Polytherapy increases the risk of infertility in women with epilepsy

Reproductive capability is an important concern for women with epilepsy (WWE). We aimed to ascertain the magnitude of infertility in a cohort of WWE who were anticipating pregnancy.

A prospective cohort of WWE enrolled in the Kerala Registry of Epilepsy and Pregnancy (1998-2007) in the preconception stage. The endpoint was occurrence of pregnancy. They were divided into those who remained infertile (IG group) and those who had become pregnant during the follow-up period (FG).

Out of 375 women followed up for 1-10 years, 231 had pregnancy and 144 remained infertile (38.4%). Pregnancy occurred within 2 years of follow-up for most patients in the FG group. The IG group had higher mean age, lower education, and longer follow-up when compared to the FG group. Infertility was least (7.1%) for those with no antiepileptic drug (AED) exposure and higher (p = 0.001) with AED exposure (31.8% with 1 AED, 40.7% with 2 AED, and 60.3% with 3 or more AED exposure). Those exposed to phenobarbital had significant risk of infertility, but no such trend was observed with valproate or other drugs. On multiple logistic regression, use of 3 AEDs or more (odds ratio [OR] 17.9; 95% confidence interval [CI] 2.14-149.48), older age (OR 1.32; 95% CI 0.84-2.09), and low education (OR 2.91; 95% CI 1.82-4.65) remained as the important predictors of infertility.

More than a third (38.4%) of WWE had infertility. The important predictors of infertility were exposure to multiple AEDs, older age, and lower education.