Women with epilepsy may be at increased risk of infertility, a study of women from India suggests.
The study included 375 women who planned to have a child, average age 26, who were followed until they became pregnant or for up to 10 years. During the study period, 62 percent of the women became pregnant.
The rate of infertility among women with epilepsy was more than twice the 15 percent rate in the general population. Women taking three or more drugs for epilepsy were 18 times more likely to be infertile than those taking no epilepsy drugs -- 60 percent versus 7 percent. Infertility rates were 41 percent for women taking two epilepsy drugs and 32 percent for those taking one epilepsy drug, the study authors found.
"This may be due to the adverse effects of taking multiple drugs or it could be a more indirect effect because people who are taking multiple drugs are more likely to have severe epilepsy that is difficult to treat," study author Sanjeev Thomas, of the Sree Chitra Tirunal Institute for Medical Sciences and Technology in Trivandrum, India, said in a news release from the American Academy of Neurology.
The researchers found that the drug phenobarbital was associated with significant risk of infertility, while no such link was noted with valproate or other drugs.
The study findings are published in the Oct. 12 print issue of the journal Neurology.
"Based on these findings, women with epilepsy should be counseled about the potential risk of infertility and referred for an evaluation if they have not conceived within two years" of trying to become pregnant, Dr. Alison M. Pack, an assistant professor of clinical neurology at Columbia University in New York City, wrote in an accompanying editorial in the journal.
Dr. Steven V. Pacia, director of the Comprehensive Epilepsy Center at Lenox Hill Hospital in New York City, said: "Certain antiepileptic medications (AEDs), including phenobarbital, may affect the metabolism of normal hormones in women with epilepsy. This effect will be enhanced at higher doses and by the addition of several other AEDS that may be expected in patients with more severe epilepsy.
"However, patients with more severe epilepsy can be expected to have a higher incidence of cognitive problems, mood disorders and hyposexuality, which may also lead to higher rates of infertility," he added.
SOURCES: American Academy of Neurology, news release, Oct. 11, 2010; Lenox Hill Hospital, news release, Oct. 11, 2010
