• Home
  • Pamphlets and Brochures
  • Donate now
  • Frequently Asked Questions
  • Please read

Our Helplines

Motherisk Helpline
1-877-439-2744 (Toll-free)
416-813-6780 (Toronto and GTA)

Alcohol and Substance

Effects of selective serotonin reuptake inhibitors on sperm and male fertility

Lauren Riggin, MD and Gideon Koren, MD FRCPC FACMT

June 2015



Some of my male patients who are taking antidepressants are planning to become fathers. Do selective serotonin reuptake inhibitors (SSRIs) affect sperm, causing either decreased fertility or increased risk of congenital anomalies?


There is limited evidence regarding paternal SSRI use before conception and its effects on reproductive outcomes; however, there might be some increased risk of subfertility based on animal studies and sperm-quality studies. There are insufficient data at this time to change prescribing practices of SSRIs in men who are hoping to become fathers.


Certains de mes patients qui prennent des antidépresseurs projettent d'avoir un enfant. Les inhibiteurs spécifiques de la recapture de la sérotonine (ISRS) affectent-ils le sperme et peuvent-ils causer soit une diminution de la fertilité ou encore une augmentation des risques d'anomalies congénitales?


Il existe peu de données probantes concernant l'utilisation d'ISRS avant la conception chez les hommes souhaitant procréer et leurs effets sur la reproduction; par contre, il pourrait y avoir une augmentation des risques d'hypofertilit√© selon des études effectuées sur des animaux et la qualité du sperme. Il n'y a pas suffisamment de données en ce moment qui justifieraient qu'on change les pratiques concernant la prescription d'ISRS chez les hommes qui souhaitent devenir pères.

Despite a large increase in the number of studies documenting the effects of maternal medication use on pregnancy outcomes, there remains a relatively large void in studies on paternal exposures and reproductive outcomes. A few studies of exposures in men have suggested that radiation increases the risk of pregnancy loss and stillbirths 1,2; organic solvents increase the rate of congenital malformations 3 and neural tube defects, 4 decrease the vitality and mobility of sperm, 5 and lower the success rates of in vitro fertilization 6; and chemotherapeutic agents increase chromatin damage in human sperm. 7 Therefore, more research is needed to better understand the effects of paternal exposures on sperm and reproductive outcomes.

Paternal use of selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are very commonly prescribed. In fact, a Dutch database study found that 13.6 per 1000 fathers took SSRIs in the 6 months before conception. 8 Given that spermatogenesis takes approximately 74 days, the fact that fathers taking SSRIs represent the fathers of more than 300 children in this study is reassuring.

Studies that specifically investigated the effects of paternal SSRI use on reproductive outcomes are very sparse. There have been a few animal studies 9-11 and 5 studies in humans 12-16 that evaluated the effects of SSRIs on sperm. Only one of these, a case report, looked at reproductive outcomes other than semen parameters. 13 There are no studies in humans that evaluate the effects of paternal SSRI use on the fetus.

In an animal study fluoxetine decreased spermatogenesis, sperm motility, and sperm density. It also decreased the weight of male reproductive organs and decreased testosterone and follicle-stimulating hormone levels. Finally, the study found that there was a decrease in the number of pregnancies and in the number of viable fetuses with paternal fluoxetine use. 9 In another study evaluating fluoxetine in mice, there were increases in sister chromatid exchanges and sperm abnormalities that were dose dependent. There was also a decrease in sperm count and sperm motility in the fluoxetine groups compared with control mice. 10 Similarly, a study of citalopram in mice found that there was an increase in DNA strand breaks and oxidative DNA damage in sperm. 11 Neither of these studies specifically evaluated reproductive outcomes.

In humans, the first report to implicate SSRIs in reduced fertility was a case report with 2 cases: the first man was taking citalopram and had oligozoospermia and decreased motility but these parameters returned to the normal range 1 month after discontinuation of citalopram. The second man was taking sertraline and had decreased sperm concentration and motility, and again the parameters returned to normal 3 months after ceasing sertraline. 13

A follow-up study of 35 healthy men found that there was an association between paroxetine use (for 5 weeks) and DNA fragmentation that would not have been detected with routine fertility screening. The authors suggested that changes to sperm DNA integrity might negatively affect men's fertility but did not measure this directly. 12

Three additional studies on human sperm suggested reduced concentration and motility and altered morphology with escitalopram 14 and any SSRI, 15 and reduced motility with any SSRI. 16 In each of the above studies and in subsequent reviews 17 it was concluded that the abnormal semen parameters (decreased sperm concentration and motility, and damaged DNA) and quick recovery upon discontinuation could be due to SSRIs negatively affecting sperm transport. They also all stated that more studies are necessary before a clinical conclusion can be drawn.


At this time there is no evidence regarding paternal SSRI use and fetal outcomes, so this should be an area of future study. More studies are required to determine if changes in semen parameters result in decreased fertility. If a patient presents with decreased fertility and is taking an SSRI, reducing the dosage might have a benefit; however, we do not recommend refraining from providing men with necessary medical treatment, particularly if there are no fertility issues, based on this evidence alone.


Motherisk questions are prepared by the Motherisk Team at The Hospital for Sick Children in Toronto, Ont. Dr. Riggin is a resident in psychiatry at Western University in London, Ont. Dr. Koren is the founder of the Motherisk Program.

Do you have questions about the effects of drugs, chemicals, radiation, or infections in women who are pregnant or breastfeeding? We invite you to submit them to the Motherisk Program by fax at 416 813-7562; they will be addressed in future Motherisk Updates.

Published Motherisk Updates are available on the Canadian Family Physician website (www.cfp.ca) and also on the Motherisk website.

View abstract »»


Competing interests
None declared.

Copyright © the College of Family Physicians of Canada
Can Fam Physician
Vol. 61, No. 6, June 2015 431-433
Copyright © 2015 by The College of Family Physicians of Canada


  1. Delbès G, Hales BF, Robaire B. Toxicants and human sperm chromatin integrity. Mol Hum Reprod 2010;16(1):14-22. Abstract/FREE Full Text
  2. Parker L, Pearce MS, Dickinson HO, Aitkin M, Craft AW. Stillbirths among offspring of male radiation workers at Sellafield nuclear reprocessing plant. Lancet 1999;354(9188):1407-14. CrossRef | Medline | Google Scholar
  3. Hooiveld M, Haveman W, Roskes K, Bretveld R, Burstyn I, Roeleveld N. Adverse reproductive outcomes among male painters with occupational exposure to organic solvents. Occup Environ Med 2006;63(8):538-44. Epub 2006 Jun 6. Abstract/FREE Full Text
  4. Logman JF, de Vries LE, Hemels ME, Khattak S, Einarson TR. Paternal organic solvent exposure and adverse pregnancy outcomes: a meta-analysis. Am J Ind Med 2005;47(1):37-44. CrossRef | Medline | Google Scholar
  5. Xiao G, Pan C, Cai Y, Lin H, Fu Z. Effect of benzene, toluene, xylene on the semen quality of exposed workers. Chin Med J (Engl) 1999;112(8):709-12. Medline | Google Scholar
  6. Tielemans E, van Kooij R, Looman C, Burdorf A, te Velde E, Heederik D. Paternal occupational exposures and embryo implantation rates after IVF. Fertil Steril 2000;74(4):690-5. CrossRef | Medline | Google Scholar
  7. O'Flaherty C, Hales BF, Chan P, Robaire B. Impact of chemotherapeutics and advanced testicular cancer or Hodgkin lymphoma on sperm deoxyribonucleic acid integrity. Fertil Steril 2010;94(4):1374-9. Epub 2009 Jul 9. CrossRef | Medline | Google Scholar
  8. Crijns I, Bos J, Knol M, Straus S, de Jong-van den Berg L. Paternal drug use: before and during pregnancy. Expert Opin Drug Saf 2012;11(4):513-8. Epub 2012 Mar 23. Medline | Google Scholar
  9. Bataineh HN, Daradka T. Effects of long-term use of fluoxetine on fertility parameters in adult male rats. Neuro Endocrinol Lett 2007;28(3):321-5. Medline | Google Scholar
  10. Alzahrani HA. Sister chromatid exchanges and sperm abnormalities produced by antidepressant drug fluoxetine in mouse treated in vivo. Eur Rev Med Pharmacol Sci 2012;16(15):2154-61. Medline | Google Scholar
  11. Attia SM, Bakheet SA. Citalopram at the recommended human doses after long-term treatment is genotoxic for male germ cell. Food Chem Toxicol 2013;53:281-5. Epub 2012 Dec 8. CrossRef | Medline | Google Scholar
  12. Tanrikut C, Feldman AS, Altemus M, Paduch DA, Schlegel PN. Adverse effect of paroxetine on sperm. Fertil Steril 2010;94(3):1021-6. Epub 2009 Jun 10. CrossRef | Medline | Google Scholar
  13. Tanrikut C, Schlegel PN. Antidepressant-associated changes in semen parameters. Urology 2007;69(1):185.e5-7. CrossRef | Medline | Google Scholar
  14. Koyuncu H, Serefoglu EC, Yencilek E, Atalay H, Akbas NB, Sarica K. Escitalopram treatment for premature ejaculation has a negative effect on semen parameters. Int J Impot Res 2011;23(6):257-61. Epub 2011 Jul 21. CrossRef | Medline | Google Scholar
  15. Safarinejad MR. Sperm DNA damage and semen quality impairment after treatment with selective serotonin reuptake inhibitors detected using semen analysis and sperm chromatin structure assay. J Urol 2008;180(5):2124-8. Epub 2008 Sep 18. CrossRef | Medline | Google Scholar
  16. Relwani R, Berger D, Santoro N, Hickmon C, Nihsen M, Zapantis A, et al. Semen parameters are unrelated to BMI but vary with SSRI use and prior urological surgery. Reprod Sci 2011;18(4):391-7. Epub 2010 Oct 19. Abstract/FREE Full Text
  17. Koyuncu H, Serefoglu EC, Ozdemir AT, Hellstrom WJ. Deleterious effects of selective serotonin reuptake inhibitor treatment on semen parameters in patients with lifelong premature ejaculation. Int J Impot Res 2012;24(5):171-3. Epub 2012 May 10. Medline | Google Scholar
Valid XHTML 1.0 Transitional [Valid RSS]

Motherisk is a proud affiliate of MotherToBaby, an information service of the non-profit Organization of Teratology Information Specialists (OTIS) across North America.

* - "MOTHERISK - Treating the mother - Protecting the unborn" is an official mark of The Hospital for Sick Children. All rights reserved.

The information on this website is not intended as a substitute for the advice and care of your doctor or other health-care provider. Always consult your doctor if you have any questions about exposures during pregnancy and before you take any medications.

Copyright © 1999-2018 The Hospital for Sick Children (SickKids). All rights reserved.

The Hospital for Sick Children (SickKids) is a health-care, teaching and research centre dedicated exclusively to children; affiliated with the University of Toronto. For general inquires please call: 416-813-1500.

  |  Contact SickKids  |  Terms of Use