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Polytherapy increases the risk of infertility in women with epilepsy

Background: Reproductive capability is an important concern for women with epilepsy (WWE). We aimed to ascertain the magnitude of infertility in a cohort of WWE who were anticipating pregnancy. Methods: A prospective cohort of WWE enrolled in the Kerala Registry of Epilepsy and Pregnancy (1998–2007) in the preconception stage. The endpoint was occurrence of pregnancy. They were divided into those who remained infertile (IG group) and those who had become pregnant during the follow-up period (FG). Results: Out of 375 women followed up for 1–10 years, 231 had pregnancy and 144 remained infertile (38.4%). Pregnancy occurred within 2 years of follow-up for most patients in the FG group. The IG group had higher mean age, lower education, and longer follow-up when compared to the FG group. Infertility was least (7.1%) for those with no antiepileptic drug (AED) exposure and higher (p = 0.001) with AED exposure (31.8% with 1 AED, 40.7% with 2 AED, and 60.3% with 3 or more AED exposure). Those exposed to phenobarbital had significant risk of infertility, but no such trend was observed with valproate or other drugs. On multiple logistic regression, use of 3 AEDs or more (odds ratio [OR] 17.9; 95% confidence interval [CI] 2.14–149.48), older age (OR 1.32; 95% CI 0.84–2.09), and low education (OR 2.91; 95% CI 1.82–4.65) remained as the important predictors of infertility. Conclusion: More than a third (38.4%) of WWE had infertility. The important predictors of infertility were exposure to multiple AEDs, older age, and lower education.