Effect of Phenytoin on Semen

Abstract

Male patients receiving antiepileptic drugs (AEDs) have often complained of hyposexuality. Few studies have been done on semen analysis, which is relevant for assessment of potential and possible reproductive outcome in such cases. We evaluated the effect of epilepsy itself and/or phenytoin (PHT) on the male reproductive system. Fifty-five patients with epilepsy (42 with PHT and 13 untreated) and 28 healthy normal controls were studied by semen analysis. Serum samples from 21 of the 55 patients were also analyzed for testosterone, luteinizing hormone (LH), and follicle-stimulating hormone. Results showed lower volume of seminal fluid, spermatozoa concentration, and total sperm count in untreated and PHT-treated patients as compared with controls, although no difference was evident between the patient groups. Morphologically abnormal sperm were more increased in untreated patients than in PHT treated and control subjects. Hormonal analysis showed lower levels of testosterone in 9 patients. LH levels were increased in one third of the patients. Our results suggests an effect of seizures on the male reproductive system, and PHT may have a slight additive (if any) influence.

Alterações sexuais na epilepsia: resultados de uma avaliação multidisciplinar

“…Taneja e col. 31 encontraram diminuição do volume de fluido seminal e da concentração e motilidade dos espermatozóides em pacientes epilépticos sem tratamento e naqueles tratados com DPH, sugerindo que a epilepsia pode afetar a função gonadal de forma independente do tratamento com DAEs. O mecanismo mais aceito é a disrupção da função hipotalâmica pelas descargas epilépticas, levando a aumento de prolactina, inibição da liberação de GnRH, com consequente diminuição da liberação de LH e FSH e, finalmente, diminuição do nível de testosterona livre e diminuição na produção de esperma.…”

Hormon- und Sexualstörungen bei Epilepsie

“…Ältere Studien mit strukturierten oder unstrukturierten Interviews fanden diese noch häufiger bei 38-71 % [3,4,6,[38][39][40].…”

“…Abnormale Spermienanalysen, mit verminderter Spermienzahl, abnormaler Morphologie oder verminderter Motilität der Spermien, wurde bei bis zu 90 % von Männern mit Epilepsie berichtet [38,41].…”

Epilepsy in men: The effect of the disease and its therapy on reproductive endocrine functions

“…Enzyminduzierende AEDs können auch zu einem Anstieg des Serum-Östradiols führen [22,31]. Obwohl Östradiol nur 1% der gonadalen Steroide von Männern ausmacht, beeinflusst es nahezu zu 50% des negativen Feedback am Hypothalamus.…”

“…Tierexperimentelle Studien zeigten unspezifische Spermienveränderun-gen bei Gabe unterschiedlicher Antiepileptika [27,31]. Medikamentenspezifische gonadale Veränderun-gen in den Tubuli seminiferi und eine Hemmung der Spermiogenese wurden bei Wistar-Ratten nach Langzeitbehandlung mit VPA nachgewiesen [25].…”