Antidepressants implicated in male factor infertility

Written by Kylie Hughes for psychiatrist practitioner Dr. Robin Stone M.D  for her medical blog.

A paper is in press that implicates antidepressant medication with male fertility issues.  The research builds on a litany of information about the effects of antidepressants on women during and after pregnancy, and begins to fill the void about how these medications affect fertility, especially in men.

In an earlier study, researchers found that selective serotonin reuptake inhibitor (SSRI) medication had negative affects on semen.  Patients on SSRIs experienced decreased sperm count, impaired motility, and abnormal sperm form.  The comforting news is that improvements were recorded within one to two months of stopping medication.

In the most recent study, the same team took 35 healthy males aged 18 to 65 and examined the effect of paroxetine (Paxil) on their semen.  Paxil was chosen because 1) it has a relatively short half-life, and 2) it’s associated with erectile dysfunction and delayed ejaculation.

The subjects’ semen remained within normal ranges for physical characteristics such as volume, motility, and concentration.  But when the researchers examined DNA fragmentation in the sperm, they found that it had increased from an average 13.8 percent before taking Paxil, to 30.3 percent after four weeks of therapy.  The percentage of patients with abnormal levels of sperm DNA fragmentation rose from 9.7 percent to 50 percent.

The researchers theorize that sperm DNA damage increases with antidepressant medication because SSRIs slow sperm transport during production.  This effect may be more pronounced with Paxil than other SSRIs because Paxil has a strong affect on delayed ejaculation.  The finding is concerning because sperm DNA damage is associated with reduced fertility.  Rates of sperm DNA fragmentation at 30 percent or higher are correlated with reduced rates of conception and embryo implantation.  It’s some consolation, however, that semen parameters, DNA fragmentation, erectile dysfunction, and ejaculation returned to normal levels within one to two months of therapy cessation.

So this begs the question: Where a man taking antidepressant medication is part of a couple struggling to conceive, should he stop taking his medicine for a few months?  My professional response is “it depends”.  Given that untreated depression can be accompanied by serious health risks, it’s not a question that a patient should answer alone.  It demands close consultation with a mental health professional who thoroughly understands the patient’s circumstances and the drugs involved.

Further reading:

Wang, B 2009 ‘Paroxetine may affect sperm quality’, Reproductive Psychiatry Resource & Information Center of the Massachusetts General Hospital Center for Women’s Mental Health.


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