Women with epilepsy at risk of infertility

Women with epilepsy may be more likely to experience infertility, according to new research published in the October 12, 2010, print issue of Neurology®, the medical journal of the American Academy of Neurology.

The study of women in India found that women with epilepsy experienced infertility at more than twice the rate of that found in the general population. The research also found that women who were taking multiple epilepsy drugs were more likely to be infertile than those taking fewer drugs or no drugs for epilepsy.

The study involved 375 women with an average age of 26 who were anticipating becoming pregnant. The women were followed until they became pregnant or for up to 10 years. During that time, 62 percent became pregnant, while 38 percent remained infertile. The infertility rate for the women in the general population in India is 15 percent.

Those who were taking three or more drugs for epilepsy were 18 times more likely to be infertile than those taking no epilepsy drugs. Seven percent of those taking no epilepsy drugs were infertile, compared to 32 percent of those taking one epilepsy drug, 41 percent of those taking two epilepsy drugs, and 60 percent of those taking three or more epilepsy drugs.

"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," said study author Sanjeev Thomas, DM, of the Sree Chitra Tirunal Institute for Medical Sciences and Technology in Trivandrum, India.

Older women and women with less than 10 years of education were also more likely to experience infertility. Thomas said the relationship between lower education and infertility could also be due to difficult-to-treat epilepsy, which may make completing additional years of education challenging.

The study found that most pregnancies occurred within two years. "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," said editorial author Alison M. Pack, MD, of Columbia University in New York.

Those taking the drug phenobarbital had significant risk of infertility, but no such trend was observed with valproate or other drugs.