your partner taken antibiotics, such as erythromycin or gentamycin, or antifungal medications, such as ketoconazole, or been treated for psoriasis with methotrexate? Has he been on anabolic steroids? These medicines can all affect sperm production.
Do you or your partner take medication for high blood pressure? Sometimes, when you’ve been taking a medication for a long time, you almost forget that it can have serious side effects. Men who take certain types of antihypertensives called calcium channel blockers may produce sperm that can’t penetrate eggs well; other high blood pressure medications may cause retrograde ejaculation, a condition in which the semen is pushed backwards into the bladder instead of being ejaculated out; or they may cause an inability to get and sustain an erection. Some antihypertensives are dangerous in early pregnancy as they can cause birth defects. Other antihypertensive drugs are available that don’t have these effects, so talk to your doctor about switching medications if possible.
Category A is for drugs that have a proven safety record backed by research on women.
Category B drugs have shown safe use in animals, but there are no well-controlled studies in humans.
Category C includes drugs where animal studies have shown an adverse effect but there are no well-controlled human studies to tell us what happens in humans. This is where a risk-benefit evaluation helps to decide if the medication should be used.
Category D is where studies have shown an adverse effect for humans but where special circumstances may warrant the use of the medication.
Category X: Well, what do you think — does X sound good? You are right — the answer is “no.” These medications have proven adverse effects on pregnancy and no amount of benefit outweighs the risk — just don’t use them.
The good and bad of antidepressants
Considering how many people are using antidepressants, it is surprising how little research has been done on the influence of antidepressants on fertility. There are a number of categories of medications that are antidepressants. However, the largest group are the selective serotonin reuptake inhibitors (SSRIs). These work by increasing the levels of serotonin in the brain. Serotonin is a chemical in the brain that acts as a messenger between brain cells. Examples of SSRIs are Prozac, Lexapro, Zoloft, Paxil, and Celexa to mention a few.
A recent review identified 16 articles that studied the effect of SSRIs on fertility. Six of the studies demonstrated no effect on fertility, three suggested a negative effect, and one demonstrated an increase in pregnancy rate. Although the research methodology was considered poor, six of the studies demonstrated a negative effect on the semen parameters. So, what to do? First, ask yourself if you really need those little happy pills. If not, stop — under the direction of the prescribing physician since some cannot be stopped suddenly. If you truly need those pills, so be it. Just remember to notify your fertility doctor of the pills you are taking.
Reviewing nonprescription medications
It is amazing how often we grab an over-the-counter (OTC) medication to take care of a back sprain after playing pick-up basketball or a rash on the leg after hiking in the woods. Who checks with a doctor first? Well, things are different when you are trying to get pregnant and — as we warn you about vitamins and supplements in Chapter 9 — you need to pay a little bit more attention to what you are putting in or on your body. Your fertility clinic will no doubt give you a list of medications that are acceptable, but here a few general tips that you should think about before popping a pill or rubbing on salve:
Acetaminophen is generally considered safe to use as a painkiller for various aches and pains.
NSAIDS (non-steroidal anti-inflammatory drugs), including ibuprofen, may interfere with ovulation and can increase bleeding if taken prior to any procedures (like an egg retrieval). One study suggests that high doses impact sperm production. These should be used with clinic instruction only.
Aspirin can increase bleeding so use with direction only.
Milk of magnesia and antacids are usually fine to settle down that “icky” tummy.
Topical preparations for itches (like Cortaid) or minor skin infections (like Neosporin) can be used as long as you don’t overdo it and ignore what is causing the problem.
Deciding if you need a mammogram
It’s not essential to have a mammogram before getting pregnant, especially if you’re over the age of 40 or if you have a family history of breast cancer. In fact, the American College of Obstetricians and Gynecologists (ACOG) recommends that discussions between physicians and patients of screening mammography to determine when to start them should take place around age 40, but definitely by age 50. Some fertility clinics are making mammograms “required” for all patients who will undergo IVF or are over a certain age, so don’t be surprised if this test gets added to your list of things to do. You might think that having a mammogram “can’t hurt.” That actually is very incorrect. Every medical test has a certain “false positive” rate, meaning that the test says you have a problem when in fact you don’t. So, every test has a trade-off between correctly identifying a disease when it is present and correctly telling you that you don’t have a disease if you don’t. Women who have a mammogram that gives them a false positive (the test says you have breast cancer, but in fact you don’t), will undergo unnecessary further testing, interventions, and psychological trauma. The current recommendations for mammograms take into account the balance of false negatives and false positives.
Seeking other prepregnancy
