Introduction
Medication use in pregnancy is becoming increasingly common where a 68%
rise has been reported in the United States of America in the past 30
years, likely due to increasing maternal age and associated increased
risk of comorbid medical conditions (1). One systematic review revealed
a wide variation amongst developed countries where 27% to 93% of
pregnant women were on prescription drugs excluding multivitamins.
Prevalence was higher in France (93%) and lower in Northern European
countries (44-47%) (2). A cohort study of 106,000 pregnancies in Norway
between 2004 and 2006 found that 83% of mothers were on prescription
drugs between 3 months prior to conception and 3 months after giving
birth (3). On average each mother was prescribed 3.3 medications and the
most common were antibiotics and respiratory medications. Furthermore
25% of fathers were on prescription drugs over the same time frame, in
particular anti-inflammatory medications for musculoskeletal disease.
Another study examined specific drugs used across both pregnant and
non-pregnant women in United States and there was a marked age
discrepancy where younger women (aged 25-34 years) were more likely to
take beta blockers and non-steroidal anti-inflammatory medications
whereas older women (aged 35-44 years) were more likely to be taking
antidepressants and levothyroxine (see Table 1 ) (4).
Currently, nearly 3% of all babies born in the UK each year are born
due to ART(5). There have been over 1,103,000 IVF cycles performed in
the UK since 1991. In 2016 alone, there were over 68,000 IVF cycles,
resulting in 20,028 births(6). The overall trend is that IVF cycles and
births have been increasing year on year since 1991 and is projected to
increase even further. The average age of women undergoing ART in the UK
is 35.5, with the average age of women in natural pregnancy being 30.3
years (5, 7). Information on the prevalence of prescription drug use
amongst couples undergoing ART is limited and there are even less
studies available on medications taken by the male partner specifically.
Importantly, paternal factors do contribute equally towards the
epigenome and therefore prescription drug use in men may impact the
quality of sperm, fertilisation, implantation and embryo development (8,
9).
As many patients undergoing ART are older, they may be more likely to be
on more prescription medication than the rest of the child-bearing-age
population. Numerous studies demonstrate common conditions that have a
rising prevalence with age, including depression and/or anxiety,
hypothyroidism and type 2 diabetes (10, 11). It is therefore more likely
that these women will be on prescription medication for these conditions
when they undergo ART. ART currently only has a success rate (defined as
‘live births per ART cycle’) of approximately 33% in the UK therefore
it is important that any additional risks from these medications on
reproductive outcomes are clarified, advising future practice and
enabling couples to make an informed decision about medication use (5).
Minimising the risk of failed ART and/or foetal loss but also the
aforementioned teratogenic side effects of drugs is of maximal
importance.
Therefore we performed this narrative review of the current evidence on
prescription drug use to treat co-morbid health conditions in both women
and men undergoing ART. This review could then form a counselling tool
for clinicians to better discuss with their patients the impact of
specific medications for men and women having ART and guide clinical
decision making.