How Medications Affect Sperm Count and Quality

The role of sperm health is vital for couples looking to conceive. In fact, male infertility on some level plays a role in up to 40% of infertility cases. Things like lifestyle factors and medications can play a role in sperm health, but it can be normal to wonder what specific medications should be avoided. For instance, can over-the-counter medications like aspirin or ibuprofen kill sperm?

Fortunately, if taken in the proper dose and used as intended, most common over-the-counter (OTC) medications shouldn’t reduce sperm count, says Mark Surrey, MD, co-founder and medical director of the Southern California Reproductive Center. But there's no one right answer for everyone and to help point you in the right direction, here's a guide to how certain medications could affect sperm quality and count. As always, be sure to talk to your own doctor as well, especially if you are looking to conceive soon, are over the age of 35, or have any specific medical conditions.

How Medications Affect Sperm and Male Fertility

A number of things can affect sperm and fertility, such as being overweight or too thin, smoking cigarettes, excessive drinking, genetic factors, the environment, use of recreational drugs, and someone's overall health. In general, the healthier a person, "the healthier [the] sperm will be,” says Joshua M. Hurwitz, MD, a reproductive endocrinologist and partner at Reproductive Medicine Associates of Connecticut.

Medications can also affect sperm, such as by decreasing production, causing a low sperm count (the number of sperm present in ejaculate), or affecting the way the sperm functions, Dr. Hurwitz says. Low sperm count means your partner will have fewer sperm available to fertilize an egg, and if the sperm’s motility (its ability to move) is reduced, the sperm will have a difficult time reaching the egg.

How long a medication affects sperm varies depending on the medicine. A good rule of thumb is someone shouldn’t expect any changes to occur until at least 2 to 3 months after discontinuing the medication. That’s because it takes sperm about that long to form and fully mature. So what someone did in the past 90 days—for instance, using recreational drugs—will affect present sperm quality. And what someone does today will show up in sperm two to three months from now.

Some medications can also interfere with the actual production of sperm, called spermatogenesis, meaning that the sperm may not be produced at all.

With some medications, it can take much longer for sperm counts to increase. Testosterone supplements, for example, can have a lingering or even permanent effect, taking many months or even years before sperm production resumes.

Over-the-Counter Medications and Sperm Health

As Dr. Surrey noted, most OTC medications are safe to take as recommended by a doctor. However, since there are many different OTC medications and remedies that are untested, and because everyone is different, it's always a good idea to discuss you or your own partner's individual risk with a doctor. It may be helpful to be especially cautious with the following medications:

NSAIDs (Non-steroidal anti-inflammatory drugs)

A 2018 study found that men who took 1,200 mg (600 mg twice a day) of ibuprofen per day developed a hormonal condition that is linked to reduced fertility. Researchers in the study found evidence of reduced fertility beginning as soon as 14 days into taking the ibuprofen every day and the max length of time participants took the ibuprofen was 44 days straight in the study.

It’s not clear whether people taking lower doses of ibuprofen are at the same risk, or whether the effects are reversible if the drug is used for long periods of time. The good news is that according to the study, the effects are reversible when the medication is taken short-term.

Natural or herbal remedies

Just because something has a “natural” or “herbal” label, doesn’t guarantee it’s safe, or even effective. The issue with natural or herbal remedies is they generally don’t undergo the same scientific testing and aren’t as strictly regulated as medications, says Dr. Surrey. He recommends running any regular supplements you are taking by a doctor if you're concerned about how it could impact sperm health.

Another reason to be wary of so-called natural and herbal remedies that contain testosterone: any supplement that has the term “male enhancement,” “andro booster,” “T-booster” or similar has testosterone or analogs of testosterone, which will decrease sperm production, adds Dr. Hurwitz.

Prescription Medications

If your partner is taking any of the following prescription medicines, discuss them with a healthcare provider to determine what impact it may have on your attempts to become pregnant.

Steroids and testosterone therapy

Testosterone puts sperm production at a complete standstill. In fact, testosterone can be so harmful to sperm that the World Journal of Men's Health calls it a "contraceptive."

“Testosterone supplements of any form will cause sperm count to drop to zero—whether there’s a little of it in a vitamin someone takes, in illegal anabolic steroids at the gym, or a prescription testosterone replacement from the doctor,” says Dr. Hurwitz. The supplements decrease the body’s ability to make its own testosterone, making it unable to produce sperm. As mentioned earlier, it can take months or years before normal sperm production resumes after the use of testosterone.

Chemotherapy drugs

Chemotherapy medication is another drug that wipes out sperm count. “Chemotherapy works by killing rapidly dividing cells,” says Shona Murray, MD, an ob-gyn and director of Advanced Reproductive Medicine at the University of Colorado Denver. “It primarily targets the cancer cells; however, sperm cells are also dividing cells and so will too be targeted by the chemotherapy,” she explains. It’s common for individuals who have been treated to have no sperm in their ejaculate after chemotherapy.

Natural fertility may return in 1 to 5 years after discontinuation of the drugs, notes the American Cancer Society. However, it’s not clear what damage there is to the sperm DNA and the exact impact on someone's sperm could depend on what type of chemotherapy they have, any additional treatments, and the areas treated, so talk to a doctor about if there's a recommended time length to wait after stopping chemotherapy treatment.

Blood pressure medications

In addition to possibly causing decreased libido and erectile dysfunction, blood pressure medications, namely calcium channel blockers, can interfere with the ability of sperm to fertilize the egg, says Dr. Murray. Some blood pressure meds have also been associated with decreased semen volume, sperm concentration, and motility, she adds.

Opioids

Not only is it possible for these pain medications to cause erection and ejaculation problems, opiods can also decrease testosterone levels and sperm production, Dr. Hurwitz says.

Antidepressants

When used longer than one month, selective serotonin reuptake inhibitors (SSRIs) may have a negative effect on sperm production, reducing its mobility and quantity, according to 2022 research. Additionally, SSRIs can cause a person’s libido to drop, which could present a challenge depending on your conception method, Dr. Murray adds.

Antibiotics

Certain antibiotics, while helpful for treating bacterial infections, could interfere with sperm quality. For instance, Ketoconazole, an antifungal antibiotic, interferes with testosterone and sperm production. And other antibiotics may have a minor effect on sperm function, Dr. Murray says.

However, the reason someone is taking the antibiotics in the first place may be more relevant to sperm health. “Any underlying illness that causes a fever and thereby overheats the testicles can adversely affect sperm count for up to two months,” Dr. Murray notes.

Biologics

Biologics are manufactured medications that are usually used in the treatment of autoimmune disorders, like arthritis, lupus, and ulcerative colitis. Some can reduce sperm count, and Dr. Hurwitz says they may also cause DNA damage to the sperm. Research on the impact of biologics on sperm and DNA is still ongoing, so Dr. Hurwitz encourages anyone using these drugs to consult with their urologist or fertility specialist before trying to get pregnant.

Fertility-Friendly Medication Alternatives

If your partner is currently using a medication that could affect sperm quality, the first step to take is to talk to a doctor. Some medications may be important for overall health, which can also affect sperm health, so it's important not to discontinue any medication without first talking to your doctor. Your doctor may recommend some solutions that could include:

• Switching medications. In some cases, if a drug does affect sperm quantity or quality, it may be possible to switch to another medication that has less of an impact on fertility, says Dr. Hurwitz. Your doctor may also be able to offer alternatives, such as a lower dose.
• Lifestyle changes. Lifestyle modifications may improve the underlying condition and decrease the need for some medications, Dr. Murray adds. For instance, someone with high blood pressure may be able to reduce the need for medication by getting to an appropriate weight, increasing physical activity, or changing their diet.
• Non-medication interventions. In addition, medication-free alternatives may be worth discussing with a doctor. For example, acupuncture can be just as effective as medication for chronic pain, and cognitive behavior therapy can help relieve mild to moderate cases of depression.
• Freezing sperm. Lastly, for medications that your partner cannot stop taking, such as chemotherapy drugs, you can discuss what options may be available for freezing sperm to use later for conception.