What are the infertility drugs
Medicines versus the desire to have children
Sexual dysfunction is one of the most common side effects of antidepressants and antipsychotics and often affects compliance. Among the antidepressants, bupropion and mirtazapine are sometimes rated as more favorable, especially with regard to erectile dysfunction (19). Selective serotonin reuptake inhibitors (SSRIs) are known to have a reversible impairment of sperm quality. This information has to be included in the information for healthcare professionals since 2012 (21). The delay in ejaculation is also used therapeutically for premature ejaculation, for example with the SSRI dapoxetine.
Treatment of the underlying disease is also essential for psychotropic drugs. Abrupt discontinuation of the medication is taboo. If necessary, the man must discuss the procedure with his doctor. In particular, drug-induced hyperprolactinemia should be avoided. For example, substance changes, dose reductions or even a break in therapy are possible. There are various case reports in the literature in which a man was able to father a child after changing therapy.
Antihistamines as non-prescription drugs are often classified as "rather harmless". It is not entirely clear whether they reduce male fertility. Case reports describe decreased sperm motility when taking, for example, fexofenadine and cetirizine, which improved several months after discontinuation. After several years of infertility, the man was able to successfully father children (22, 23).
On the other hand, there have been reports of an increase in fertility. Men with fertility problems and an increased number of mast cells in the sperm fluid benefited from mast cell stabilizers such as ketotifen and azelastine; the pregnancy rate increased (24, 25).
Patients often take antihistamines for months, for example for hay fever. Due to the positive case reports, discontinuation appears to be sensible on a trial basis. If the symptoms are severe, the patient could use a nasal or inhaled corticosteroid, for example.
Anti-inflammatory drugs and analgesics
The so-called weak analgesics or non-steroidal anti-inflammatory drugs (NSAIDs) are predominantly taken as self-medication, often for a long time and without a problem. However, the data on the influence of NSAIDs on male fertility are sparse and not entirely clear.
Most people believe that NSAIDs do not affect spermatogenesis (26). In contrast, a study found a reduced number and quality of sperm with chronic use of non-prescription NSAIDs, predominantly acetylsalicylic acid (27). In vitro, various NSAIDs altered testosterone and prostaglandin production in human testis cells and could thus influence fertility (28). A group of experts recommends an individual approach: Men with an unfulfilled desire to have children should undergo a spermiogram. If this is normal, you can continue to take NSAIDs. If there are any deviations, they should discontinue these medications (29).
This must be distinguished from the influence of chronic inflammatory processes and infections. Chronic inflammation, especially in the urogenital area, must be treated by a doctor. He should advise men about autoimmune diseases, since immunosuppressants, but also chronic inflammatory diseases themselves can influence male fertility.
Azoospermia (no sperm in the ejaculate), decreased libido and erectile dysfunction have been described for opioids such as morphine, methadone and fentanyl (12). High doses of opioids decrease the release of GnRH and subsequently LH, FSH and testosterone. The effect is reversible after discontinuation (12). In animal experiments, effects on the offspring, for example with regard to weight, endocrinology and behavior, have been shown if the male animal was given opioids at the time of conception (30).
If a patient needs opioids for a short time, the pharmacist can inform the patient and his doctor about the reversible effects on fertility. If long-term use is required, a pain specialist should assess whether and how a change is possible.
Search for valid information
Compared to information about the influence of drugs on fertility in women, information for men is less available. The specialist information is often very general. Particularly in the case of old substances, no distinction is even made between male and female animals when specifying the effects on fertility.
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