Can antidepressants cause male infertility?

Researchers suggest that men taking SSRIs suffer a drop in sperm counts. Emma Baines investigates.

What is the story?

Antidepressants such as Prozac (fluoxetine) could be responsible for reduced fertility in men, according to media reports.

The papers reported that researchers in the US had found that SSRIs, which are taken by millions of people in the UK for the treatment of depression, could be damaging male fertility.

Men taking the drugs were found to suffer a ‘dramatic fall’ in their sperm count while on the treatment, the papers said. They had reduced sperm concentration and impaired sperm motility.

When they stopped taking the SSRIs, the men’s fertility problems disappeared, although they came back if they started antidepressant treatment again.

The papers concluded that by taking SSRIs men risked being unable to start a family.
 
What is the research?

The reports are based on a presentation made at the American Society for Reproductive Medicine’s 62nd Annual Meeting, held last week in New Orleans.

The conference was given details of a case report of two patients in which a link between SSRI use and infertility was seen.  The two men were referred to a clinic for fertility problems. They had severely impaired sperm concentration and motility.

Tests showed that they had no physical or endocrine problems that would account for their infertility. However, they were both taking SSRIs, with one taking sertraline (Lustral) and the other on citalopram (Cipramil).

The researchers found that while they were taking the drugs, the men had extremely small amounts of motile sperm.

However, after they had stopped taking antidepressants their sperm concentration and motility returned to healthy levels. When the men were put on alternative medication (bupropion [Zyban] and venlafaxine [Efexor]) their sperm motility dropped to nearly zero again.

The researchers are planning a pilot study of normal healthy men to test the effects of SSRIs on semen parameters. It will include 35 adult men with no known sexual dysfunction and without any mental illness who are trying to start a family.

After an initial screening semen analysis, the men will take paroxetine (Seroxat) for five weeks. Their semen will be analysed periodically while on the medication and for one month after discontinuing the drug to see if there are any changes in semen parameters associated with SSRI use.
 
What do the researchers say?
 
Lead researcher Dr Cigdem Tanrikut, from the Cornell Medical Center in New York, said that the mechanism by which SSRIs might impair sperm motility was unclear.

But she added that men taking the drugs should not worry about their future fertility as SSRIs did not appear to have any long-term negative effects on sperm production.

‘The time course of improvements to normal semen parameters was within one month of discontinuing the antidepressant,’ she said.

‘This suggests that the SSRI has an impact on sperm transport through the male reproductive tract, rather than any effect on sperm production. Alterations in sperm producing would take approximately three months to show any improvements.’
 
Dr Tanrikut added that this indicated that SSRIs were having transient and easily reversible effects on fertility.
 
Any patients taking antidepressants who were trying to start a family could be offered a semen analysis to see if their fertility had been affected, she suggested.

What do other experts say?

Dr Allan Pacey, senior lecturer in andrology at the University of Sheffield and secretary of the British Fertility Society, said not too many conclusions could be drawn from a case study of just two people.

But he said that it was certainly worth investigating further. ‘Although it is only based on two patients, because they act as their own controls in effect, it is quite a good correlation,’ he said.

‘There is clearly a rationale for trying a different drug if they fail to conceive in a reasonable length of time.
 
‘What we don’t know of course is whether all men taking the drug respond this way or whether it is just a small cohort.

 
‘I don’t think we should be adjusting clinical protocols just yet. We need to gather the evidence first.’

Informing patients

  • US researchers are planning a study to see if SSRIs cause male infertility.
  • They have reported two cases of men who were infertile while taking the drugs, but had normal fertility when they stopped taking them.
  • Patients should not stop taking SSRIs without consulting their GP first.
GPletters@haymarket.com
 
62nd Annual Meeting of the American Society for Reproductive Medicine

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