Avoiding Toxins Including Spermatotoxic Medications

Gillian Stearns, MD; Paul J. Turek, MD


Semin Reprod Med. 2013;31(4):286-292. 

In This Article

Abstract and Introduction


Global rates of infertility are significant, especially in many developing countries. In developed countries, infertility affects up to 15% of the reproductive-age population, with male factors involved in 50% of cases. During medical evaluation, a review of current and past medications and social habits is essential, as they may adversely affect fertility. In addition, knowledge of exposure is important for counseling regarding future fertility, as many such toxic exposures have reversible effects. We reviewed the English literature over the past 35 years for all types of studies that have examined drug, medication, and other exposures that have been linked to altered semen quality and male fertility. Both human and animal studies were included in this analysis. The goal of this review is to delineate the medication and habitual risk factors that have been associated with male infertility.


There are four ways in which drugs may influence male fertility: direct gonadal toxicity, alteration of the hypothalamic-pituitary-gonadal (HPG) hormonal axis, impairments in erectile function or ejaculation, and adverse effects on libido.[1–3] Although quite variable, the semen analysis has traditionally been used to evaluate the impact of risk factors on male infertility.[4] Clinically, semen volume, sperm motility, and morphology are the most commonly assessed parameters, as it is clear that abnormalities in these parameters decrease the likelihood of conception.[5] Unfortunately, the semen analysis does not reveal cause-specific abnormalities that can be used to implicate reproductive toxins.[6] However, through animal studies and observational studies in humans, associations between reproductive toxins and male infertility have been found and are reviewed here.