Summary: Purpose: To describe a potential association between male infertility and valproate (VPA) exposure. VPA has been implicated in the development of polycystic ovarian disease and subsequent menstrual and infertility problems in women with epilepsy. Infertility has been well described in population-based studies of persons with epilepsy. The low marital rates for men with epilepsy have previously been thought to play a major contributing role.Methods: We report a case of a 32-year-old man whose wife and he were able to bear a child before the development of his epilepsy. With VPA monotherapy, the family were unable to conceive despite 4 years of unprotected intercourse. An infertility evaluation of the man revealed a very low sperm count of <50,00O/ml, no motile sperm, I6 million, 50% motility, 78% viability, and 72% with abnormal structure.Conclusions: One must be cautious in extrapolating from a case report, but these findings strongly suggest a direct effect of VPA on spermatic structure and function. Key Words: Valproate-Infertility-Epilepsy .It has been established that people with epilepsy, particularly women, have significantly lower fertility rates than persons without this disorder (1). Increased rates of reproductive and endocrine disorders have been documented in women with epilepsy for both primarily generalized (2), and partial epilepsies (3). Valproate (VPA) has been implicated in the development of polycystic ovarian disease and hyperandrogenism in women with epilepsy (4). Social and biologic influences affecting fertility in both men and women with epilepsy were studied by Schupf and Ottman (3, but relatively little attention has been paid to the issues of infertility in men with epilepsy. Chen et al. (6) studied the in vitro effect of antiepileptic drugs (AEDs) on human spermatic motility. They demonstrated marked inhibition of motility with exposure to phenytoin (PHT), carbamazepine (CBZ), and VPA. We report a case of a man with partial epilepsy whose infertility appeared to be associated with VPA exposure.
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