Infertility common in women with epilepsy

Women with epilepsy have a higher-than-average risk of fertility problems, particularly those on multiple anti-seizure drugs.

Guidelines from the American Academy of Neurology and American Epilepsy Society already suggest that during pregnancy, women take only one anti-seizure medication whenever possible to lower the chances of birth defects. It is not clear which drugs in particular may be related to fertility problems. 

Previous research has found that women with epilepsy have lower-than-average pregnancy rates, but it has been suggested that lower marriage rates or women's personal decisions against pregnancy might explain the connection. 

Researchers studied 375 women with epilepsy in south India who were planning a pregnancy and were followed for an average of almost three years, and up to 10 years in some cases. It was found that overall, 38 percent of the women failed to conceive during the study period. The researchers lacked a control group of women without epilepsy; instead they used data reported for the general population of Kerala, indicating that about 15 percent of married women were infertile. Besides multiple-drug therapy, lower education levels and older age were also related to a greater risk of infertility in the epilepsy group. Putting all these factors together, it appeared that more-difficult epilepsy that is drawn over longer period of time and requiring treatment with multiple anti-epileptic drugs is associated with increased risk.

Of women on just one medication, 32 percent failed to conceive during the study period. That figure was 41 percent among women on two epilepsy drugs, and 60 percent among those on three or more drugs. Only 7 percent of those not taking any anti-seizure medication failed to conceive during the study. The findings strengthen the evidence that women with epilepsy have a higher-than-average risk of fertility problems. They also indicate that women taking multiple anti-epilepsy drugs may be particularly at risk.

The results do not prove, however, that the drugs themselves are to blame, or at least fully to blame. Since women on multiple epilepsy drugs are likely to have more severe epilepsy, it's possible that the severity of the disorder plays a role. Whatever the reasons for the association, the results do suggest that women with epilepsy should be advised that they may have a higher-than-average risk of infertility. Women who are planning a pregnancy talk with their doctors; if possible, those on multiple epilepsy drugs may want to trim their drug regimen down. More research is therefore needed into how the various epilepsy drugs might affect fertility.