Epilepsy’s Impact on Fertility

There do not appear to be any differences in pregnancy rates, time to conceive, or pregnancy outcomes in people with epilepsy compared to the general population. People with epilepsy experience infertility at the same rate as people who do not have epilepsy and may need to consider fertility treatment to help them get pregnant.  

If a patient with epilepsy has been actively trying to get pregnant for six months or longer, offer a referral to a fertility specialist like an OB-GYN or reproductive endocrinologist. 

This page provides information to help clinicians consult with their patients about how their epilepsy may impact their fertility and fertility treatment decisions.

Topics covered on this page include:

Valproic Acid & PCOS

Some studies show increased rates of polycystic ovarian syndrome (PCOS) in people with generalized epilepsy who were prescribed valproic acid. PCOS is a risk factor for infertility. 

Patients with Epilepsy Using Fertility Treatments to Conceive

Some of your patients with epilepsy will require fertility treatments to get pregnant. There are three key points to consider when discussing this issue with your patients:

  • The rate of patients with epilepsy requiring fertility treatments to conceive is similar to that of the general population. 
  • People with epilepsy have a similar fertility treatment success rate as those without epilepsy. 
  • Most people with epilepsy will not experience increased seizure activity while undergoing fertility treatment.

However, given how significantly fertility treatment protocols — including those for intrauterine insemination (IUI), and in-vitro fertilization (IVF) — can vary, it is crucial that epilepsy care clinicians stay involved and informed when their patients undergo fertility treatments. 

Fertility Treatments & ASMs

Most people with epilepsy do not experience increased seizures during fertility treatments. But it is still important to understand their fertility treatment regimen, carefully monitor their anti-seizure medication (ASM) levels, and adjust their ASMs when necessary. 

Before your patient with epilepsy begins fertility treatment, their fertility team should share a detailed protocol with the patient’s neurologist. If the patient is receiving a hormone-based treatment, make sure their ASM levels are checked and, if necessary, change their ASM dosage. 

Lamotrigine & Prescribed Estrogen

Clinicians should pay particular attention to lamotrigine levels in patients taking estrogen, a common component of some fertility treatments. Use of prescribed estrogen may reduce lamotrigine levels. 

Guide Your Patients 

Patients can be reassured that they are just as likely to achieve pregnancy as their peers who do not have epilepsy. When a patient with epilepsy considers pregnancy, address their fertility and fertility treatment concerns in your pregnancy planning conversations.  

Your patients who need fertility treatments can confidently use them as a path to conception. Partnering with your patients and their fertility care teams to ensure treatment protocols are shared will ensure you can track and address any potential impacts on ASMs. 

Reviewed by: Laura Kirkpatrick, MD, August 2023