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My husband and I are both taking anti-depressants. We’ve been having difficulty getting pregnant and are going to start our first IVF cycle. Do anti-depressants impact either men’s or women’s fertility? Could taking anti-depressants decrease the likelihood that our IVF cycle will be successful?

Written by our medical expert Dr. Stephen Hudson, Director of the Victoria Fertility Centre in British Columbia, Canada.

I am going to restrict my answer to the SSRI’s (Selective Serotonin Reuptake Inhibitors) which are the most commonly prescribed anti depressants. There are many other anti depressants, however addressing all of these is beyond the scope of this reply.

The SSRI’s boost mood by altering the balance of neurotransmitters (specifically serotonin) and affecting the way brain cells send and receive messages.

Beginning with men, research suggests that the SSRI’s can affect sperm in a number of ways. Studies have shown that these medications affect sperm DNA integrity.  The integrity of sperm genetic material (the DNA) can be tested by a variety of tests that look at the sperm DNA fragmentation index (DFI). The higher the DFI the more DNA damage there is. It is found that higher DFIs are associated with lower chances of IVF success and also higher miscarriage rates. Studies on men taking SSRI’s have found significantly higher DFIs, and in some cases also lower sperm counts and sperm motility. The good news is that the DFIs appear to return to normal within 2 to 3 months after men stop taking SSRI’s.

Turning to women, surveys have found that as many as 10% of women undergoing IVF are taking anti depressants (mostly SSRI’s). It is not completely clear whether or how these drugs affect IVF success rates. Some published studies have found that IVF pregnancy rates were up to 5-10% lower in women on these medications. However, the subject is not so simple because other studies have found that women with anxiety and depression may also have lower IVF success rates, whether or not they are taking anti depressants. So it is difficult to pinpoint the precise reason for these findings.

Another very important issue is the effects that antidepressants taken during pregnancy may have on a fetus. Animal studies seem to conclusively show that fetal exposure to the SSRI’s result in subsequent abnormal postnatal neurobehaviour (brain behavior). Observational research studies suggest there may be an increased incidence of autism spectrum disorders in children born to mothers who take anti depressants during their first trimester.  There also appears to be an increased risk of certain birth defects (particularly cardiac) in babies born to women taking SSRI’s – in particular Paxil – in early pregnancy. Furthermore there appears to be a slightly increased incidence of miscarriage in women taking SSRI’s.

In summary therefore, the answer is yes, there may be a reduced chance of IVF success if you and your husband are taking anti depressants. Furthermore there may be an increased risk of autism, birth defects and miscarriage if anti depressants are taken in early pregnancy.

My advice is that you speak with your doctor. There are alternatives to anti depressant medication for the management of some forms of mood disorders. Psychotherapy, supportive counselling, yoga, relaxation and mindfulness training, diet and exercise are all alternative therapies that have been shown to help alleviate depression and anxiety. That said, it should be remembered that depression is an illness and a potentially very serious one. If you need medication, you should take it without guilt and be reassured that the risks are small. (I would recommend that Paxil be avoided.)

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