How Medications Can Affect Female Fertility

There are certain medications that can affect female fertility, so here's what you need to know if you're trying to conceive.

Many things can affect female fertility, from underlying medical conditions like thyroid disorders or obesity to polycystic ovary syndrome (PCOS), structural problems, and partner fertility as well. And in some cases, medications that someone takes could also impact fertility, as some medications can affect the menstrual cycle.

"Because a woman's menstrual cycle is tightly controlled by the interaction between the brain, ovaries, and uterus, any health problem or medication that disrupts this communication could adversely affect ovulation and make it challenging for women to achieve a pregnancy," explains Alan Copperman, MD, director of reproductive endocrinology at the Icahn School of Medicine at Mount Sinai in New York City.

That being said, some medications are necessary to treat certain conditions—and left untreated, some medical conditions can also impact fertility—so it can feel overwhelming to know what's "safe" and what drugs could lead to potential infertility, even temporarily.

As with most things concerning your health, you should always talk to a doctor about any medications you are taking and what impact they could have on your fertility. In some cases, your doctor may recommend alternatives that are just as effective as prescriptions and over-the-counter (OTC) medications. Never stop taking a medication without talking to your doctor and learn more about what medications may impact your fertility.

Related: Best At-Home Fertility Tests to Help You Conceive and Track Reproductive Health

How Medication Can Affect Female Fertility

There are three main ways medication can interfere with fertility, and two of them pertain directly to people with female reproductive organs, explains Jason Griffith, MD, an OB/GYN and specialist in reproductive endocrinology at the Houston Fertility Institute:

• By impacting ovulation

• By changing endometrial or uterine receptivity to a pregnancy

• By impacting sperm production and quality

Valerie Baker, MD, chief of the division of reproductive endocrinology and infertility at the Stanford University School of Medicine, adds that often, a medication can alter the hormones that control ovulation. "A medication may affect the ability of a woman's body to ovulate (release an egg) or a man's sperm count by affecting the production of follicle-stimulating hormone (FSH) or luteinizing hormone (LH) by the pituitary gland," she says.

And stopping the medication doesn't always immediately reverse the effects either. "Most medications are out of the system within days, but some can interfere with normal egg production for months," says Dr. Copperman. For example, a doctor may advise anyone taking the chemotherapy agent methotrexate to wait three months before attempting conception. It may also take your body a month or two to get back to its optimal fertility after stopping some forms of birth control.

Related: Getting Pregnant After Birth Control: All Your Questions, Answered

The delay in the return of someone's cycle after stopping hormonal birth control does not necessarily mean something is wrong with their fertility, however. Instead, "this is most likely because the uterine lining is recovering after a long time of suppression," notes Richard Paulson, MD, president-elect of the American Society for Reproductive Medicine and an OB/GYN professor at the Keck School of Medicine of the University of Southern California. Depo-Provera (a contraceptive injection), for example, can take a particularly long time to clear the system, lingering in the body for up to 10 months after the last shot.

Related: How Long Does It Take to Get Pregnant? Well, That Depends

What Medications Can Affect Female Fertility?

Clear answers regarding fertility and medicines aren't always apparent. "There are thousands of medications out there and for many, if not most of them, the effect on fertility has not been well-studied," points out Dr. Baker. "There are also many untested over-the-counter remedies that are purported to improve fertility, but convincing scientific data is lacking," adds Dr. Griffith. Fortunately, most OTCs don't interfere with fertility, but it's always a good idea to check with your doctor first, and be cautious when it comes to the following categories:

NSAIDs (non-steroidal anti-inflammatory drugs)

Some reports have suggested that NSAIDs like Motrin or Advil could have a minor and temporary impact, says Dr. Copperman. "These can interfere with ovulation, particularly the ability of the egg to be released by the ovary," explains Dr. Griffith. However, it should be noted that even among research that has been done, the impact has only been found on a small amount of people.

Natural or herbal remedies

The concern with this group is that there's little to no data nor regulation of content. "So-called 'natural 'herbs sometimes contain substances that can act like hormones (estrogens or progestins), including animal products made from the adrenal, testes or ovaries," says Dr. Paulson. And anything that acts like hormones in your body can potentially impact your own unique hormonal processes that control menstruation and ovulation.

Prescription medications

If you are currently taking any of the following drugs, discuss their impact as it relates to your desire to become pregnant with your healthcare provider.

• Psychiatric medications. Medications like anti-depressants and some anti-psychotics can interfere with the hormonal regulation of ovulation and may also elevate associated hormone levels such as prolactin. For instance, risperidone may increase levels of the hormone prolactin and lead to a lack of ovulation. SSRIs may also impact fertility: "A recent study showed that women who were taking SSRIs (selective serotonin reuptake inhibitors) took significantly longer to conceive; these may also reduce the efficacy of infertility treatment and are associated with miscarriage and preterm birth," reports Dr. Domar. However, research is still ongoing and not conclusive on the direct impact of SSRIs and fertility and it's also worth considering that untreated depression and anxiety are also associated with infertility as well.

• Prescription NSAIDs. The risks here are similar to OTC NSAIDs but may increase if the dose of medication is higher or you are taking the medication long-term.

• Steroids. This class of medications, including anabolic steroids and corticosteroids (cortisone, prednisone) used to treat asthma and lupus, are made from testosterone and could have a serious effect on female fertility. In particular, steroids may prevent the release of hormones needed for ovulation and menstruation.

• Antiepileptic. Anti-seizure medications such as phenytoin, carbamazepine, and valproate medications may impact fertility.

• Thyroid medications. If the dose isn't well-regulated (too high or too low), prolactin levels may be affected.

• Skin products with hormones. Avoid those with estrogen or progesterone, which may alter ovulation.

• Chemotherapy, especially alkylating agents, can be toxic to the ovary, potentially resulting in permanent infertility.

Fertility-Friendly Alternatives

In some cases, prescriptions are necessary to manage a health condition. And equally as important, some health conditions require medication in order to have the best chance at conceiving. But if you know you are taking a medication that could impact fertility and you hope to conceive in the near future, talk to your doctor to find out if there are any alternatives that may be right for you.

For instance, there are medication-free interventions that can help with serious health conditions such as anxiety and depression, as well as chronic pain. "I strongly urge women who are taking an SSRI to review the pro/con list of remaining on it and to try other options, such as cognitive behavior therapy, which can be just as effective in most cases but with no side effects," says Dr. Domar. Acupuncture, a complementary treatment used to treat pain, is another effective alternative therapy example.

There is no "right" number of medications to take or not take before trying to conceive. Everyone is different and some medications may be necessary for you to be in optimum health, while others may be worth a second look.

"It's a good idea to sit down with your doctor before you get pregnant to discuss the safety of each one, and to attempt to either switch to safer ones or try non-pharmaceutical approaches," recommends Dr. Domar. For serious cases, such as chemotherapy for cancer, you can also discuss the possibility of freezing eggs prior to beginning medication.

Key Takeaway

Some medications are necessary for someone to be in optimum health before attempting to conceive, while others may have an impact on fertility. It's always a good idea to talk with your doctor about any medication or supplements you are taking regularly before you attempt to conceive.

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