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. However, 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. 

We recommend that 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.

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 can vary — including those for intrauterine insemination (IUI), and in-vitro fertilization (IVF) — 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 so that this can be taken into consideration if seizures do worsen. If fertility treatments involve prescription estrogens,  this may lower lamotrigine levels. For patients who are sensitive to drops in the lamotrigine levels, short-term dose adjustment may be considered. Following levels may guide management during the present or future treatment cycles.

Before your patient with epilepsy begins fertility treatment, their fertility team should share a detailed protocol with the patient’s neurologist.

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.  

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: EPMC Expert Panel, March 2025