What are the effects of cannabis (marijuana) on male and female fertility?

From the Guidelines

Cannabis use should be avoided by couples trying to conceive due to its negative impact on both male and female fertility. The effects of cannabis on fertility are not fully understood, and more research is needed to determine the exact mechanisms by which it impairs reproductive health 1. However, it is known that certain lifestyles and behaviors, such as vaping and cannabis use, can have unclear short- and long-term effects on reproductive health.

Key Points to Consider

• The impact of cannabis on male fertility is unclear, but it is believed to be related to lifestyle and behavioral factors 1.
• The effects of cannabis on female fertility are also not well understood, but it is thought to be related to the disruption of the menstrual cycle and ovulation.
• More research is needed to determine the exact mechanisms by which cannabis impairs reproductive health, including its effects on the hypothalamic-pituitary-gonadal axis and the endocannabinoid system.
• The ability to restore reproductive potential through lifestyle changes, such as weight loss and enhanced metabolic health, remains understudied 1.

Recommendations for Couples Trying to Conceive

• Couples planning pregnancy should discontinue cannabis use to allow reproductive function to normalize.
• The route of administration does not eliminate the reproductive risks associated with cannabis use.
• More research is needed to determine the exact effects of cannabis on fertility and to develop evidence-based guidelines for couples trying to conceive.

Future Directions

• The genomic revolution has the potential to improve our understanding of the effects of cannabis on reproductive health and to develop medically-based treatments for infertile males and females 1.
• The emergence of new therapies, such as agonists of glucagon-like peptide-1 receptors, may have implications for reproductive health and fertility.

From the Research

Effects of Cannabis on Male Fertility

• Cannabis use has been associated with adverse effects on male reproductive health, including altered reproductive hormones, abnormal spermatogenesis, and testicular atrophy 2, 3, 4, 5
• Exposure to cannabinoids can disrupt the hypothalamus-pituitary-gonadal axis, leading to negative impacts on reproductive potential 3, 6
• Studies have reported lower sperm concentrations, reduced sperm motility, and inhibited capacitation and fertilizing capacity in cannabis users 4, 5
• Animal models have demonstrated a role for cannabis in testicular atrophy, reduced libido, and sexual function, although these results have not been replicated in human studies 5

Effects of Cannabis on Female Fertility

• Cannabis use has been associated with adverse effects on female reproductive health, including infertility, abnormal embryo implantation and development, and altered menstrual cyclicity 2, 6
• Exposure to cannabinoids can disrupt the hypothalamic-pituitary-gonadal axis, leading to negative impacts on reproductive potential 6
• The main psychoactive component of cannabis, delta-9-tetrahydrocannabinol, can cross the placenta and has been detected in breast milk, posing potential risks to fetal and offspring health 2

Overall Impact of Cannabis on Fertility

• The available evidence suggests that cannabis use can negatively impact both male and female fertility, although further studies are needed to fully understand the effects of cannabis on reproductive health 2, 3, 6, 4, 5
• Clinicians should be aware of the potential effects of cannabis on fertility when prescribing medical marijuana therapies to individuals of reproductive age 5