Does kava kava affect fertility?

Kava Kava and Fertility

Based on available evidence, kava kava should be avoided when attempting to conceive or during pregnancy, as it may decrease renal blood flow (potentially affecting reproductive organs), has significant drug interactions that could interfere with fertility treatments, and has been associated with neonatal dermopathy when used during pregnancy.

Perioperative and Physiological Concerns Relevant to Fertility

Renal Blood Flow Effects

• Kava has been documented to decrease blood flow to the kidneys, potentially via inhibition of cyclooxygenase 1
• This mechanism of reduced blood flow could theoretically affect other pelvic organs including reproductive structures, though direct fertility studies are lacking 1

Drug Metabolism Interactions

• Kava extracts significantly inhibit multiple cytochrome P450 enzymes (CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP4A9/11) 1
• These interactions are clinically significant because many fertility medications and hormonal treatments are metabolized through these same pathways 1
• If undergoing fertility treatments or taking any reproductive hormones, kava could alter the effectiveness of these medications 1

Sedative Properties and Perioperative Risk

• Kava acts through GABA transmission potentiation, producing sedative effects 1
• The Society for Perioperative Assessment and Quality Improvement (SPAQI) recommends holding kava for 2 weeks before surgery due to potential additive or synergistic effects with anesthetics, benzodiazepines, and opiates 1
• This sedative mechanism could theoretically affect hypothalamic-pituitary function, though this has not been directly studied 1

Pregnancy-Related Concerns

Documented Neonatal Effects

• A 2024 case report documented neonatal ichthyosiform dermopathy in an infant whose mother used kava throughout pregnancy 2
• The infant's rash resolved by day 22 of life, but the case demonstrates transplacental passage of kava compounds 2
• The mother also developed ichthyosiform dermopathy during pregnancy that resolved after stopping kava postpartum 2

Lack of Safety Data

• No controlled studies exist examining kava's effects on human fertility, conception rates, or pregnancy outcomes 3, 2
• Animal toxicology studies showed hepatotoxicity and other organ effects but were not designed to assess reproductive outcomes 3

Clinical Recommendations

For Those Attempting to Conceive

• Discontinue kava use when planning pregnancy due to:
  • Potential effects on renal and possibly pelvic blood flow 1
  • Significant drug interactions that could interfere with fertility medications 1
  • Lack of safety data in pregnancy 2

For Those Undergoing Fertility Treatment

• Hold kava for at least 2 weeks before any fertility procedures to allow clearance of enzyme inhibition effects 1
• Inform fertility specialists about any kava use, as it may affect medication dosing requirements 1

Alternative Approaches

• For anxiety management during fertility treatment, consider evidence-based alternatives such as lavender supplementation, which has shown efficacy for anxiety without documented fertility concerns 1
• The American Urological Association recommends focusing on proven lifestyle modifications for fertility: smoking cessation, weight loss if overweight, regular exercise, and dietary improvements (lower fats/meats, more fruits and vegetables) 4, 5

Important Caveats

Quality of Evidence

• Direct evidence linking kava to fertility outcomes is essentially non-existent - recommendations are based on mechanism of action, drug interactions, and case reports rather than controlled trials 1, 2
• The precautionary principle applies here: absence of evidence of harm is not evidence of safety, particularly for pregnancy exposure 2

Hepatotoxicity Concerns

• While not directly related to fertility, kava's association with hepatotoxicity in some preparations is an additional reason for caution 3, 6
• Traditional water-soluble extracts appear safer than acetone-based extracts, but this distinction is often unclear in commercial products 6