Medications That Can Lower Sperm Count

Male infertility has many possible causes, including poor sperm quality. Poor sperm quality can include a low sperm count, abnormally shaped sperm, or sperm that cannot move properly. Anything that negatively affects sperm production can cause male infertility.

Poor sperm quality can be caused by obesity, vitamin and mineral deficiencies, inadequate exercise, wearing briefs rather than boxers, low testosterone, medical conditions, and some common prescription drugs. If you are experiencing infertility due to poor sperm quality and you take certain prescription medications, then there is a chance that the medications may be causing or contributing to your infertility.

What is sperm quality?

Sperm quality is determined by semen analysis, which assesses sperm count, sperm concentration, sperm motility (ability to move), and sperm morphology (shape). Low sperm count and other indications of poor sperm quality can cause male infertility. Many factors can affect sperm quality, including hormone levels, nutrition, testicle temperature, and medications.

A variety of prescription medications can affect sperm quality by decreasing sperm count and sperm concentration, impairing normal motility, increasing abnormally shaped sperm, and causing DNA damage within sperm. These medications mostly cause or contribute to male infertility by affecting sperm production, leading to the production of fewer sperm or abnormal sperm that do not function properly.

Prescription medications that impair sperm production

Many drugs can affect sperm quality, but those listed here are the drugs most commonly associated with poor sperm quality. Both the name brand and generic forms of these drugs can affect fertility, including combination drugs that contain one or more of the following:

Many antidepressants affect sperm quality:

• Selective serotonin reuptake inhibitors (SSRIs) — Celexa (citalopram), Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline).
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) — Effexor (venlafaxine).
• Norepinephrine-dopamine reuptake inhibitors (NDRI) — Wellbutrin (bupropion).
• Tricyclic antidepressants (TCAs) — Amitriptyline.
  
• Atypical antidepressants — Trazodone.

Antibiotics:

• Macrobid (nitrofurantoin).
• Aczone (dapsone).
• Nizoral (ketoconazole), oral forms only.

Antiepilepsy drugs:

• Tegretol (carbamazepine).
• Dilantin (phenytoin).
• Depakote (valproate).

Antiretroviral drugs used to treat HIV and other conditions:

• Zirgan (ganciclovir).
• Invirase (saquinavir).
• Valcyte (valganciclovir).

Calcium channel blockers, including combination drugs that include one of the following:

• Cardizem (diltiazem).
• Procardia (nifedipine).

Drugs to treat urinary tract conditions and benign prostatic hyperplasia (enlarged prostate):

• Alpha-adrenergic antagonists (alpha-blockers) — Flomax (tamsulosin) and Rapaflo (silodosin).
• 5-alpha-reductase inhibitors — Avodart (dutasteride) and Propecia or Proscar (finasteride).

Drugs used to treat various conditions that affect testosterone levels:

• Danocrine (danazol).
• Deca-Durabolin (nandrolone).
• Eulexin (flutamide).
• Lupron (leuprolide).
• Oxandrin or Anavar (oxandrolone).

Opioid pain medications can affect sperm quality with long-term use or when the controlled-release form is used:

Various other drugs:

• Azulfidine (sulfasalazine) — an anti-inflammatory drug
• Rapamune (sirolimus) — an immunosuppressant drug
• Many different chemotherapy drugs

Understanding how drugs affect sperm quality

The effect of medications on sperm production is well understood for some—but not all—prescription drugs. Research into the effects of prescription drugs on sperm quality is lacking for many medications. Some of the evidence for reduced sperm count and motility comes only from animal studies, without clear evidence of how these drugs affect sperm in humans. In some cases, only a few case studies of individual patients have shown lowered sperm quality due to that medication. Many factors influence how an individual will be affected by medication, and different people have different side effects.

Improving fertility

In some cases, impaired fertility caused by medications can be permanent, such as testicular damage caused by chemotherapy. Fortunately, the negative effects are reversible for most medications that decrease sperm quality. This means that discontinuing a medication causing a low sperm count may restore normal fertility. Remember, you should never stop taking prescription medication without discussing it with your doctor first. Some of the drugs that affect sperm quality are life-saving medications; stopping them can be extremely dangerous. Also, some drugs can cause serious side effects or withdrawal symptoms if the dose is not tapered off slowly.

If a medication is contributing to infertility, then your doctor may consider switching you to a different medication, lowering the dose, or stopping that medication altogether. Discuss the risks and benefits of making changes to your medications with your healthcare provider; it may be one step toward improving your fertility.

There are many potential causes of low sperm quality — prescription medications are only one factor. A variety of conditions can cause male infertility, not just poor sperm quality. If you are experiencing infertility, you should discuss the possible causes with your doctor or another healthcare provider. If medications are playing a role in your infertility then you may want to consider changing or stopping medications, but you should only do so after discussing the risks and benefits with your doctor. Just as there are many causes of poor sperm quality, there are also many ways to improve sperm quality, including diet, exercise, and herbal supplements.