MHM Magazine

Introduction Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse, and affects a significant portion of the population, with global rates ranging from 8 - 30%. Within psychiatric populations, the impact of psychiatric medications on fertility is an area of growing concern. Preconception considerations are required when prescribing psychiatric medications, as they may affect fertility in both males and females. Psychiatric medication and fertility Most antidepressants can negatively impact fertility in both genders. Depressive disorders themselves can reduce libido and cause sexual dysfunction, necessitating a careful evaluation of the benefits of treating depressive symptoms against the risks of medication-induced sexual side effects. Psychiatric medications in males Male sexual dysfunction due to psychiatric treatment is a significant concern that can lead to nonadherence. Several chronic disorders, such as hypertension, diabetes mellitus, bipolar disorder, and epilepsy, can exacerbate sexual dysfunction and fertility issues in men. Antidepressants in males Selective Serotonin Reuptake Inhibitors (SSRIs) SSRIs are known to negatively affect sperm concentration, motility, and morphology. Common side effects include decreased libido, erectile dysfunction, delayed ejaculation, and anorgasmia. • Fluoxetine: In vitro studies have shown a dose-dependent decrease in sperm volume and motility, along with reductions in sexual organ weight and plasma testosterone and FSH(follicular-stimulating hormone) levels. • Sertraline: Case studies report that Sertraline reduces sperm concentration and motility, though improvements are observed upon discontinuation. Clinical trials have shown significant reductions in sperm count and morphological abnormalities after three months of treatment. Premature ejaculation SSRIs are also used to treat premature ejaculation by delaying ejaculation, which can enhance the quality of sexual intercourse and increase coital frequency. However, excessive delay in ejaculation may increase infertility risks due to oxidative damage to By Dr Lavinia Lumu Specialist psychiatrist Johannesburg, Gauteng lavinia.lumu@yahoo.com PSYCHIATRIC MEDICATION AND FERTILITY: PRECONCEPTION PRESCRIBING CONSIDERATIONS IN PSYCHIATRY MHM | 2025 | Volume 12 | Issue 1 | Psychiatric Medication and Fertility: Preconception Prescribing Considerations in Psychiatry MHM 6 | MENTAL HEALTH MATTERS | 2025 | Issue 1 H