Impact of Sertraline on Sperm Quality
Yes, sertraline can negatively affect sperm quality, including reducing sperm concentration, decreasing normal morphology, and increasing sperm DNA fragmentation, which may impact fertility in men. 1
Effects on Sperm Parameters
- Sertraline has been shown to cause a significant reduction in sperm concentration and percentage of normal morphology in men 1
- The percentage of sperm DNA fragmentation is significantly higher in men taking sertraline compared to those using behavioral therapy for premature ejaculation 1
- Sertraline inhibits CatSper Ca2+ channels in human sperm, which are essential for proper sperm function and fertilization 2
- This inhibition of CatSper channels by sertraline can impair ligand-induced acrosome reaction and sperm penetration into viscous media 2
Mechanism of Action
- SSRIs like sertraline can cause oxidative damage to sperm due to prolonged residence in the male reproductive tract 3
- The increase in ejaculatory latency seen with SSRIs likely contributes to their negative effects on semen quality 3
- Sertraline is approximately four times more potent at suppressing prostaglandin-induced Ca2+ influx versus steroid-induced Ca2+ influx in sperm 2
- The drug directly inhibits alkaline- and voltage-activation of CatSper channels in sperm 2
Clinical Implications
- Men who are trying to conceive should be particularly cautious about sertraline use 1
- Sertraline is sometimes prescribed for premature ejaculation, which paradoxically increases the number of young men on SSRI therapy who may experience fertility issues 3
- While SSRIs like sertraline are used to treat ejaculation problems (premature, absent, delayed), they can simultaneously impair sperm quality 4
- Animal studies suggest that sertraline exposure can cause histological alterations in the testes and affect sperm quality even in offspring exposed during development 5, 6
Potential Mitigating Approaches
- Behavioral therapy for conditions like premature ejaculation may be a safer alternative for men concerned about fertility, as it has not been shown to affect semen parameters 1
- Preliminary research suggests that probiotics (specifically Lactobacillus rhamnosus) might help alleviate some reproductive side effects of sertraline, though this requires further investigation in humans 5
- For men experiencing sexual dysfunction while on sertraline, discussing alternative medications or treatment approaches with their healthcare provider is recommended 7
Monitoring and Considerations
- The FDA drug label for sertraline notes sexual dysfunction as a common side effect, with ejaculation failure (primarily delayed ejaculation) reported in 14% of male patients versus 1% in placebo groups 7
- Decreased libido is reported in 6% of sertraline users compared to 1% in placebo groups 7
- Men with fertility concerns who require sertraline for mental health conditions should consider semen analysis monitoring 1, 3
- The detrimental effects on sperm should be weighed against the therapeutic benefits of sertraline for the individual's mental health condition 7, 3