How Medications Affect Sperm Count

Certain medicines can lower sperm count or quality, affecting the chances of creating a pregnancy. Here's what both sperm-and egg-havers need to know when they're trying to conceive.

Couple Talking With Fertility Doctor
Photo: Alexander Raths/Shutterstock

You likely already know how important overall health is for fertility and pregnancy. However, many people overlook the possibility of male infertility and how much sperm quality affects the chances of conceiving. In general, the healthier a person, "the healthier [the] sperm will be,” says Joshua M. Hurwitz, M.D., a reproductive endocrinologist and partner at Reproductive Medicine Associates of Connecticut. And while you probably already know that a number of things that can affect sperm and fertility, such as being overweight or too thin, smoking cigarettes, excessive drinking, and use of recreational drugs, you may not be aware that some medications can also interfere with sperm fertility.

How medicines affect male fertility

Most of the medications that affect sperm will decrease production, causing a low sperm count, but some others can affect the way the sperm functions, Dr. Hurwitz says. Low sperm count means your partner will have fewer sperm available to fertilize an egg, and if the sperm’s motility (its ability to move) is reduced, the sperm will have a difficult time reaching the egg.

How long a medication affects a man’s sperm varies depending on the medicine. A good rule of thumb is a man shouldn’t expect any changes to occur until at least two to three months after he discontinues the medication. That’s because it takes sperm about that long to form and fully mature. So what he did in the past 90 days—for instance, using recreational drugs—will affect his sperm (or the baby he makes) today. And what he does today will show up in his sperm two to three months from now.

With some medications, it can take much longer for sperm counts to increase. Testosterone supplements, for example, can have a lingering effect, taking many months or even years before sperm production resumes. In some cases, it doesn’t return at all.

Over-the-counter medications

Fortunately, if taken in the proper dose and used as intended, most common OTC medications shouldn’t reduce sperm count, says Mark Surrey, M.D., co-founder and medical director of the Southern California Reproductive Center. However, since there are many different OTC medications and remedies that are untested, it’s best to play it safe. If you’re trying to become pregnant, discuss any OTC meds with your guy’s doctor first, and be especially cautious with the following:

  • NSAIDs (non-steroidal anti-inflammatory drugs). A recent study found that men who took 1,200 mg (600 mg twice a day) of ibuprofen per day developed a hormonal condition that is linked to reduced fertility (and usually occurs only in older men). It’s not clear whether men taking lower doses of ibuprofen are at the same risk, or whether the effects are reversible if the drug is used for long periods of time (they are reversible when the medication is taken short-term). If your guy uses ibuprofen or other painkillers frequently, he should discuss his fertility with his doctor.
  • Natural or herbal remedies Just because something has a “natural” or “herbal” label, doesn’t guarantee it’s safe (or even effective). The issue with natural or herbal remedies is they generally don’t undergo the same scientific testing and aren’t as strictly regulated as medications, says Dr. Surrey. So it’s better for guys to stay away from them if the couple is trying to conceive.

Another reason to avoid so-called natural and herbal remedies: the possibility of testosterone. Any supplement that has the term “male enhancement,” “andro booster,” “T-booster” or similar has testosterone or analogs of testosterone, which will decrease sperm production, explains Dr. Hurwitz.

Prescription medications

If your partner is taking any of the following medicines, discuss it with his or your health care provider to determine what impact it may have on your attempts to become pregnant.

  • Steroids/testosterone therapy Testosterone puts sperm production at a complete standstill. “Testosterone supplements of any form will cause sperm count to drop to zero—whether there’s a little of it in a vitamin a man takes, he uses illegal anabolic steroids at the gym, or he gets a prescription testosterone replacement from his doctor,” says Dr. Hurwitz. The supplements decrease the body’s ability to make its own testosterone, therefore making it unable to produce sperm. As mentioned earlier, it can take months or years before normal sperm production resumes after use of testosterone (if it recovers at all), so if there are any plans of pregnancy in the future, it’s best for men to steer clear of anabolic steroids and testosterone supplements.
  • Chemotherapy drugs Chemotherapy medication is another drug that wipes out sperm count. “Chemotherapy works by killing rapidly dividing cells,” says Shona Murray, M.D., an ob-gyn and director of Advanced Reproductive Medicine at the University of Colorado Denver. “It primarily targets the cancer cells; however, sperm cells are also dividing cells and so will too be targeted by the chemotherapy,” she explains. It’s common for men to have no sperm in their ejaculate after chemotherapy. Natural fertility may return in one to five years after discontinuation of the drugs; however, it’s not clear what damage there is to the sperm DNA, so it’s recommended that a man wait at least two years after chemotherapy before attempting pregnancy, says Dr. Murray.
  • Blood pressure medications In addition to possibly causing decreased libido and erectile dysfunction, blood pressure medications, namely the calcium channel blockers, can interfere with the ability of sperm to fertilize the egg, says Dr. Murray. Some blood pressure meds have also been associated with decreased semen volume, sperm concentration, and motility, she adds.
  • Opioids Not only is it possible for these pain medications to cause erection and ejaculation problems, they can decrease testosterone levels and sperm production, Dr. Hurwitz says.
  • Antidepressants It’s well known that many antidepressants, especially selective serotonin re-uptake inhibitors (SSRIs), can cause a person’s libido to drop. Additionally, SSRIs may have a negative effect on sperm production, Dr. Murray says.
  • Antibiotics If your guy has to take a round of antibiotics, it may affect his swimmers. Ketoconazole, an antifungal antibiotic, interferes with testosterone and sperm production, and other antibiotics may have a minor effect on sperm function, Dr. Murray says. However, the reason he’s taking the antibiotics in the first place may be the bigger issue. “Any underlying illness that causes a fever (and thereby overheats the testicles) can adversely affect sperm count for up to two months,” Dr. Murray says.
  • Biologics These drugs are usually used in the treatment of autoimmune disorders, like lupus and ulcerative colitis. Some can reduce sperm count, and Dr. Hurwitz says they can also cause DNA damage to the sperm. “Damaged DNA can lead to birth defects or miscarriages, so any man using these drugs should consult with their urologist or fertility specialist before trying to get pregnant,” he warns. It takes about six months for sperm to return to normal after stopping biologics.

Fertility-friendly alternatives

Just because your guy uses one (or more) of these meds, it doesn’t mean the two of you can’t become parents. It’s a good idea for him to have a sit-down with his doctor and discuss every medication he takes and how it might affect your attempt to become pregnant. In most cases, if a drug does affect sperm quantity or quality, the man can switch to another medication that has less of an impact on his fertility, says Dr. Hurwitz.

Even better, lifestyle modifications may improve the underlying condition and decrease the need for some medications, Dr. Murray says. For instance, losing weight, being physically active, limiting salt intake and making other changes may help get your guy’s blood pressure under control so that he no longer needs the medication. Of course, your partner should never stop taking a required medication without his doctor’s approval.

In addition, he may want to talk to his doctor about whether medication-free alternatives might work for him. Acupuncture for pain and cognitive behavior therapy for depression are a couple that are worth looking into, for example.

Even if your partner will be taking chemotherapy drugs, it doesn’t automatically mean your conception dreams are over. Doctors usually recommend men bank or freeze sperm beforehand, if possible.

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