How Your Medications Are Impacting Your Fertility

When working with women through their conception journey we are frequently asked about how hormonal birth control can impact their chances of conceiving. This is a relevant question and one we answer in this post, however, it is also important to consider what other medications could be impacting your chances of conceiving. Some of which are available over the counter. We have put together a list of the most common medications we see our population of preconception patients taking and our opinion based on the scientific literature available.

NSAIDS: Anti-Inflammatory Pain Killers.

Most Commonly Used: Aleve (naproxen) and Voltaren (diclofenac)

 Studies have shown that these medications may delay ovulation or if used frequently enough can temporarily inhibit ovulation. They were shown to reduce progesterone in women taking them frequently for muscle pain. The occasional NSAID is not likely to make an impact but frequent use (daily or up to 4 times a week) may warrant exploration into root cause of pain and natural alternatives.

Naturopathic Approach: Identifying the root cause of pain. Nutrient and herbal therapy to reduce inflammation in the body. Acupuncture to resolve chronic headaches and reduce muscle and joint pain.

Anti-Histamines: anti-allergy drugs, often prescribed for seasonal allergies and unexplained hives or allergic reactions.

Most Commonly Used : Loratadine (Alavert, Claritin), Fexofenadine (Allegra), Diphenhydramine (Benadryl), Brompheniramine (Dimetane), Cetirizine (Zyrtec), Chlorpheniramine (Chlor-Trimeton), Clemastine (Tavist).

This class of drugs is debated among the medical community as we do not have enough well designed studies to confirm a correlation. However, there have been studies to show anti-histamines reduce blood flow to the uterus. Research has also shown that there are histamine receptors in the uterus and that human embryos secrete histamine, contributing to their capacity to implant. All of this to say when trying to conceive we believe it may be worth switching to natural alternatives to manage allergy symptoms or reducing your use.

Naturopathic Approach: High dose oral vitamin c and plant complexes that reduce over activity of the immune system causing symptoms.

 Mood Stabilizing Medication – anti-depressants, anti-anxiety, sedatives and sleeping pills.

Most Commonly Used during pregnancy: Celexa (citalopram), Prozac (fluoxetine) Zoloft (sertraline).

Not Safe in Pregnancy: Paxil (paroxetine), Mono Amine Oxidase Inhibitors (Nardil, Parnate)

Paxil has been shown to increase risk of fetal heart defects . Effexor (venlafaxine) and Cymbalta (duloxetine)—research has shown that this class of drug SNRIs can increase your risk of post-partum hemorrhage.

This class of drug can be a little tricky to navigate. The decision to use anti-depressants during pregnancy must always be based on the balance of risk vs benefit. Changes to your medication must always involve a discussion with your primary health care provider (family doctor and/or psychiatrist). The risk of birth defects and other health concerns is still quite low; however few medications have been proven safe during pregnancy and certain types of antidepressants have been associated with a higher risk of complications for babies. This is why it is important to discuss your options with your family doctor. They will work with you to reduce your babe’s exposure to the medication. This is achieved by trying to limit therapy to 1 single medication dosing the lowest amount to see effect. We recommend having these discussion and beginning the transition process 3-6 months prior to trying to conceive.

Naturopathic Approach: Encouraging and educating patients on the risks of certain medications. After a discussion is had with your primary care provider we can discuss natural ways to help reduce side effects throughout the transition process such as acupuncture and nutrient support. Acupuncture and counselling are highly recommended for helping improve mood, improve sleep and reduce anxiety while transitioning to a new medication and managing your mood throughout pregnancy.

Ultimately, we are here to support you and your conception journey. We encourage collaborative care with your family doctor and by no means are suggesting that coming off anti-depressants entirely is the best decision for you.

 Synthetic Hormonal Contraception : The Pill, Nuva Ring, Mirena IUD, Depo Shot, The Patch

Long term use of contraception should not be underestimated. Birth control uses synthetic hormone, meaning our detox pathways in place for metabolizing hormones are not as effective at clearing these substances. Many variables contribute to your bodies capacity to return to normal hormone levels that promote conception. Contraception and synthetic hormones deplete your body of relevant vitamins and minerals. These contribute to pathways responsible for detox, gut health, and energy production. This is relevant for detoxification of our hormones to maintain a healthy balance conducive for conception. It also impacts the capacity of the follicle and future embryos because energy production in the cells is needed to complete necessary cellular divisions to maintain a pregnancy.

Naturopathic Approach: Liver support and detoxification, dietary modifications to improve detox and natural hormone building. Nutrient supplementation to correct for micro deficiencies. Education on ovulation tracking and the noticeable physical signs during a natural cycle.

(*synthetic hormone suppresses ovulation, therefore preventing cervical changes and discharge changes!).

 If you having been trying to conceive or are planning on trying book now to learn more about how to optimize your chances.

Your EAST ND Fertility Specialists

Jodie + Céline

References :

Histamine enhances cytotrophoblast invasion by inducing intracellular calcium transients through the histamine type-1 receptor, Liu et al, Mol Reprod Dev 2004 Jul;68(3)345-53.

Identification of a histamine-releasing factor secreted by human pre-implantation embryos grown in vitro. Cocchiara et al, Journal of Reprod Immunology 1988 Jun;13(1):41-52

Effect of mepyramine, a histamineH1 and burimamide, a histamine H2 receptor antagonist, on ovum implantation in the rat. Brandon et al, J. Reprod. Fertil. 1977 July;50(2)251-4.

Implantation and deciduation process after the action of the antihistamine preparation diaprizin in early rat embryogenesis. Ontogenez 1981; 12(6) 596-604.

Unipolar major depression in pregnant women: General principles of treatment. https://www.uptodate.com/contents/search. Accessed Jan. 8, 2018.

Antenatal depression: Risks of abnormal infant and child development. https://www.uptodate.com/contents/search. Accessed Jan. 8, 2018.

Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk. 11th ed. Philadelphia, Pa.: Wolters Kluwer Health Lippincott Williams & Wilkins; 2017. http://www.ovid.com/site/index.jsp. Accessed Feb. 26, 2018.

Non-steroidal anti-inflammatory drugs inhibit ovulation after just 10 days. ScienceDaily. ScienceDaily, 11 June 2015.