Women with epilepsy have only one fourth to one third as many children as women in the general population. Many explanations have been proposed, and it is likely that not only one factor, but rather a combination of factors, may reduce fertility in women with epilepsy. A potential mechanism is the direct effect of seizures on the hypothalamus, disrupting ovulation as well as causing the elevation of prolactin levels seen soon after a generalized tonic-clonic seizure. Also, epilepsy and possibly, treatments for epilepsy may interfere with the hypothalamic-pituitary axis, leading to menstrual irregularities, anovulatory cycles, and polycystic ovary disease (PCOD).29 The induction of hepatic metabolism and decrease in the unbound fraction of the sex hormones by the use of some AEDs is also likely to play a role. Diminished libido may be a key factor in the lower fertility rates observed among women with epilepsy. A study of sexual dysfunction in epilepsy found that genital blood flow is significantly diminished in women with partial epilepsy, representing a diminution in one of the physiologic aspects of sexual arousal.32
Another study found that women with epilepsy were only 37% as likely to have had a pregnancy as unaffected female siblings.33 This lower rate was maintained even among married women, whereas the similarly decreased fertility seen among men in the study was primarily attributable to a smaller proportion of men with epilepsy who had ever married. This reinforces the notion that biological and psychological factors are likely to play a major role in decreased fertility observed in women with epilepsy. Another study showed that a majority of women with temporal lobe epilepsy had menstrual abnormalities and more than a third had reproductive endocrine disorders (such as polycystic ovaries and hypogonadotropic hypogonadism).34
Reviewed February 2004 by Cynthia Harden, MD, Weill Cornell Medical College.
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