Altered sexual and reproductive functions in epileptic men taking carbamazepine.
BACKGROUND
Epileptic men may experience hormonal changes that may alter semen quality and sexual function. Alterations in male sexual and reproductive parameters may also be due to treatment with antiepileptic drugs to control seizures.


OBJECTIVE
To evaluate serum hormone concentrations, semen quality, the frequency of sexual intercourse (FSI), and erectile function in men with epileptic seizures controlled by carbamazepine (CBZ).


METHODS
The five-question form of the International Index of Erectile Function (IIEF-5), and semi-structured questionnaire.


METHODS
One hundred and eighteen men, aged 18-45 years, were included in this controlled, cross-sectional study: 63 men taking CBZ (epileptic group) were compared to 55 healthy men (control group). Blood sample was collected to determine hormones concentrations. Erectile function and the frequency of sexual relations were assessed by using questionnaires. Sperm morphology was analyzed by examining the quality of the head, intermediate part and tail of the spermatozoa.


RESULTS
Using the IIEF-5, we observed a significant association between erectile dysfunction (ED) and groups (P < 0.01), where epileptic men had 17.33 (95% CI 3.59, 83.52) odds to have erectile dysfunction. Adjusted odds ratio to group considering luteinizing hormone, prolactin, Serum total testosterone, androstenedione, and dehydroepiandrosterone, androstenedione levels and free androgen index, we observed only group effect where epileptic men had 10.47 (95% CI 2.75, 39.83) odds to have FSI < 3 times a week. Sperm vitality was altered in 27% of the epileptic subjects compared with 5.4% of the control group (P < 0.002). Sperm motility differed significantly between groups, with A + B motility ≤50% observed in 98.4% of the epileptic group and in 85.4% of the control group (P < 0.01). Sperm morphology <14% was observed in 93.7% of the epileptic men, compared with 34.6% of the controls (P < 0.001). CBZ users, showed less sexual intercourse then controls (P ≤ 0.001).


CONCLUSIONS
Epileptic men taking CBZ present with changes in hormonal levels, altered semen quality, ED, and a reduction in coital frequency.
Sector of Human Reproduction, Department of Gynaecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, São Paulo University, Ribeirão Preto, Brazil. romareis@fmrp.usp.br
Rosana Maria
RM
Reis
Alexandre Gonçalves
AG
de Angelo
Américo Ceiki
AC
Sakamoto
Rui Alberto
RA
Ferriani
Lúcia Alves Silva
LA
Lara
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D002220:Carbamazepine / Q000009:adverse effects* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004833:Epilepsy, Temporal Lobe / Q000097:blood / Q000188:drug therapy*; D007172:Erectile Dysfunction / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis; D012739:Gonadal Steroid Hormones / Q000097:blood; D006801:Humans; D008297:Male; D055101:Semen Analysis; D012725:Sexual Behavior / Q000187:drug effects*; D013081:Sperm Motility / Q000187:drug effects; D055815:Young Adult
D000927:Anticonvulsants; D012739:Gonadal Steroid Hormones; D002220:Carbamazepine