Medications known to impact male fertility and sperm quality

There are a number of drugs that could alter sperm quality parameters (concentration, motility, morphology) or in some way have a negative effect on male fertility. In this post we’ll look at a review that lists medications linked to male infertility, either in humans or in animal models.

Note that this post will serve as a quick reference that lists the drugs that affect male fertility. For more info on the specific studies, or for individual references and guidelines on managing treatment, please refer to the review article referenced.

Consult with your doctor and discuss these particular studies before making any treatment changes. It’s also a good idea to do an independent search to see if there’s any new studies not covered here (I explain how to do this at the bottom of this post).

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Medications that affect sperm health or male fertility

This information is sourced from a review by Semet et al. 2017 (link to PDF). Please check out this reference for more info (it’s open access), particularly the table on page 643, as it contains all the references and guidelines for managing treatment that aren’t included here. This was the most thorough review I found on the subject, but it is from 2017, so it may be dated in some ways.

Immunosuppressive drugs. This is a class of drugs that suppress or reduce the strength of the body’s immune system. Siroliumus, Ciclosporine and Tacrolimus are linked to negative effects on sperm quality in humans and/or animals. Azathioprine and mycophenolate mofetil aren’t known to affect sperm, but are mutagenic. Fingolimod is teratogenic in animals (interferes with normal fetal development).

Corticosteroids. These medications have anti-inflammatory properties. Prednisone and Prednisolone have no known effect on sperm formation in humans, although it’s biologically possible.

Non-steroidal anti-inflammatory drugs (NSAIDs) and salicylates. These drugs can reduce pain and inflammation. Chronic use of Acetylsalicylic acid (aspirin) and Sulfasalazine can have a negative effect on sperm quality. Mesalazine can also have a negative effect on sperm quality.

Immunomodulators. These are agents that modify the immune response or the functioning of the immune system. Monoclonal antibodies (Trastuzumab, Alemtuzumab, Rituximab, Cetuximab, Bevacizumab, Omalizumab, Anakinra) and TNF-alpha inhibitors (Adalimumab, Etanercept) have no known effects on sperm quality. The TNF-alpha inhibitor Infliximab has been shown to have a negative effect on sperm quality. Dabrafenib, Vismodegib, Ipilimumab, Leflunomide, Thalidomide and Interferon gamma have been shown to have negative effects on male fertility in animals and/or humans. Interferons alpha and beta, and immunoglobulin IV are not known to have an effect.

Tyrosine kinase inhibitors. This is class of drugs that specifically block the action of enzymes called tyrosine kinases, and are used to treat certain cancers and other diseases. Sorafenib can alter sperm parameters in animal models.

Opiates/opioids. This class includes medications derived from opium, like morphine, as well as synthetic drugs that mimic their pharmacological effects. Morphine can lead to fertility decline in rats. Cocaine can have a negative effect on human sperm parameters.

5-alpha reductase inhibitors. This class of drugs is for treating benign prostatic hyperplasia and androgenetic alopecia. Finasteride and Dutasteride are linked to decreases in sperm count.

Alpha-blockers. These drugs primarily affect alpha-adrenergic receptors and are used to treat hypertension, Raynaud’s disease, benign prostatic hyperplasia (BPH) and erectile dysfunction. Tamsulosin is linked to negative effects on sperm quality.

Hormonal treatments. This refers to medications affecting hormone levels, such as anabolic steroids and androgens. Anabolic steroids, testosterone and androgens are linked to negative effects on sperm quality.

Antiandrogenic drugs. These drugs prevent androgens from expressing their biological effects on responsive tissues. Cyproterone acetate and Flutamide are linked to negative effects on sperm quality.

Diuretics. This class includes drugs that help to rid the body of salt (sodium) and water. Spironolactone is linked to impaired sperm motility.

Antibiotics. A class of medications that kill or slow down the growth of bacteria. Nitrofurantoin, Erythromycine, Cotrimoxazole, Tetracyclines, Aminosides, Penicillin and Quinolones are linked to negative effects on sperm quality in animals and/or humans.

Antimalarials. These are drugs used to prevent or cure malaria. Chloroquine is linked to decreased sperm motility in rats.

Antifungal drugs. These are medications to treat fungal infections. Ketoconazole, Fluconazole and Amphotericine B are linked to negative effects on sperm quality in animals.

Antiparasitic drugs. These are drugs to treat parasite infections. Metronidazole is linked to negative effects on sperm quality in animals.

Antiviral drugs. These are drugs to treat viral infections. Ribavirine, Acyclovir and Antiretroviral therapies are linked to negative effects on sperm quality in animals and/or humans.

Retinoids. These are drugs based on vitamin A and primarily used for skin conditions. Isotretinoin and Acitretine are linked to negative effects on the male reproductive system in animals but not humans.

Acid reflux drugs. These are medications used to treat acid reflux conditions. Cimetidine and Lansoprazole are linked to negative effects on the male reproductive system.

Antidepressants. These are drugs used to treat depression. Imipramine, Selective Serotonin Reuptake Inhibitors (Fluoxetine, Paroxetine, Sertraline, Fluvoxamine, Citalopram, Venlafaxine), Buspirone and Lithium salts are all linked to negative sperm quality in animals and/or humans.

Antipsychotics. These are drugs used primarily to manage psychosis, including schizophrenia and bipolar disorder. Insufficient data for Chlorpromazine, Haloperidol and Metoclopramide, but biologically possible to impact sperm.

Antiepileptics. These drugs treat seizures. Valproate, Phenytoin, Carbamazepine and Oxcarbazepine are all linked to negative sperm quality in animals and/or humans.

Gout medications. These medications treat gout. Colchicine is linked to negative sperm quality.

Antihypertensive drugs. These medications help to manage hypertension. Beta-blockers (Propranolol, Carvediolol, Metoprolol, Atenolol, Nebivolol), Calcium channel blockers (Nifedipine, Amlodipine, Verapamil, Diltiazem), Angiotensin-Converting Enzyme (Captopril, Enalapril) and Methyl-dopa are all linked to negative sperm quality in animals and/or humans.

Anticholesterol drugs. These drugs help manage high cholesterol. Statins (Simvastatin, Atorvastatin) and Gemfibrozil are linked to decreased sperm parameters in rats.

Again, this information is sourced from a review by Semet et al. 2017 (link to PDF). Please check out this reference for more info (it’s open access), particularly the table on page 643, as it contains all the references and guidelines for managing treatment that aren’t included here.

What if my medication isn’t on this list? Is it safe to assume it doesn’t affect sperm?

While a number of drugs were listed in this article, it’s not meant to be 100% complete.

If you are on a medication, it’s important to do a quick Google search and see if there’s any studies that show effects on male fertility. A good way to do this is to use Google Scholar, which only includes published scientific research as search results. Simply type in your medication name and “sperm” or “male fertility” to get a list of the available studies.

Since the same drug can have different names (the chemical name, the generic/non-propritary name and the marketed name), it’s important to try searching using these different names to catch all the available studies.

Once you’ve identified some studies, bring them to your doctor and see what they recommend. Good luck!

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About Embryoman

Embryoman (Sean Lauber) is a former embryologist and the founder of Remembryo, an IVF research and fertility education website. After working in an IVF lab in the US, he returned to Canada and now focuses on making fertility research more accessible. He holds a Master’s in Immunology and launched Remembryo in 2018 to help patients and professionals make sense of IVF research. Sean shares weekly study updates on Facebook, Instagram, and Reddit regularly. He also answers questions on Reddit or in his private Facebook group.

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