We previously reported that paroxetine, a selective serotonin reuptake inhibitor (SSRI), may affect sperm motility and may thus have a negative impact on male fertility.  Many women who are planning a pregnancy question whether SSRIs and other antidepressants may affect fertility; this is obviously a particularly important issue for those who are having difficulty conceiving.

To date, there have been no clinical studies examining the impact of SSRI treatment on fertility in women who are attempting to conceive naturally.  There have, however, been several studies which have observed pregnancy rates in women who are attempting to conceive through IVF while taking SSRIs.

In a study from Friedman and colleagues, including a total of 41 women taking SSRIs while undergoing IVF, pregnancy and live birth rates did not differ between women who were and were not treated with SSRIs.  On the other hand, a retrospective chart review from Northwestern University Medical School observed that pregnancy rates were slightly lower among women who were undergoing IVF while taking SSRIs (41%) versus a matched control group of women who were not taking SSRIs (50%).

So how should these findings be interpreted?  One of the limitations of these studies is that they fail to address the impact of depression on fertility.  Among women undergoing infertility treatment, the prevalence of anxiety and depressive symptoms is high, yet many women do not receive any treatment or are only partially treated.  Depression can potentially affect prolactin secretion, the hypothalamic-pituitary-adrenal axis, and the gonadal axis, all of which can in turn affect fertility and, possibly, the success of infertility treatment.

Some, but not all, studies suggest that success rates may be lower in women suffering from depression or anxiety.  If there is a reduction in pregnancy rates among women taking SSRIs, is this is an effect of the medication or the underlying depression?  Or are there are other factors that are more common in women with depression (such as smoking, obesity)?  Given the prevalence of depression in this population, further studies are essential to help answer these questions.

In Part 2 of this topic, we will review the role of serotonin in reproduction as a means of addressing the potential effects of SSRI antidepressants on fertility.

Ruta Nonacs, MD, PhD

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