Addiction and Infertility: A Complicated Relationship

This article is a guest contribution written for Trak Fertility by Dr. Gerard M. DiLeo, MD CLCP – Medical Reviewer at Addictions.com.

Substance abuse affects not only the person using, but the relationships around them as well. When someone has an addiction, everything becomes a distant second, including employment, responsibilities, and even one’s legal freedoms. One area that is not discussed much is in the area of intimacy and fertility, which are both profoundly affected negatively by substance abuse, dependence, and addiction. Men in particular are impacted by physically by substance abuse. Abusing substances can cause low sex drives as well as mechanical failure from erectile dysfunction or the inability to maintain an erection.

Addiction Counters the Benefits of Intimacy

The popularity of sex and its very necessity for reproduction can make its failure catastrophic in those couples seeking to have a normal physical relationship and/or a child, respectively. Addiction inhibits the normal functions of intimacy in both the relationship and fertility areas of a man’s reproductive life.

Addiction is entirely self-consuming:

  • By its very nature, it means that one’s dependence on a substance is such that he/she will do anything to get more, at the expense of one’s relationships, employment, or even freedom.
  • The dependence nature of the addiction means that he/she will suffer physically and psychologically, even to the point of life-threatening levels in some cases, when running out of the substance or self-weaning. The only safe way to avert danger due to the dependence is to seek professional treatment.

When one’s life is revolving around such dire circumstances, intimacy and relationships suffer. This lack of intimacy lessens the chances of a successful, normally functioning sexual relationship. Either sex is avoided on the front end due to a low sex drive, or the function of sex is thwarted during sexual activity because of physical limitations such as erectile dysfunction or sperm count problems.

Addiction is Counterproductive for Dads-to-be

The ways in which intimacy can fail with drug abuse are due to their adverse effects. This failure is often neglected in the population as a whole because of the more pressing complications of substance abuse, such as overdose, cardiac complications, kidney failure, and liver failure.

However, when substance abuse occurs in the younger populations—in those who are still resilient enough to ward off these attacks on their organs—sexual dysfunction can become the prominent complaint, with the other physiological setbacks yet to come as a bad mid-life surprise.

There are three primary areas in which substance abuse and its complication, addiction, can alter a couple’s ability to achieve pregnancy, as they relate to men specifically:

  1. Decreased libido. Libido is the medical word for “sex drive.” When sex is not actively sought or one’s sex drive does not come naturally, even if intercourse is performed it can be dissatisfying in its quality of consummation or unsuccessful in its actual completion.
  2. Erectile dysfunction. Erectile dysfunction (E.D.) is failure to achieve or maintain an erection, which is the mechanical necessity for effective penetration in intercourse.
  3. Hypogonadism. Hypogonadism means low functioning of a man’s sexual glands, i.e., his testicles. Testicles not only make sperm, but are the glands that produce testosterone, too. When this gland underperforms—or fails outright—there is inadequate production of testosterone which can affect many things, from one’s libido (sex drive) to sperm count abnormalities (low sperm count or overproduction of abnormal sperm).

The Drugs Used Can Alter a Man’s Sexuality in Different Ways

Healthy sexual function relies on a complex balance of many processes, from hormonally dependent glands in the brain (the hypothalamus, the pituitary) to one’s thyroid gland to testicular function. There are many drugs that can affect this balance, and sexual abilities can be at risk for abnormal function or become vulnerable to failure.

Drugs that can put your reproductive physiology at risk include the following:

  • Anabolic steroids: these are abused as a way to attain muscle mass and improve athletic and competitive performance. They can cause abnormal sperm production and low sperm count, testicular atrophy, infertility, and erectile dysfunction.
  • Opioids: narcotic abuse, especially when it is chronic, can cause low testosterone directly, and this will indirectly affect both sperm count and libido. Even if opioid abuse is treated via a methadone program, methadone itself can result in low testosterone.
  • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, and other psychiatric medications can cause elevation in prolactin, loss of libido, and also erectile dysfunction. The higher level of prolactin (which is the milk let-down hormone in women, although men have it, too, but in smaller quantities) is associated with low libido, elevated thyroid hormone, and hypogonadism [see above, one of the three primary sexual dysfunctions]. There can also be enlargement of the male breasts, which is a cosmetic concern.
  • Benzodiazepines: Clonazepine and other benzos can cause erectile dysfunction, either with inability to achieve an erection or in failure to maintain it.
  • Stimulants: such as cocaine and amphetamines, while initially stimulating arousal, ultimately have a negative effect on the ability to achieve or maintain an erection. Cocaine has been associated with an elevated prolactin level, called hyperprolactinemia [see “Antidepressants” above]. It is also a potent vasoconstrictor, famously affecting the nasal septum, but also haunting men by its cause of erectile dysfunction.
  • MDMA/Ecstasy: these affect testosterone and sperm production negatively.
  • Alcohol: can decrease libido. Also, chronic use can cause liver dysfunction and contribute to generalized debilitation, which secondarily affects all sexual function negatively.
  • Marijuana: according to Dr. Yazigi, a reproductive expert, about 33% of chronic users of marijuana have low sperm counts; also, sperm motility, a major determinant of their normal function, is lowered.

In Conclusion

Reproduction is a miraculous process and it is a complex interaction of many things, both within a man and a woman as well as between them. The sequence and balance of the rise and fall of the hormones responsible for testicular function is at risk when drugs are used chronically for chronic conditions or when drugs or alcohol are abused, resulting in dependence and addiction.

Treatment for substance abuse disorders and addiction, for any man of reproductive age, besides portending well for his health in general, will also assure optimal sexual function at the glandular, hormonal, and performance levels. Of course, this will bring back the joy to the physical act and the psychological bonding it is designed to enhance. Also, it goes without mentioning in detail that becoming a parent implies a responsibility for being a good steward for your body, because the children you raise will be depending on you.

REFERENCES

Crenshaw, T. L., & Goldberg, J. P. (1996). Sexual pharmacology: drugs that affect sexual functioning. WW Norton & Co.

Nieschlag, E., & Vorona, E. (2015). MECHANISMS IN ENDOCRINOLOGY: Medical consequences of doping with anabolic androgenic steroids: effects on reproductive functions. European journal of endocrinology173(2), R47-R58.

Cocores, J. A., Miller, N. S., Pottash, A. C., & Gold, M. S. (1988). Sexual dysfunction in abusers of cocaine and alcohol. The American journal of drug and alcohol abuse14(2), 169-173.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769315/

https://www.vice.com/en_ca/article/jmba3x/we-asked-three-doctors-what-drugs-do-to-your-sperm-915.

Cocores, J. A., Dackis, C. A., & Gold, M. S. (1986). Sexual dysfunction secondary to cocaine abuse in two patients. The Journal of clinical psychiatry.

Grover, S., Mattoo, S. K., Pendharkar, S., & Kandappan, V. (2014). Sexual dysfunction in patients with alcohol and opioid dependence. Indian journal of psychological medicine36(4), 355.

https://pubs.niaaa.nih.gov/publications/arh22-3/195.pdf.

Daniell, H. W. (2002). Hypogonadism in men consuming sustained-action oral opioids. The Journal of Pain3(5), 377-384.

Corona, G., Mannucci, E., Fisher, A. D., Lotti, F., Ricca, V., Balercia, G., … & Maggi, M. (2007). Effect of hyperprolactinemia in male patients consulting for sexual dysfunction. The journal of sexual medicine4(5), 1485-1493.

van Amsterdam, J., Opperhuizen, A., & Hartgens, F. (2010). Adverse health effects of anabolic–androgenic steroids. Regulatory Toxicology and Pharmacology57(1), 117-123.

Fossey, M. D., & Hamner, M. B. (1994). Clonazepam‐related sexual dysfunction in male veterans with PTSD. Anxiety1(5), 233-236