Is bupropion (Bupropion HCl) effective for treating infertility?

Bupropion HCl for Infertility

Bupropion HCl is not recommended for the treatment of infertility as there is no evidence supporting its efficacy for this indication and it may potentially impair sperm quality in males.

Evidence on Bupropion and Fertility

Male Fertility

• Animal studies suggest bupropion may negatively impact male fertility parameters. Research in rats showed that bupropion treatment (30 mg/kg for 30 days) impaired sperm quality by increasing the incidence of non-progressive sperm 1.
• The FDA drug label for bupropion does not indicate it as a treatment for infertility. In fertility studies with rats at doses up to 300 mg/kg/day, there was no evidence of impaired fertility 2.
• There is no evidence in clinical guidelines supporting bupropion as a treatment for male infertility.

Female Fertility

• While one study examined bupropion extended-release (150 mg/day for eight weeks) for sexual dysfunction in infertile women, it did not evaluate fertility outcomes or pregnancy rates 3. The study found that psychosexual therapy was more effective than bupropion for improving sexual function.
• No clinical guidelines recommend bupropion for female infertility treatment.

Bupropion's Established Uses

Bupropion is FDA-approved and recommended in guidelines for:

• Smoking cessation 4
• Major depressive disorder 2
• Seasonal affective disorder 2

The U.S. Preventive Services Task Force (USPSTF) found convincing evidence that bupropion hydrochloride sustained-release (bupropion SR) substantially improves achievement of tobacco cessation in nonpregnant adults who smoke 4.

Special Considerations in Pregnancy

• The USPSTF found no evidence on the benefits of bupropion SR to achieve tobacco cessation in pregnant women or to improve perinatal outcomes in infants 4.
• Recent guidelines (2024) on ADHD in pregnancy note that bupropion does not seem to be associated with major congenital malformations or other significant adverse obstetrical outcomes, although data are limited 4.
• There is a possible small absolute increase in the risk of certain cardiovascular malformations with first-trimester exposure to bupropion monotherapy, but confounding by indication cannot be ruled out 4.

Alternative Approaches for Infertility

For male infertility, evidence-based approaches include:

• Weight loss, smoking cessation, moderate alcohol consumption, and avoiding excessive heat exposure to improve sperm quality 5
• Human chorionic gonadotropin (hCG) injections and FSH injections for hypogonadotropic hypogonadism 5
• Selective estrogen receptor modulators (SERMs) for idiopathic oligospermia 5
• Avoiding testosterone monotherapy if fertility is desired, as it suppresses spermatogenesis 5

Conclusion

Bupropion has established efficacy for smoking cessation and depression but lacks evidence supporting its use for infertility treatment. In fact, animal studies suggest it may potentially impair sperm quality. Patients seeking treatment for infertility should be directed toward evidence-based fertility treatments rather than bupropion.