This post calls on everyone, male or female, currently or previously taking any drug who thinks that a drug may have impacted on their fertility.
Fertility should be of interest to anyone taking serotonin reuptake inhibiting drugs – SSRIs, SNRIs, tricyclics, antihistamines, antibiotics, analgesics and related drugs – and we will use SSRIs to illustrate the issues but the points made apply to most medicines, far more than the obvious ones like finasteride (Propecia) and isotretinoin (Accutane).
It applies to calcium channel blocking drugs used for hypertension, angina, and cardiac arrhythmias, to the benzodiazepines, antipsychotics, and anticonvulsants which between them are probably given to 20 to 25 percent of the population, and drugs you wouldn’t expect to cause infertility – like testosterone.
We’d have been amazed, if told when RxISK began that it would have featured sex so much. That has been down to you – not us. You have generated huge amounts of the information now available about the effects of antidepressants on sexual function, both while taking them and after stopping.
Fertility is the latest angle that you, reporting to RxISK and drawing to our attention in other ways, have put in the frame. In terms of looking at issues drugs cause or prevent, this is virgin territory.
Fertility hinges on conception. But drugs do many more things in men and women beyond conception than are dreamt in most of our philosophies. Fertility problems conjure up sperm counts in men, and hormonal issues in women, but there are other ways in which drugs can enter and corrupt this central human mission.
One of the acknowledged issues you aren’t being told about is that SSRIs cause sperm counts to plummet, affecting not just counts but sperm quality and both the quantity and quality of the semen in which sperm function, all of which may compromise fertility.
There are many reports of drug induced hormonal imbalances and breast enlargement in the medical literature with no link to fertility. If your breasts enlarge (gynecomastia) on a drug, you are likely infertile for the time being. While some of these issues are reversible after discontinuation of treatments, the long-term effects of drugs on fertility have never been studied.
With people increasingly taking antidepressants for months, years, or even decades, they seem almost certain to affect national fertility rates which are falling. See Pharmageddon and Fertility. We don’t know what long-term effects there might be for children who took antidepressants, or for those exposed to antidepressants in the womb.
SSRIs and related medications cause significant sexual dysfunction. Conception will be more challenging for couples trying to conceive if one or both are on antidepressants. While a difficulty maintaining an erection and ejaculating are the obvious problems for men, these can be overcome with testicular sperm aspiration, but the failure to conceive naturally through intercourse is still a fertility problem.
For women or couples, a loss of libido is going to make conception less likely, along with other factors in women that make sex less comfortable or even feasible. Rates of IVF in most Western countries are escalating rapidly.
Finally, several drug groups like SSRIs, finasteride, isotretinoin and anticoagulants can cause post-treatment sexual dysfunction (PSSD for SSRIs), which can have drastic effects including marriage breakup, job loss, and suicides.
PSSD and related conditions make it difficult or impossible to engage in not just sex but also normal romantic relationships. These are intimacy shattering problems; leaving many people bereft of something they looked forward to and the rest of their family often wondering what has gone wrong.
A recent paper Sara Baldini and colleagues stimulated this post. She investigated the role of medications in male factor infertility by searching the FDA Adverse Event Reporting System for reports of fertility problems. Unsurprisingly, SSRIs made an appearance in the top 10. But the surprising result was that finasteride came top of the list with more than double the number of reports than the drug in second place, testosterone.
Finasteride is prescribed to young men to combat male pattern baldness and can produce a similar condition to PSSD called post-finasteride syndrome (PFS). It’s possible that the large number of reports may have been a coordinated effort on the part of PFS sufferers to report their issues to FDA. This doesn’t make the reports any less valid. It shows that most people don’t report their problems to a country’s drug regulator.
These results are a tribute to PFS activism. If only because SSRIs are used in vastly greater amounts than finasteride, there should have been many more reports of PSSD than for finasteride. But SSRIs also make people indifferent which may play a part in poor reporting. Antipsychotics make people even more indifferent than SSRIs and likely cause just as much infertility but don’t appear in the Baldini report.
Your country needs you. In a post soon, we will lay out the impact of SSRIs on national fertility rates. The brief message is – wherever you live, you have a DUTY to draw your sex and fertility problems to the attention of politicians and authorities.
Whatever country on earth you come from, RxISK would welcome your RxISK Reports.
To widen the impact, can you also report to your country’s drug regulator
- Estonia has one but we can’t reach it from here
- France 1
- France 2 France has regional pharmacovigilance centres which may be better
- Germany 1
- Germany 2 – this is the drug approval agency.
- Germany 3 – this is apparently the best link to use
- Greece – where the word pharmakon comes from
- Ireland – who invite you to make this site work hard for you
Netherland 2 – Lareb who are a great site – they act on reports.
- Spain 1
- Spain 2 Spain also do regional pharmacovigilance
- United Kingdom – Give you numbers of report received.
Some of these sites like the UKs may also give numbers of reports on your drug and its problems that they have received. Let us know if the do.
EMA is like a cross between the Medici and Kakfa’s Castle. They say they have thousands of scientists doing pharmacovigilance but they don’t seen to have a reporting website – they pharm this out to Europe’s regions like France or Spain and private companies to do the reporting.
Eudravigilance gives numbers of drug events sent into EMA from the regions.
If you have any sexual side effects at all, these affect fertility and can be reported as such. For example, a loss of libido should be reported as both a loss of libido and a fertility issue.
MedDRA – The Medical Dictionary for Regulatory Activities recently added a code for post-SSRI sexual dysfunction (10086208). Anyone reporting PSSD to a drug regulator should specifically mention “post-SSRI sexual dysfunction” and “MedDRA code 10086208”.
But don’t just put “PSSD”. When we wrote our 300 Cases paper, we had to exclude a lot of reports because people only listed PSSD with no specific symptoms. Adverse event reporting databases work by logging all the symptoms you report against a list of terms. If you don’t specify the different symptoms (eg. genital anaesthesia, erectile dysfunction, orgasmic sensation decreased), when researchers check the database to see if particular drugs are causing these problems, they won’t find anything – because you didn’t report them.
And add fertility.
To see what kinds of reaction terms are available and are being used, or may have already been reported on your drug, visit our Drug Search page, which has a downloadable list of all reaction terms used in FDA’s database.
A useful way might be to visit our Sex and Relationships zone, and enter the name of an SSRI or SNRI in the search facility. This will give you a list of all sex and relationship related reactions that have been logged for that drug.
You’ll probably find that terms like “genital anaesthesia” and “orgasmic sensation decreased” are fairly low in the list despite being the hallmark features of PSSD. As mentioned above, it’s likely that some people with PSSD have so far only described their problem in terms of erectile dysfunction and loss of libido.
(The FDA database weirdly uses the English spelling of the word anaesthesia, so please be aware when looking for it – and with all other terms beware of US, UK or other spellings).
To report a fertility problem, we suggest using “Infertility Male” or “Infertility Female”.
For those of you who want to research all adverse event reporting sites in more detail and join our mission to get decent reporting – Here are all MedDRA codes.
If something you think isn’t on the FDA Adverse Reporting System either in a usable way or not there, for instance, you can put it there by reporting a better term and adding the appropriate MedDRA code. One example might be penile shrinkage which has lots of online reports but may not be in FAERS. Ideally get others to report it too with the best MedDRA code.
Men – can you get a sperm count, plus tests for quality and motility, and semen analysis. This may be confronting. No-one knows how much sperm counts recover after stopping an SSRI or other drugs. Men with PSSD ironically may have better sperm counts than anyone else.
There are a lot of online reports from people with PSSD – PFS etc – describing visible changes in semen volume and quality – typically a reduced amount of semen and watery. But there seem to be almost no reports of anyone having these things tested. The more data we have on these issues, the better.
If you’ve had any of these tests done, please let us know the results. If you haven’t, consider having them.
In the Zone
Sex is often linked to being In the Mood. RxISK already lets you get In the Zone for sex. In the very near future we will want you to get in the zone for fertility.
After languishing for some years, we’ve relaunched the RxISK Zones . These aim at making it easier for you to gather information about key drug effects and help you to become an expert in these areas, hopefully letting us know how to make this work better for people like you.
A Hair Zone – We’ve had floods of reports on drug impacts on hair. In the 1960s women and hairdressers showed experts are often irrelevant to finding out what drugs really do.
A Skin Zone – Skin is the biggest organ we have, the boundary between us and the world, and the impact of drugs on it can be highly political.
A Suicide Zone – It is now clear that antibiotics, pain-killers, statins and hundreds of other drugs beyond the psychotropic drugs can cause suicide.
A Violence Zone – When a drug someone else takes can harm you or one you take can harm others, this makes drug induced violence a highly political and contested area.
A Sex and Relationship Zone – Also a zone where a drug your partner takes can harm you or vice versa.
A Withdrawal Zone – Getting hooked to a drug undermines our autonomy – the last thing we want. Many gut, asthma or allergy drugs in addition to brain drugs cause this.
A Vision Zone – Your reports have made RxISK a go to place for visual snow and other problems happening in plain sight that not even eye doctors currently link to the drugs you may be on.
A Fertility Zone – is our next Mission. We hope to announce the birth any moment. Why Fertility? Because in addition to the drug you are on harming your partner or their drug harming you, this is where a drug you or they are on can affect the entire country in which you live. National authorities are very worried about these effects but at the moment keeping very silent about them.