Anti-hypertensives:
Essential hypertension is thought to affect 0.6 to 2.7% of pregnancies and is more common in older populations and obese women (42). Treatment of high blood pressure is essential to reduce the risk of cardiovascular complications such as stroke and heart disease, but also to reduce the perinatal complications of pre-eclampsia, placenta abruption and intrauterine growth restriction. This literature review used the four most common classes: calcium channel blockers, ACE inhibitors, diuretics and beta blockers and found no papers on the drugs used prior to and during ART treatment effects on ART outcomes. Prevalence of hypertension is also increasing so it is important the effects of these medications are analysed, especially as there is such little data available.
Similarly essential hypertension affects almost 25% of men aged 35 to 44 years (43) and research suggests that the diagnosis of hypertension in men is associated with impaired semen quality; lower semen volume, lower sperm count and reduced motility (44). Lu et al. performed a retrospective analysis of semen results used for ART during a two-year period (1999-2001) and found no impact on sperm quality following treatment with beta blockers (45). Another study analysed high blood pressure and treatment with anti-hypertensives and their effect on semen quality (46). They found that men with hypertension were more likely to have one or more semen abnormalities compared to men without hypertension. In terms of treatment, beta blockers were associated with lower semen volume, sperm concentration and motility. There were also isolated differences observed in men taking either ACE inhibitors, Calcium Channel Blockers and Angiotensin Receptor Blockers, with diuretics providing no statistically significant differences. These studies suggests that it may be the underlying diagnosis of hypertension that leads to the sperm parameter anomalies as opposed to the medication and if the high blood pressure is well controlled, the impact on fertility is minimal (46) . However, given the results are conflicting, larger, high-quality randomised control trials are required to clarify the associations with treatment for high blood pressure and reproductive outcomes.