What to Know About Taking Prescription Medications & Fertility Treatment

Navigating fertility treatments can be complex, especially for individuals managing other health conditions with medications. Understanding how these medications interact with fertility treatments is crucial both for patient safety as well as for optimizing outcomes – so, we asked Spring Fertility physician Dr. Angie Wang a few questions about fertility treatments and various prescription medications (including SSRIs, GLP-1 medications, thyroid medications, anti-seizure medications, and antihypertensives). Here’s what you should know: 

*Note that if you are taking prescription medications and considering fertility treatments, you should always consult with your doctors for guidance based on your specific case and medical history. 

Understanding Medications and Their Impact on Fertility Treatments

Medications such as SSRIs for depression and anxiety, GLP-1 medications for diabetes, thyroid medications, anti-seizure medications, and antihypertensives can have implications for fertility treatments. Each type of medication affects the body differently, which can influence fertility outcomes and the management of treatments. 

SSRIs and Fertility Treatments:

SSRIs (Selective Serotonin Reuptake Inhibitors) are commonly prescribed for depression and anxiety. While essential for mental health, their use during fertility treatments requires careful consideration. 

Can I continue my SSRIs while undergoing egg freezing and IVF?  

SSRIs can be continued for both egg freezing and IVF. There is no need to stop during your stimulation cycle. 

Do SSRIs affect hormonal balance and ovarian reserve?  

The mechanism of SSRIs to affect serotonin modulation, which will certainly affect general hormonal balance. Some studies suggest that SSRIs may also affect the hypothalamic pituitary ovarian (HPO axis), which may affect ovulation or lead to irregular cycles. However, this does not occur in all patients and some may see no effect on their menstrual cycles.  There is not conclusive data that SSRIs affect ovarian reserve. It can also be difficult to study what the effect of SSRIs are specifically, versus the effect of underlying depression. 

Can I use SSRIs while trying to conceive naturally? 

While trying to conceive naturally, it is very important that your mental health is optimized prior to becoming pregnant. If your symptoms are well controlled on your current SSRI regimen, we do not recommend changing as long as  your medication is Pregnancy Category C or better. Some SSRIs such as Paroxetine are Pregnancy Category D due to possible linkage with birth defects, and medications in this category should be further discussed with your OB prior to trying to conceive, as a switch may be needed. 

GLP-1 Medications and Fertility Treatments: 

GLP-1 medications, including Ozempic (semaglutide), are widely prescribed for type 2 diabetes management. They function by mimicking the actions of the hormone GLP-1, facilitating insulin release and suppressing glucagon production to regulate blood sugar levels. In addition to regulating blood sugar levels, GLP-1 medications also influence gastric emptying. Gastric emptying refers to the rate at which food leaves the stomach and enters the small intestine for further digestion and absorption. GLP-1 medications, including Ozempic, can slow down gastric emptying, leading to prolonged feelings of fullness and reduced appetite. This effect contributes to their role in aiding weight loss and glycemic control. 

Can I continue my GLP-1 medication while undergoing egg freezing and IVF?  

Due to concerns about gastric emptying and risk of aspiration during anesthesia, we recommend stopping GLP-1 agonists at the time of the baseline ultrasound. At a minimum, patients are instructed to withhold any dosing of the medication one week prior (if weekly dose) or the day before (if daily dose) to their scheduled procedure. 

Can I use GLP-1 medication while trying to conceive naturally? 

As data about GLP-1 medication in pregnancy is limited, the current recommendation is to stop medications 2 months prior to trying to conceive naturally. 

Thyroid Medications and Fertility Treatments:

Thyroid medications are crucial for individuals with thyroid disorders, which can significantly impact fertility. 

Can I continue thyroid medications while undergoing egg freezing and IVF?  

Thyroid medications should be continued while undergoing egg freezing and IVF. 

Can I use thyroid medications while trying to conceive naturally? 

Thyroid medications can be used while trying to conceive naturally. However, if a patient has hypothyroidism, it is important to use a medication that has T4, which crosses the placenta. Thyroid medication formulations with T3 do not cross the placenta, so there is a chance that baby can be hypothyroid even if the mother’s thyroid levels are normal. 

Can I use thyroid medications while pregnant? 

See above. 

Anti-Seizure Medications and Fertility Treatments:

Anti-seizure medications are essential for individuals with epilepsy but can pose challenges during fertility treatments. 

Can I continue my anti-seizure medication while undergoing egg freezing and IVF?  

Anti-seizure medications can be continued during egg freezing and IVF. 

Do anti-seizure medications affect hormonal balance and ovarian reserve?  

There is no current evidence that anti-seizure medications that affect ovarian reserve. Some anti-seizure medications may affect general hormonal balance, including raising prolactin which can also affect menstrual cycles. Please discuss with your doctor if you have any questions or experience any menstrual-related side effects. 

Can I use anti-seizure medications while pregnant? 

While it is important to optimize anti-seizure medications prior to achieving pregnancy, not all medications are safe to take during pregnancy. Some medications such as valproic acid are associated with neural tube or other birth defects. In general, medications to continue during pregnancy should be Pregnancy Category C or better. It is important to work with your doctor to optimize your regimen on a safe medication for pregnancy prior to trying to conceive. 

Antihypertensive Medications and Fertility Treatments:

Managing high blood pressure is vital for overall health, including during fertility treatments. 

Can I continue my blood pressure medication while undergoing egg freezing and IVF?  

Blood pressure medications can be continued during egg freezing and IVF. 

Can I use blood pressure medications while pregnant? 

Adequate control of blood pressure is important during pregnancy to prevent complications such as preeclampsia. However, not all blood pressure medications are recommended during pregnancy, and depending on your regimen you may need to switch to a regimen that is recommended for pregnancy. Please consult your OB before you try to conceive to optimize your regimen to determine if any changes are needed. 

Balancing Medication Use and Fertility Goals: Managing health conditions with medications while pursuing fertility treatments requires a delicate balance. 

• Open Communication: Engage in open discussions with healthcare providers about all medications being taken, including SSRIs, GLP-1 medications, thyroid medications, anti-seizure medications, and antihypertensives. This ensures personalized and safe treatment plans. 

• Mental and Physical Health: Both mental and physical health are vital for successful fertility treatments. Managing conditions like depression, anxiety, diabetes, thyroid disorders, epilepsy, and hypertension effectively contributes to better fertility outcomes. 

Navigating fertility treatments while managing other health conditions with medications such as SSRIs, GLP-1 medications, thyroid medications, anti-seizure medications, and antihypertensives involves careful consideration and coordination with healthcare providers. At Spring, our expert providers work with you to help you understand the potential impacts of these medications on fertility and pregnancy, so you can make informed decisions that prioritize their overall health and fertility goals.