Medication Risks When Trying to Conceive

Why Do Everyday Medications Affect Fertility?

Medications can interfere with conception in several ways, and a 2023 systematic review in Fertility and Sterility maps them out for men: hormonal disruption, toxicity to the cells that make sperm, effects on how sperm function, ejaculatory problems, and the potential to harm a developing embryo.^[1] The female side runs on a different clock, which is why the same drug can matter for one partner and barely register for the other.^[1][3]

Timing is part of the story. Sperm production takes approximately 74 days, so a drug that suppresses the testes today shows up in a semen analysis (spermiogram) two to three months later - and recovery after stopping can take one cycle or longer, depending on the drug.^[21] On the female side, a drug's effect often plays out within a single menstrual cycle - for example, by preventing ovulation - and commonly eases once the medication is stopped.^[3][17]

That difference matters. For the man, the question is usually sperm quality over months. For the woman, it's often whether an oocyte (egg) is released during this cycle. Both can be affected at once, and both deserve a look when a couple is struggling to conceive.^[1][3]

→ Learn more: Infertility

Can Ibuprofen and Other Painkillers Affect Conception?

Yes - in women, regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may temporarily interfere with ovulation.^[3][17] The mechanism is specific. Releasing an egg depends on signaling molecules called prostaglandins - produced through the COX-2 pathway, that help rupture the mature follicle. NSAIDs work by shutting prostaglandin production down, which is exactly how they relieve pain, and exactly why they can keep the follicle from opening.^[17]

When that happens, the follicle luteinizes - it goes through the hormonal motions of ovulation - but never releases the oocyte.^[17] Clinicians call it luteinized unruptured follicle (LUF) syndrome, and the 2020 American College of Rheumatology reproductive health guideline names it as a cause of subfertility. The guideline takes it seriously enough to make a formal recommendation: in a woman who is having difficulty conceiving, consider stopping NSAIDs before conception, provided her underlying condition stays controlled.^[3]

Bottom Line:
For a woman trying to conceive, the fix is usually straightforward. Because the effect acts on a single cycle, NSAID-related ovulation problems ease once the drug is stopped, so pausing NSAIDs around the time of ovulation - or asking a doctor about a non-NSAID pain reliever - is the practical step.^[3][17]

What About Ibuprofen and Male Fertility?

The picture for men is less settled. A widely cited finding is that ibuprofen can push the male hormone system into compensated hypogonadism - a state where the brain has to shout louder (higher luteinizing hormone) to keep testosterone normal, which hints at strained testicular function.^[11][22] A 2025 nationwide cohort study linked ibuprofen use to measures of male infertility and pointed to that same hormonal pathway.^[11]

Here's the catch. Other work has found no measurable effect of ibuprofen on actual semen parameters, so the evidence is genuinely mixed. The honest summary: occasional, normal-dose use is unlikely to be the reason a couple isn't conceiving, while heavy or long-term use is the version worth discussing with a doctor.^[2][11]

How Do Testosterone and Anabolic Steroids Affect Sperm?

They suppress the body's own sperm production - often all the way to zero.^[7][8] This is the most counterintuitive entry on the list, because many men take testosterone expecting it to boost virility. The opposite happens to fertility.

The reason is a feedback loop. The brain and testes talk to each other through the hypothalamic-pituitary-gonadal (HPG) axis. When testosterone or anabolic-androgenic steroids flood in from outside, the brain reads the signal as "we have plenty" and switches off the hormones (follicle-stimulating hormone (FSH) and luteinizing hormone (LH)) that drive the testes.^[7] Intratesticular testosterone collapses, sperm production stalls, and the result is severe oligozoospermia or azoospermia - very few sperm, or none at all.^[7][8]

That's also why testosterone has been studied as a male contraceptive: the sperm suppressing effect is reliable enough to use on purpose.^[7]

Key Insight:
Prescribed testosterone - gel, patch, or injection - is not a fertility treatment. For a man trying to conceive, it acts more like birth control, and switching to fertility-sparing options should be discussed with a specialist before starting it.^[1][7]

The good news is that the effect is usually reversible. After stopping, spermatogenesis tends to recover, though the timeline is highly variable - commonly 4 to 12 months, and in some men up to 24 to 30 months, depending on dose, duration, and age.^[7][8] When recovery is slow, specialists can prompt the system back on with medications such as clomiphene citrate and human chorionic gonadotropin (hCG). One cohort restored sperm to a mean of around 22 million/mL within an average of 4.7 months on such regimens.^[7]

→ Learn more: Male Infertility

Which Heart and Blood-Pressure Medications Affect Fertility?

Several common cardiovascular drugs can lower sperm quality, and some reported effects appear reversible after medication changes - though any change belongs with the prescribing doctor, because uncontrolled blood pressure is itself risky.^[1][6] Because high blood pressure itself becomes more common with age - the same age when many men are trying to conceive - this is an easy interaction to miss.^[1][25]

Calcium Channel Blockers

Calcium channel blockers (for example, nifedipine and verapamil) can interfere with the final step of fertilization. Sperm rely on calcium to power their motion and to complete the acrosome reaction - the chemical change that lets a sperm penetrate the egg. A 2025 systematic review found that calcium channel blockers can impair sperm motility and the acrosome reaction, producing a reversible form of infertility that can occur even when hormone levels look normal.^[1][6]

Beta-Blockers and ACE Inhibitors

Beta-blockers are associated with measurable changes in semen. Using a large infertility dataset, researchers found that men taking beta-blockers had lower semen volume, sperm concentration, and motility than men on no medication. The same analysis linked ACE inhibitors to reduced semen volume and motility (the capacity for self-directed movement). The data here are limited, so these are associations rather than proven cause - but they're worth raising if a man on long-term blood-pressure treatment is struggling to conceive.^[1]

Spironolactone

Spironolactone, used for high blood pressure and heart failure, is also an anti-androgen (testosterone blockers) - and that property is where reproductive effects show up. In women, it commonly causes menstrual irregularity and could in theory interfere with ovulation. A 2024 study of patients undergoing fertility treatment found no measurable drop in oocyte yield among those who kept taking it.^[18][24]

Important:
Do not stop or switch blood-pressure medication without medical advice - uncontrolled hypertension is dangerous and may itself affect fertility and pregnancy health.

Do Antidepressants and Antipsychotics Affect Fertility?

Some do, and this is one area where the effects clearly differ between men and women.^[4][5] It's also an area where stopping the medication can do more harm than the drug itself - so the goal is informed adjustment, not abrupt cessation.^[26]

→ Learn more: Female Infertility

Antidepressants in Men

Selective serotonin reuptake inhibitors (SSRIs) can affect sperm quality. A 2022 meta-analysis in Frontiers in Pharmacology pooled data from 222 men - a modest sample, but with consistent findings - and found that SSRIs reduced normal sperm morphology, concentration, and motility. It also raised the DNA fragmentation index - a marker of genetic damage in sperm - with effects appearing within three months of use.^[4] The drug studied most, paroxetine, increased sperm DNA fragmentation in roughly half of treated men in earlier work, and a 2025 systematic review reached similar conclusions about SSRIs as a class.^[4][16]

This sounds alarming, but for many men it isn't a reason to stop. SSRI effects on sperm tend to ease after the drug is stopped, and untreated depression carries its own real costs.^[16] The practical move is a conversation about alternatives. In a randomized trial, duloxetine showed no meaningful effect on sperm DNA, semen parameters, or hormones.^[19]

Antidepressants in Women

In women, SSRIs act higher up - on the brain signals that drive ovulation. A 2025 scoping review found that SSRIs may impair ovulation by suppressing gonadotropin-releasing hormone (GnRH) and the downstream hormones LH and FSH, with some studies also noting raised prolactin and changes in menstrual cycle length. The result is a plausible biological route to reduced fecundability - a lower chance of conceiving per cycle, reported in several observational studies.^[5]

Antipsychotics and Prolactin

Many antipsychotics have been associated with increased prolactin, and high prolactin is a direct brake on ovulation. By blocking dopamine, these drugs lift prolactin levels, which can suppress the hormones needed to release an oocyte and lead to anovulation (ovaries fail to release a mature egg during a menstrual cycle) and absent periods. Among the newer agents, risperidone is the most likely to do this. Prolactin-sparing alternatives such as aripiprazole or quetiapine are often preferred when fertility is a goal. The effect falls mainly on women, though elevated prolactin can reduce libido and fertility signals in men too.^[12]

Important:
Never stop an antidepressant or antipsychotic on your own to improve fertility. Relapse of depression or psychosis is a serious risk. Any change should be planned with the prescribing clinician, who can often switch to a fertility-friendlier option.^[5][12]

What Other Common Drugs Affect Fertility?

Beyond painkillers, hormones, heart drugs, and psychiatric medications, a handful of other prescriptions carry fertility or pregnancy risks worth knowing - and a few are genuine "stop before you try" drugs.^[3][14]

Methotrexate and Immune-Suppressing Drugs

Methotrexate is the clearest example of a drug a woman should stop before conceiving, planned with her prescribing clinician. It causes birth defects and pregnancy loss. In women who took it after conceiving, the miscarriage rate was 42%, against 17–22% in unexposed groups, with a higher rate of major birth defects.^[14] Guidelines therefore advise stopping methotrexate well before trying. The 2020 ACR guideline recommends discontinuing it within 3 months of attempting conception.^[3][14]

For men, the guidance has shifted. The strong theoretical worry about methotrexate damaging sperm hasn't held up in the data, and the 2020 ACR guideline now conditionally supports men continuing methotrexate while trying to father a pregnancy. Two drugs remain firmly off-limits for men trying to conceive: cyclophosphamide and thalidomide. And if a couple struggles while the man is on sulfasalazine - which can cause reversible drops in sperm count - a semen analysis (and a possible switch) is the recommended step.^[3]

Opioid Painkillers

Long-term opioid use suppresses reproductive hormones in both sexes. Opioids act directly on the brain to inhibit GnRH, which lowers testosterone in men and disrupts the cycle in women.^[9] In men, this opioid-induced androgen deficiency is common, and a 2025 review describes its prevalence as high, varying widely across studies depending on the opioid and how low testosterone is defined.^[10] In women, chronic opioids can cause irregular or absent periods, which directly affects the chance of conceiving.^[9][23]

Epilepsy Medicines

Some antiepileptic drugs affect fertility, and valproate stands out. In women, it's linked to PMOS (polyendocrine metabolic ovarian syndrome* *– the 2026 term that replaced polycystic ovary syndrome [PCOS]) 26, a leading cause of ovulation problems.^[13] In men, the evidence is mixed: pharmacovigilance and clinical data link valproate to reduced sperm count, motility, and abnormal forms, but the largest cohort study to date - comparing roughly 92,000 valproate-exposed men with over 535,000 unexposed - found no significant difference in infertility.^[1][15][20] Older enzyme-inducing drugs such as carbamazepine and phenytoin can lower bioactive testosterone by speeding up hormone metabolism. Because seizure control is non-negotiable, any change here belongs with a neurologist - but it's a real reason to review the regimen before trying.^[13]

Hair-Loss and Prostate Drugs

Finasteride - taken for hair loss and enlarged prostate, carries one of the strongest signals for drug-related male infertility. A 2026 pharmacovigilance study of two large safety databases identified 19 high-risk drugs, and finasteride was the standout. It met the strictest criteria for cause and effect, with sperm parameters worsening on the drug and improving after stopping. The related drug dutasteride and minoxidil raised similar concerns.^[15]

Chemotherapy and Cancer Drugs

Chemotherapy is in a category of its own: it can damage oocytes and sperm severely, and the effect is sometimes permanent rather than reversible. When fertility matters and treatment can't be delayed, the priority shifts from avoiding the drug to preserving fertility first - banking sperm, or freezing eggs or embryos, before treatment begins.^[1][3]

Which Medications Affect One Partner More Than the Other?

Most of these drugs hit one partner harder than the other, so it helps to see them side by side.^[1][3][5] The table below summarizes the common medications, their main fertility effect, the partner most affected, and whether the effect typically reverses after stopping.

The table is compiled from the available research and is a guide for discussion with the prescribing clinician - not a reason to stop any medication.

Source: Alhamam et al., Fertility and Sterility (2023)^[1]; Sammaritano et al., 2020 ACR Reproductive Health Guideline^[3]; and the additional sources.1,3,5,6,7,9,13,14,15

→ Learn more: Hormonal Panel for Infertility

So, What Should You Do Now?

If you're trying to conceive, the goal isn't to stop everything - it's to find the few medications that matter for your situation and adjust them safely.

Step 1: List Every Medication and Supplement

Write down everything both partners take, including over-the-counter drugs like ibuprofen and anything bought without a prescription. The cabinet often holds the answer.

Step 2: Flag the High-Impact Drugs

Pay special attention to testosterone, anabolic steroids, methotrexate, finasteride, opioids, and valproate - these have the clearest fertility or pregnancy effects and almost always need review.

Step 3: Do Not Stop Prescriptions on Your Own

Never abruptly stop antidepressants, antipsychotics, blood-pressure drugs, or seizure medicines to boost fertility. Ask the prescribing doctor about fertility-friendlier alternatives instead.

Step 4: Get a Semen Analysis and Cycle Check

A semen analysis for the man and ovulation tracking for the woman give a baseline to compare against after any medication change - on their own they cannot prove that a drug is the cause.

Step 5: Ask About Fertility Preservation Before Gonadotoxic Treatment

If chemotherapy or another fertility-damaging drug is unavoidable, discuss sperm, egg, or embryo freezing before treatment starts, not after.

Step 6: Compare Clinics and Get a Specialist Review

A fertility specialist can review your full medication list against your goals and coordinate with your other doctors. Compare clinics on experience with medication-related infertility before you commit.

→ Compare fertility clinics worldwide: MedicalNavigator.com/clinics/reproductive-medicine

Too Long, Didn't Read

• In women, NSAIDs like ibuprofen may block ovulation by stopping the follicle from rupturing.
• Testosterone and anabolic steroids suppress sperm production and can cause azoospermia - zero sperm.
• Sperm production typically recovers 4 to 12 months after stopping steroids, sometimes longer.
• Some heart and blood-pressure drugs lower sperm motility and volume, but the effect is usually reversible.
• SSRIs damage sperm DNA in men and can impair ovulation in women; never stop them without advice.
• Methotrexate must be stopped before conception in women - it raised miscarriage rates to 42%.

References

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