Epilepsy and Reproduction

Hormonal factors may influence seizure susceptibility, and epilepsy and antiseizure medications (ASM) may affect hormone levels. Fertility is reduced in men and women with epilepsy. This is likely multifactorial, including psychosocial factors, polypharmacy, reduced hormonal levels, anovulatory cycles, and sperm abnormalities. Several ASM interact with and reduce the efficacy of the oral contraceptive pill (OCP). The combined OCP can reduce lamotrigine levels to an extent that has a clinical impact. Safety of usage during pregnancy has not been established for most ASM. Current data support that lamotrigine and levetiracetam are safe. Recently, the effects of ASM in men considering conception have also been raised, although this remains controversial. Levels of ASM may fall during pregnancy, potentially contributing to loss of seizure control. Poor seizure control during pregnancy has been associated with adverse outcomes, and regular reviews during pregnancy are essential to ensure safety for women with epilepsy and their offspring.