trying to get pregnant at this time. Is it affect sperm quality?Thanks

  • Carole Says:

    Hi Aija-
    It is possible, depending on the the type of antibiotic, duration of use and dose. Please ask your pharmacist and your fertility doctor to be sure. From the post, I noted a few types that COULD be problematic- but again, you’ll need to ask your doctor and’or pharmacist. : 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. – See more at: http://fertilitylabinsider.com/2011/10/medications-that-can-impair-sperm-quality-and-fertility/#sthash.QFkUgJWq.dpuf

  • Stephanie Says:

    My husband’s doctor recently prescribed Allopurinol for gout. There are very vague references on the Internet that it *may* impair fertility. Can you cite any specific studies or show any links that offer more solid proof of that? I am not finding anything concrete. Thank you!

  • Carole Says:

    Hi Stephanie,

    A quick PubMed search for “Allopurinol sperm quality” brought up no studies in human, and only two studies in dog. In this case, they thought the alloprinol treated dogs had improved sperm parameters compared to untreated dogs, but this may have been because the allopurinol treated an underlying infection which was causing the sperm quality issues. http://www.ncbi.nlm.nih.gov/pubmed/19345025 and http://www.ncbi.nlm.nih.gov/pubmed/22690941

    Another animal study in which they exposed embryos to allopurinol also did not find any harmful effects and may have been beneficial for bovine embryo development . http://www.ncbi.nlm.nih.gov/pubmed/?term=Allopurinol+ivf

    A single rat study http://www.ncbi.nlm.nih.gov/pubmed/11818514 showed that it’s use was helpful for sperm quality because of its anti-oxidant effect; decreasing apotosis (cell death) in germ cells exposed to a cryptorchid state. Cryptorchid refers to the situation in which the testis is located in the abdomen where it shouldn’t be- because it failed to descend into the scrotum. Rat testies were surgically pulled high into the abdomen to mimic the condition , resulting in exposure of the testis to high temperatures that are bad for sperm quality, and apparently increased cell death in the testis. Allopurinol helped reduce the cell death.

    The prescription information for allopurinol does not list fertility side effects http://www.webmd.com/drugs/drug-8610-Allopurinol+Oral.aspx?drugid=8610&drugname=Allopurinol+Oral

    I was unable to find any study data suggesting it will hurt sperm quality. On the other hand- men who have no medical need for this should not take it to benefit fertility– there is no data to support that use either. The animal studies that showed beneficial effects all showed these effects as a side effect of treating an underlying condition.

    So bottom line, based on this, I see no reason not to follow your physician’s advice. Good Luck!!

  • DH on blood pressure meds and TTC Says:

    […] […]

  • Russ Says:

    I have been taking the drugs: Hydrocodone-APAR 5-325m and Merhylprednisolone 4 mg, and Prednizone 15 mg for about 3 weeks; and Doxazosin 8 mg for several years; and Tramadol 50 mg occasionally like once a month for several years but recently daily for one month. Will these drugs harm sperm, and if so, how many months must pass for sperm to return to normal?

  • Carole Says:

    Dear Russ,
    I do not have the expertise to answer your question. Your pharmacist or physician would be much better resources. It takes approximately 75 days for your body to make a mature sperm so drugs taken anytime over a 75 days previous could negatively impact – or help- these sperm that are in “production mode”. Likewise, if you stop taking a harmful drug, you should let at least 75-90 days pass so that you have cleared these possibly affected sperm from your system. Good Luck!! Carole

  • kevin Says:

    can tetnis shots imunization shots kill sperm calls also i have trouble going longer than 5 minutes durring sex plus i dont ejaculate much sperm as i used to what helps produce more what natural products may help my sex drive etc

  • kevin Says:

    sperm cells i meant

  • Carole Says:

    Kevin,
    I am not qualified to answer your questions about sexual function. These questions would be better answered by a urologist specializing in male problems.Best Wishes.

  • Matt Says:

    Hi Carol, are you please able to advise how long it would take for finasteride to be out of your system and sperm? With many thanks for this

  • Carole Says:

    Hi Matt,
    Check out this article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205531/ Based on this, I think it must move out of the system readily but you would have to wait for 80 days for the next batch of sperm to be mature. So, if there is an effect on count, you might see a gradual increase over this time. Good Luck! c.

  • meagan Says:

    My spouse has been on apo-amoxi clav 875/125 mg since June of this year to treat a serious infection.
    If I were to get pregnant could there be a problem with the development of the baby due to him being on that medication?

  • Carole Says:

    Dear Meagan,
    Here’s a fact sheet on the medicine to discuss with your doctor: https://www.medicines.org.uk/emc/medicine/21728 It is probably not a negative factor for embryo development based on this excerpt from the article in the link :
    Pregnancy
    Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/foetal development, parturition or postnatal development (see section 5.3). Limited data on the use of amoxicillin/clavulanic acid during pregnancy in humans do not indicate an increased risk of congenital malformations. In a single study in women with preterm, premature rupture of the foetal membrane it was reported that prophylactic treatment with amoxicillin/clavulanic acid may be associated with an increased risk of necrotising enterocolitis in neonates. Use should be avoided during pregnancy, unless considered essential by the physician.

    Lactation
    Both substances are excreted into breast milk (nothing is known of the effects of clavulanic acid on the breast-fed infant). Consequently, diarrhoea and fungus infection of the mucous membranes are possible in the breast-fed infant, so that breast-feeding might have to be discontinued. Amoxicillin/clavulanic acid should only be used during breast-feeding after benefit/risk assessment by the physician in charge.

    With any medical question/concerns, it is always best to speak with your physician. Good Luck! Carole

  • Justin Says:

    Can Epilepsy or any medications for the treatment affect getting a couple pregnant?

  • Carole Says:

    Hi Justin,
    The short answer is yes- for women. See these links: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205530/ From this article: Antiepileptic drugs used during the management of women with epilepsy may also produce reproductive and endocrinal disturbances.[2] They may interfere with the hypothalamic pituitary axis and produce amenorrhea, oligomenorrhea, and prolonged and irregular cycles.[2] Higher incidence of PCOD is also reported in women taking valproate sodium, and a retrospective series reported PCOD in 43% of women taking valproate for epilepsy.[2,6] A recent study done in India, concluded that infertility was least common (7.1%) in those epileptic women who were not on antiepileptic drug (AED) exposure compared to those who were with AED exposure (31.8% with one AED exposure, 40.7% with two AED exposures, and 60.3% with three or more AED exposures).[1] Epileptic women who were taking phenobarbital had a significantly higher risk of infertility, but no such trend was observed with other AED drugs.[1] Infertility was also common in epileptic women who were older in age, with lower education.[1]

    There is also evidence that men with epilepsy are at greater risk of infertility- both from the disease itself as well as the medications used to treat epilepsy. More here: http://www.efepa.org/living-with-epilepsy/men-with-epilepsy/ Please discuss these concerns with your doctor because there may be alternative medications. Good Luck!! Carole

  • Essam Says:

    Hello
    I have chronic sinusitis & I’m on daily use of clarinase (pseudoephedrin -loratidine)
    Does this affect my sperm count or function??

  • Carole Says:

    Essam,
    I would ask your local pharmacist. He/she will give you the best information and advice. Good Luck! Carole

  • Essam Says:

    Hi Carole
    I asked him & he informed me to ask an infertility specialist so I’m asking you for help?
    Thanks in advance

  • Carole Says:

    Hi Essam,
    I am not a physician so I can not give you medical advice about drugs. I did find one article on psedoephedrine effects http://www.ncbi.nlm.nih.gov/pubmed/22644002 that discusses a study in which they gave pseudoephedrine to rats and the rats developed sperm quality problem. I am not aware of any human studies on this topic. You should try to find a urologist who specializes in male infertility- that would be the ideal reproductive specialist to discuss your concerns about medications and sperm quality. Good Luck! Carole

  • Fertility Drugs Over 40 | Secret Pregnancy Blog Says:

    […] Medications that can impair sperm quality and fertility … – I have focused on prescription medications for this post, but you should be aware that other drugs associated with infertility include: alcohol, tobacco, excessive …… […]

  • Justin Says:

    Does Suboxene cause male infertility problems? Vyyvanse?

  • Deb Says:

    My daughter has just lost her second pregnancy, they are calling it blighted ovum, sonogram, last week showed no blood flow to the sac. She has her first pregnancy 2 years ago all normal, healthy pregancy an deliver.
    Her husband taking meds for blood pressure, diabetes and gout. I read that it is because of sperm or egg quality?
    Thanks

  • Carole Says:

    Hi Deb,
    I am so sorry that your daughter suffered this difficult loss. Here are some links with more information about blighted ovum:
    http://americanpregnancy.org/pregnancy-complications/blighted-ovum/
    http://www.webmd.com/baby/guide/blighted-ovum
    The only good news is that just because this happened once, it does not mean that it will happen again. It is usually just an unfortunate genetic accident and there is much reason to hope that your daughter may have a much happier outcome in a second pregnancy. I wish your daughter and your family much good luck in the future! Carole

  • Julia Says:

    Dear Carole,

    My husband was on amoxicillin 825/125 *2 a day for 5 days and after on ofloxacin 200 for 5 days. If I were to get pregnant could it effect baby development?
    Thanks!

  • Carole Says:

    Hi Julia,
    If you became pregnant today, the sperm that fertilized your egg would have been made no less than about 80 days ago (because that how long it takes to make a sperm and get it to a mature stage) so what he was exposed to during the last 10 day so that time is probably not a major factor; however, this is a medical question that would be more appropriate for your doctor to answer. Wishing you all the best! Carole

  • Cindy Says:

    Hello, My husband has been diagnosed with Congestive Heart Failure and is on ALOT of medication. He was admitted to hospital in mid Nov 2015 and released Dec 5th. We got pregnant that month and I miscarried at 6 weeks. We have been trying to get pregnant since the miscarried (my doctor said it was ok after 1 period). I also asked her if the medication could be a problem, she didnt seem to think so, however, didnt appear confident. My husband is on the following meds: lisinopril, diltiazem, Metoprolol, Jantoven (coumadin), and furosemide. He just started on 4/4 spironolactone, and takes colchicine when he gets a gout flare up. Is it bad if we are trying to conceive while taking all these medication? Thank you!

  • Muhammad Says:

    I am kidney Transplant patient and taking ciclosporin and beta-blockers. Do it effect on my sexual life? How can I improve my sexual life after marriage? I am still single and my age is 31 years.

  • Carole Says:

    HI Cindy,
    I would follow up with a male infertility specialist (board certified urologist specializing in male infertility). This specialist would have the expertise to advise you about whether these medications are interfering with his sperm quality and fertility. Colchichine is on this list of meds that could be a problem on the CLeveland CLinic site: http://my.clevelandclinic.org/health/diseases_conditions/hic-advanced-semen-tests-for-fertility/hic-drugs-and-male-fertility
    Wishing you both much good luck!! Carole

  • Carole Says:

    Hi Muhammad,
    I am not an expert on sexual dysfunction. I would suggest that you make an appointment with a board certified urologist specializing in male infertility who would also be able to address your concerns about sexual function. Good Luck!! Carole

  • Lauren Says:

    HI Carole,

    My husband just started taking Griseofulvin two days ago, and unfortunately I let him take it because I thought I had already ovulated. It turns out I’m ovulating now and it would be our last chance to conceive until the 6 months pass (which is the time recommended to let Griseofulvin exit the body & sperm). My question is- would 2 days of the drug affect the mature sperm that have already been made? Or would they only affect the younger sperm undergoing transformation? Can the drug get to the sperm that fast? Thanks in advance.

  • Carole Says:

    Hi Lauren,
    This is really a better question for your doctor. This non-profit federal website has some information https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682295.html#side-effects It says let your doctor know if you are taking it and are trying to get pregnant, but several animal and human studies are reassuring, when the drug is taken at therapeutic (as opposed to excessive) doses. Also, it takes about 80 days to make a sperm so sperm that are available for ejaculation now were made long ago, before any exposure to the medication. So bottom line, discuss with your doctor before your husband uses more of this, but don’t panic at this point.
    http://www.ncbi.nlm.nih.gov/pubmed/17612874
    http://www.ncbi.nlm.nih.gov/pubmed/15036526
    Good Luck!! Carole

  • jeme Says:

    I was diagnosed of low motility and morphology all other sperm analysis are normal. I had a heart operation one year ago and I have been on different medications to help my heart beat and blood pressure. Now I have been trying to get my wife pregnant for a while now but its not working.
    Losatan, amordphin I have been using them for more than one year now. Can this medications cause problems with my sperm to get my wife pregnant?

  • Carole Says:

    Hi Jeme,
    I would consult either a pharmacist on this question or a urologist specializing in male infertility who should have a better understanding of what is known regarding the fertility effects of various cardiac meds on sperm motility/other parameters. Unfortunately, many times, fertility effects are only tested in rat or mice models which may not be that informative for humans. Good Luck! Carole

  • Karmaseh Says:

    My husband is on warfarin drugs, we are trying for me to get pregnant. Is it possible?

  • Carole Says:

    Dear Karmaseh,
    I am sorry you are having trouble. I do not know of any negative effects of warfarin but it would be wise to discuss with a male fertility doctor all the medications/supplements that your husband is taking. Good Luck!! Carole

  • Mo Says:

    Hi I just took a weeks course of flucoxillin which is a penicillin antibiotic.

    I would like to try for a baby , this week is there any problems if I do?
    Thanks

  • Carole Says:

    Hi Mo,
    Please ask your physician this question.
    Carole

  • Mide Says:

    Hi,
    Please have been using tramadol for a year now, can it affect my sperm? Will continue use affect my being father a child?
    Thanks as I await your response

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