Comprehensive Epilepsy Center
Women's Health - Infertility 

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Approximately 10% of American Women suffer from infertility. The medical definition of infertility is “inability to conceive after 1 year of sexual intercourse without using contraception”. Possible causes of infertility are: failure to release an egg each menstrual cycle (anovulation), endometriosis, scarred or blocked fallopian tubes, damaged reproductive organs, and cervical mucus that does not allow sperm to come into contact with the egg. 30% to 40% of couples cannot conceive due to “male factors” such as low sperm count.

Women with epilepsy (WWE) appear to have reduced fertility rates. It used to be thought that this was because many women with epilepsy did not marry, and thus chose not to have children. However, one study comparing the fertility rates of married WWE and their (nonepilptic) sisters found that the WWE were half as likely to become pregnant as their sisters. Other studies have found no difference or very little difference in fertility rates in WWE as compared to the general population. More studies need to be done before this question can be answered.

It is clear that WWE are at an increased risk for irregular menstrual cycles, hormone imbalances, and reproductive endocrine disorders such as polycystic ovary disease. For example, in WWE 35% of their menstrual cycles are anovulatory (as compared 10% in women without seizures). Specific brain regions “communicate” with the reproductive organs by sending and receiving hormonal messages. When seizures occur, these messages can be changed or interrupted. Antiepileptic medications may also contribute to sex hormone imbalances.

WWE who are having trouble becoming regnant should ask their gynecologist for a fertility evaluation. This usually includes blood hormone levels, pelvic ultrasound, and a complete gynecologic examination. Charting basal body temperature or checking a day 22 progesterone level (Day 1 = first day of menses) will help determine if ovulation is occurring. If possible, the woman’s partner should provide a sperm sample for analysis. More specific testing and procedures may be ordered if needed.