Semen quality decreased but became normal after discontinuing drugs.
NEW ORLEANS—Selective serotonin-reuptake inhibitors (SSRIs) may inhibit sperm transport, resulting in impaired sperm motility and concentration in some men, researchers report.
“We found that patients who had been on SSRI antidepressants had a quick recovery to normal semen parameters within one month after discontinuation of antidepressant use. These changes were consistent and clinically significant,” said Cigdem Tanrikut, MD, a fellow in male reproductive medicine and microsurgery at Weill Medical College of Cornell University in New York City.
At the American Society of Reproductive Medicine annual meeting here, Dr. Tanrikut presented case reports on two patients who had a clear relationship between antidepressant use and infertility. The first case was a 44-year old man with a seven-month history of primary infertility. The patient’s medical history was notable for depression; he was being treated with citalopram, an SSRI. His physical and urologic examinations were unremarkable.
Over a period of 15 months, multiple semen analyses showed he was nearly azoospermic, with only 1% motility on his initial semen analysis (performed while on citalopram). A repeat analysis four weeks after discontinuation of citalopram showed a return to normal of all parameters.
“Bupropion, an atypical antidepressant with serotonergic, noradrenergic, and dopaminergic reuptake inhibitor effects, was initiated for treatment of his depression thereafter, and a semen analysis while on this medication again showed marked oligospermia and 10% motility,” Dr. Tanrikut said.
Following two failed in vitro fertilization attempts, the man was reassessed one year after his initial presentation and, while still on bupropion, semen analysis again revealed severe impairment. During a tapering off of bupropion, semen parameters started to improve and within two months after stopping the medication, analysis showed normal semen concentration and motility.
The second case was a 35-year-old man who also presented with primary infertility. He had been taking sertraline, an SSRI, for five years. The patient’s initial semen sample while taking sertraline had a sperm concentration of only 20,000/mL and showed no motile sperm. Three months after stopping the drug, all parameters were normal, with 40 million total motile sperm in his ejaculate.
“We hypothesize that SSRIs may have an effect on sperm transport within the male reproductive tract,” Dr. Tanrikut told Renal & Urology News. “There are more than six million men in the United States on antidepressants and the numbers are increasing. We don’t know how many men may be affected, but this does warrant further study.
Very few studies have been done to assess the impact of SSRI antidepressants on male fertility status, and these select cases raise a significant concern.”
It is well known that SSRIs impair ejaculation, and some of these agents are now commonly prescribed for treatment of premature ejaculation.