Addictions and Fertility
The causes of infertility have changed significantly over the past 30 years, and the impact of environment and lifestyle on the difficulties experienced by couples plays an important role in fertility alteration. Recording of these factors began about 10 years ago.
The fertility of a generation would appear to be linked to toxic factors, the activity of which began during the intrauterine life of the mother, i.e., pollutants, which seem to act as endocrine disruptors, especially on male fetuses, and other behavior dependent toxic factors, such as smoking, alcohol and lifestyle. Fertility in adults may be altered by factors such as cannabis, antidepressants, weight, diet, profession, intense exercise, stress, sexual intercourse targeted at the date of ovulation and infertility related stress. Infertility-related toxic factors and lifestyles are still often not detected and the diagnosis and early treatment of these problems would enable natural fertility to be improved and would reduce the need for medically assisted procreation.
Addiction to illicit substances and prescription medications can have a severe impact on the fertility and reproductive function of both men and women. In many cases, negative effects can often be reversed once the individual is no longer abusing chemical substances, but in some cases reproductive damage can be permanent.
Additionally, addiction isn’t just a problem that may lead to decreased fertility, but it can also negatively impact an ongoing pregnancy.
The specialists on Human Assisted Reproduction have to encourage patients to modify habits involving alcohol abuse, smoking, opioid abuse and dependence, as well as prescription drug abuse.
Healthy sexual function relies on a complex balance of many processes, from hormonally dependent glands in the brain (the hypothalamus, the pituitary) to one’s thyroid gland and the testicular function as well. There are many drugs that can affect this balance and sexual abilities can be at risk for abnormal function or become vulnerable to failure.
Substance abuse affects not only the persons using, but the relationships around them as well. When someone has an addiction, everything becomes a distant second, including employment, responsibilities and even one’s legal freedoms.
Addiction inhibits the normal functions of intimacy in both the relationship and fertility areas of a man’s and a woman’s reproductive life.
In men, addictions are related to high damages of their reproductive physiology as following:
Anabolic steroids: they can cause abnormal sperm production and low sperm count, testicular atrophy, infertility and erectile dysfunction.
Opioids: they can cause low testosterone directly and this will indirectly affect both sperm count and libido. Even if opioid abuse is treated via a methadone program, methadone itself can result in low testosterone.
Antidepressants: they can cause elevation in prolactin, loss of libido, elevated thyroid hormone and hypogonadism and an erectile dysfunction as well.
Benzodiazepines: they can cause erectile dysfunction
Stimulants (cocaine and amphetamines): while initially stimulating arousal, ultimately they have a negative effect on the ability to achieve or maintain an erection. Cocaine has been associated with an elevated prolactin level.
MDMA/Ecstasy: they affect testosterone and sperm production negatively.
Alcohol: it can decrease libido. A chronic use can cause liver dysfunction and contribute to generalized debilitation.
Marijuana: chronic users of marijuana have lower sperm counts and sperm motility.
In women, addictions that can influence their reproductive system and consequently, their capacity to get pregnant are mentioned in the following:
Alcohol: it affects the reproductive function and the pregnancy outcome as well. Current recommendations of the American College of Obstetrics and Gynecology warn against any alcohol use during pregnancy, calling prenatal exposure to alcohol the leading preventable cause of birth defects and intellectual disabilities in children. It is suggested that alcohol abuse has a negative impact on women trying to get pregnant as well. In USA, the National Institute on Alcohol Abuse and Alcoholism defines excess drinking for healthy women as more than three drinks per occasion or more than seven drinks per week, and any amount of drinking for women who are at risk of pregnancy. In alcoholic women, a higher frequency of menstrual disturbance, abortion, and miscarriage as compared to controls is well observed. The British Medical Journal published a review concerning on the association between alcohol use and infertility. Women in the highest alcohol consumption group had a significant decrease in the probability that they would conceive, compared to women with no alcohol consumption. Another study of Brigham and Women’s Hospital and Harvard Medical School concluded that in women, the consumption of as few as four alcoholic drinks per week resulted in a 16% decrease in live birth rate from IVF.
Smoking: there is a strong association between cigarette smoking and infertility. Approximately 30% of reproductive age women and 35% of reproductive age men in the U.S. smoke cigarettes. A number of studies have shown dose-dependent effect of smoking on fertility. Studies showed that in women, even at one-half pack per day, cigarette consumption is consistently associated with decreased fecundity. A meta-analysis of literature reviews also suggests a causal relationship between cigarette smoking and female infertility. Various toxins from tobacco have been identified in the ovary and in the follicular fluid of smokers. Additionally, smoking has been associated with a shorter menstrual cycle length and it may accelerate follicular depletion leading to 1 – 4 years earlier menopause in smokers versus nonsmokers. It is very important to mention that the basal FSH levels were 66% higher in active smokers than in nonsmokers and 39% higher in passive smokers than in non-smokers which affects the oocyte quality. Current smoking is also associated with lower anti-Mullerian hormone (AMH) levels.
Concerning the human assisted reproduction treatments, a meta-analysis of studies suggests that smokers require nearly twice the number of IVF cycles to conceive as compared to nonsmokers. In addition, smokers require increased gonadotropin doses for ovarian stimulation, have lower peak E2 levels, elevated testosterone, fewer oocytes retrieved and consequently, a higher number of cancelled IVF cycles. Overall, it appears that ART may not always be able to overcome the reduction in natural fecundity associated with smoking.
Caffeine: modest use has negligible effect on fertility. On the contrary, heavy caffeine intake (500mg; > 5 cups of coffee/day or equivalent) has been associated with decreased fertility. In addition, high caffeine consumption (2-3 cups/day) during pregnancy, may be associated with an increased risk for miscarriage. A moderate caffeine consumption (1 to 2 cups of coffee per day or equivalent) before or during pregnancy, has no apparent effects on fertility or pregnancy outcomes.
Marijuana: According to the ASRM, such drug use generally should be discouraged for both men and women, particularly because of the well-documented harmful effects on the developing fetus. A detrimental impact of marijuana use on fertility has been mentioned in different studies. Women smoking marijuana for one year prior to IVF, have 25% fewer oocytes retrieved and in case of pregnancy, a significant decrease in infant birth weight is often observed.
Opioids: they include the use of heroin and the misuse of prescription opioid analgesic medication. The chronic untreated heroin use is associated with an increased risk of fetal growth restriction, placental abruption and fetal death. The current standard for pregnant women with opioid dependence is referral for opioid-assisted therapy with methadone or buprenorphine.
Non-medical use of prescription drugs: it is the third most common drug category of abuse after marijuana and tobacco. They include opioids, sedatives and stimulants, including barbiturates, and benzodiazepines. Non-medical use of stimulants is known to be most common among women younger than 50 years and roughly 67% of women reported ever having used stimulants not prescribed to them.
In conclusion, reproduction is a miraculous process and it is a complex interaction of many events, both within a man and a woman as well as between them. The sequence and balance of the rise and fall of the hormones responsible for testicular and ovarian function are at risk when drugs are used for chronic conditions or when drugs or alcohol are abused, resulting in dependence and addiction.
Any treatment for substance abuse disorders and addiction, either for a man or a woman of reproductive age, besides portending well for their health in general, will assure the wellbeing of their health in general and in the same time, the optimal sexual function at the glandular, hormonal, and performance levels.
In parallel with the diagnosis of the cause of infertility, the treatment of the infertile couple requires a detection of different environmental and lifestyle factors that influence the fertility procedure. This approach is even more necessary for the one-fourth of couples whose difficulties in their attempts to procreate are not associated with an infertility problem. The necessity of detecting toxic factors and unfavorable lifestyle factors to correct them before any medically assisted procreation treatment plays a crucial role.
Becoming a parent implies a great responsibility for an auto-control, because the children we raise will be depending on us by considering us the best template for their life.
Anastasios Argyriou
SENIOR CLINICAL EMBRYOLOGIST, MSC, PH.D.