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According Zegers-Hochschild et al., 2009 : Infertility is defined as the inability to conceive a child after one year of regular, unprotected sexual intercourse with the same partner.
- According to the WHO approximately one in every six people of reproductive age worldwide experience infertility in their lifetime.
- Infertility affects 8% to 12% of couples of reproductive age, with male factors contributing to 50% of these cases.
- A study by Agarwal et al. found that male infertility rates were highest in Africa and Central/Eastern Europe. In contrast, the rates in North America, Australia, and Central and Eastern Europe were 4.5–6%, 9%, and 8–12%, respectively.
- A study by Agarwal et al. found that male factors accounted for 20% to 70% of infertility cases, with the percentage of infertile men ranging from 2.5% to 12%
- Anabolic-Androgenic Steroids(AAS)
- A systematic review published in 2021 found that AAS use was associated with a significant decrease in sperm concentration, progressive motility, and normal sperm morphology.
- A study published in 2020 reported that up to 57% of men using AAS experienced hypogonadism (low testosterone levels), which can lead to impaired spermatogenesis.
2. Chemotherapeutic Agents
- A systematic review published in 2022 reported that up to 60% of male cancer survivors experienced infertility after chemotherapy treatment.
- A study published in 2021 found that men treated with alkylating agents like cyclophosphamide had a higher risk of azoospermia (complete absence of sperm) compared to those who did not receive these agents.
3.Antidepressants
- Kahn et al. (2019) found that men taking SSRIs had significantly lower sperm concentration, motility, and normal morphology compared to non-users.
4. Immunosuppressants
- Yassen et al. (2021) found that men taking cyclosporine and mycophenolate mofetil had a higher risk of oligozoospermia and abnormal sperm parameters compared to healthy controls.
5. Anti-Epileptic Drugs (AEDs)
- Shukor et al. (2020) reported that men taking valproic acid had significantly lower sperm concentration and motility compared to those not taking AEDs.
| Drug Class | Specific Drugs | Effects on Male Fertility |
|---|---|---|
| Anabolic-Androgenic Steroids (AAS) | Testosterone derivatives (e.g., nandrolone, stanozolol) | Decreased sperm count, motility, and normal morphology; testicular atrophy; suppressed testosterone production |
| Chemotherapeutic Agents | Alkylating agents (e.g., cyclophosphamide, cisplatin) | Testicular damage; impaired spermatogenesis; azoospermia (complete absence of sperm) |
| Antimetabolites (e.g., methotrexate) | Reduced sperm quality and motility | |
| Purine analogs (e.g., mercaptopurine) | Impaired spermatogenesis | |
| Antidepressants | Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., fluoxetine, sertraline) | Decreased sperm count, motility, and normal morphology |
| Immunosuppressants | Cyclosporine | Oligozoospermia (low sperm count); abnormal sperm parameters |
| Mycophenolate mofetil | Oligozoospermia; abnormal sperm parameters | |
| Anti-Epileptic Drugs (AEDs) | Valproic acid | Reduced sperm count and motility |
| Topiramate | Abnormal sperm parameters | |
| Anti-Inflammatory Drugs | Sulfasalazine | Impaired sperm motility; oligospermia |
6. Psychoactive drugs
- Psychoactive drugs negatively affect male reproductive functions, including sexual urge, androgen synthesis, spermatogenesis, and sperm quality. They induce testicular toxicity by promoting ROS-dependent testicular and sperm oxidative damage, inflammation, and apoptosis
| Psychoactive Drug | Effects on Male Fertility |
|---|---|
| Cannabis | Decreased sperm count, motility, and viability |
| Opioids | Decreased testosterone levels, impaired spermatogenesis, reduced sperm quality |
| Cocaine | Decreased sperm count, motility, increased sperm abnormalities |
| Methamphetamine | Decreased sperm count, motility, viability; increased sperm DNA fragmentation |
| Alcohol (excessive) | Decreased testosterone levels, impaired spermatogenesis, reduced sperm quality |
7. Antibiotics
a. Nitrofurans (e.g., Nitrofurantoin)
- Reduced sperm count and motility.
- Nitrofurantoin has been shown to negatively affect sperm parameters, likely due to its oxidative effects .
b. Tetracyclines (e.g., Doxycycline)
- These drugs can bind to calcium and affect sperm motility.
- Temporary reduction in sperm quality.
8.Antihypertensive drugs
These include:
| Antihypertensive Drug Class | Effects on Male Fertility |
|---|---|
| Calcium Channel Blockers (CCBs) | Decreased sperm motility, increased sperm abnormalities |
| Angiotensin-Converting Enzyme (ACE) Inhibitors | Decreased sperm count and motility |
| Angiotensin II Receptor Blockers (ARBs) | Decreased sperm count and motility |
| Beta-Blockers | Decreased sperm motility, increased sperm abnormalities |
9. Drugs used to treat benign prostatic hyperplasia (BPH)
These include:
| Drug Class | Specific Drugs | Effects on Male Fertility |
|---|---|---|
| Alpha-Blockers | Tamsulosin, Alfuzosin, Doxazosin, Terazosin | May cause retrograde ejaculation, reduced semen volume, and decreased sperm count and motility |
| 5-Alpha Reductase Inhibitors | Finasteride, Dutasteride | May cause decreased semen quality, reduced sperm count, motility, and morphology |
| Phosphodiesterase Type 5 (PDE5) Inhibitors | Tadalafil, Sildenafil | Generally considered safe for fertility, but may cause temporary impairment of semen parameters |
| Anticholinergics | Oxybutynin, Tolterodine | Limited data, but may potentially affect semen quality and sperm parameters |
| Combination Therapy | Dutasteride + Tamsulosin | Combination therapy may have additive effects on semen quality and sperm parameters |
