Do Selective Serotonin Reuptake Inhibitors (SSRIs) or Adderall (amphetamine and dextroamphetamine) interfere with the embryo transfer process?

SSRIs and Adderall During Embryo Transfer: Safety Considerations

Based on the most recent evidence, neither SSRIs nor Adderall (amphetamine and dextroamphetamine) appear to significantly interfere with the embryo transfer process, though caution is warranted with Adderall due to potential obstetrical risks if pregnancy is achieved.

SSRI Safety During Embryo Transfer

SSRIs are commonly used medications for depression and anxiety, conditions that frequently affect women of reproductive age. When considering their use during embryo transfer:

• SSRIs do not appear to directly interfere with the embryo transfer procedure itself 1, 2
• The risk of major congenital malformations with SSRI use during early pregnancy is not greatly increased 2
• If pregnancy is achieved, continuing SSRI treatment is generally recommended as maternal depression can have harmful consequences on fetal and infant development 1

SSRI Selection if Treatment is Needed:

If SSRI treatment is required during the embryo transfer period, medication choice matters:

• First-line options: Sertraline and citalopram have the most favorable safety profiles 3
• Avoid if possible: Paroxetine and fluoxetine have stronger associations with negative pregnancy outcomes 3

Adderall (Amphetamine/Dextroamphetamine) Considerations

For women taking Adderall who are undergoing embryo transfer:

• No direct evidence suggests Adderall interferes with the embryo transfer procedure itself
• However, if pregnancy is achieved, there are some potential risks to consider:
  • Possible increased risk for preeclampsia (aRR, 1.29; 95% CI, 1.11-1.49) 4
  • Possible increased risk for preterm birth when stimulant use continues in the second half of pregnancy (aRR, 1.30; 95% CI, 1.10-1.55) 4
  • Possible increased risk for gastroschisis, though this association has been found in only one study and the absolute risk remains small 4

Clinical Management Recommendations

1. For women on SSRIs:

   • Generally safe to continue during embryo transfer
   • If starting or switching medication, prefer sertraline or citalopram
   • Avoid paroxetine if possible due to higher risk of cardiovascular defects

2. For women on Adderall:

   • Consider risks and benefits of continuing medication during embryo transfer
   • If ADHD symptoms are well-controlled and not severely impacting functioning, consider temporary discontinuation during embryo transfer and early pregnancy
   • If medication is essential for daily functioning, continue with careful monitoring
   • Non-stimulant options like atomoxetine may be considered as alternatives, though data are limited 4

Important Caveats

• If pregnancy is achieved after embryo transfer, abrupt discontinuation of either SSRIs or Adderall may lead to withdrawal symptoms and worsening of underlying conditions
• Untreated maternal depression or ADHD can negatively impact pregnancy outcomes, including increased risks for spontaneous abortion and preterm birth 4
• The decision to continue or discontinue medication should be made with consideration of the severity of the underlying condition and the potential risks of both medication exposure and untreated illness

Monitoring After Embryo Transfer

If pregnancy is achieved:

• For SSRI users: Monitor for potential neonatal adaptation syndrome if continued through late pregnancy 2
• For Adderall users: Monitor for potential obstetrical complications including preeclampsia and preterm birth 4

The evidence suggests that the benefits of treating significant depression, anxiety, or ADHD during the embryo transfer process generally outweigh the potential risks, particularly when appropriate medication selection is made.