**1.5.8.5 Psychotherapeutic agents**

Many psychotherapeutic agents affect male fertility by suppressing the HPG axis and decreasing erectile function and libido. Indeed, one of the most significant side effects of the antidepressants is elevation of serum prolactin, leading to significant but reversible suppression of spermatogenesis (Nudell et al., 2002). Psychotherapeutic agents include antipsychotics, tricyclic and selective serotonin reuptake inhibitor (SSRI) or selective norepinephrine reuptake inhibitor (SNRI) antidepressants, monoamine oxidase inhibitors (MAOIs), phenothiazines, and lithium. There are now large numbers of patients taking SSRI or SNRI medications, many of which have significant fertility effects.

#### **1.5.8.6 Anticancer drugs**

Doxorubicin hydrochloride, Goserelin acetate, methotrexate, or fluorouracil all are the drugs used to treat various types of cancer. However, these drugs have significant side effects on sexual behaviour, altered fertility and sperm count (Nudell et al., 2002).

#### *1.5.8.6.1 Chemotherapeutic agents*

Chemotherapy for the treatment of cancer can have devastating effects on male fertility through the impairment of spermatogenesis; indeed, alkylating agents, antimetabolites, and the vinca alkaloids are all gonadotoxins. The alkylating agent, cyclophosphamide alters male fertility; treatment with 1-2 mg/kg for more than 4 months increases the incidence of azospermia and oligospermia in adult male patients (Qureshi et al., 1972). In patients with testicular cancer, the cumulative dose of cisplatin determines whether spermatogenesis is impaired irreversibly. Most patients will become azoospermic, with the majority recovering spermatogenesis within 4 years. The majority of Hodgkin's disease or leukemia patients become azoospermic after chemotherapy; this may or may not lead to permanent sterility. After treatment with mitoxantrone, vincristine, vinblastine, and prednisone combination therapy plus abdominal radiotherapy for Hodgkin's disease, sperm counts and motility were restored to pre-treatment levels in most patients (Magelseen et al., 2006).

#### **1.5.8.7 Miscellaneous medications**

Cimetidine has been reported to have antiandrogenic effects that induce gynecomastia and decreases in sperm count. Immune modulators are commonly used but, unfortunately, clear human data regarding male fertility for interferon or the immunosuppressant mycophenolate mofetil are lacking. Although cyclosporine has been found to induce

the more common short-term low-dose therapy is not likely detrimental. While in vitro data on erythromycin, tetracycline, and gentamycin suggest the potential for adverse effects on fertility, documentation of an in vivo effect in humans is lacking (Hargreaves et al., 1998). Sulfasalazine, used in the treatment of ulcerative colitis, is well known to cause defects in human sperm concentration and motility. Aminoglycosides, type of antibiotics is generally used for serious bacterial infections, like TB, and are administered under medical supervision. Aminoglycosides can negatively impact sperm production while neomycin has been shown to reduce both sperm count and motility. Macrolides, in addition to being used to treat chlamydia and Legionnaires disease, macrolides are similar to penicillin and can be used in place of it in people with a penicillin allergy. Macrolides research has mainly focused on animals, where it has been found that the antibiotic can decrease sperm motility as well as kill off sperm. It is believed that the antibiotic produces similar results in humans

Many psychotherapeutic agents affect male fertility by suppressing the HPG axis and decreasing erectile function and libido. Indeed, one of the most significant side effects of the antidepressants is elevation of serum prolactin, leading to significant but reversible suppression of spermatogenesis (Nudell et al., 2002). Psychotherapeutic agents include antipsychotics, tricyclic and selective serotonin reuptake inhibitor (SSRI) or selective norepinephrine reuptake inhibitor (SNRI) antidepressants, monoamine oxidase inhibitors (MAOIs), phenothiazines, and lithium. There are now large numbers of patients taking SSRI

Doxorubicin hydrochloride, Goserelin acetate, methotrexate, or fluorouracil all are the drugs used to treat various types of cancer. However, these drugs have significant side

Chemotherapy for the treatment of cancer can have devastating effects on male fertility through the impairment of spermatogenesis; indeed, alkylating agents, antimetabolites, and the vinca alkaloids are all gonadotoxins. The alkylating agent, cyclophosphamide alters male fertility; treatment with 1-2 mg/kg for more than 4 months increases the incidence of azospermia and oligospermia in adult male patients (Qureshi et al., 1972). In patients with testicular cancer, the cumulative dose of cisplatin determines whether spermatogenesis is impaired irreversibly. Most patients will become azoospermic, with the majority recovering spermatogenesis within 4 years. The majority of Hodgkin's disease or leukemia patients become azoospermic after chemotherapy; this may or may not lead to permanent sterility. After treatment with mitoxantrone, vincristine, vinblastine, and prednisone combination therapy plus abdominal radiotherapy for Hodgkin's disease, sperm counts and motility

Cimetidine has been reported to have antiandrogenic effects that induce gynecomastia and decreases in sperm count. Immune modulators are commonly used but, unfortunately, clear human data regarding male fertility for interferon or the immunosuppressant mycophenolate mofetil are lacking. Although cyclosporine has been found to induce

effects on sexual behaviour, altered fertility and sperm count (Nudell et al., 2002).

were restored to pre-treatment levels in most patients (Magelseen et al., 2006).

or SNRI medications, many of which have significant fertility effects.

(Schlegel et al., 1991).

**1.5.8.6 Anticancer drugs** 

*1.5.8.6.1 Chemotherapeutic agents* 

**1.5.8.7 Miscellaneous medications** 

**1.5.8.5 Psychotherapeutic agents** 

impaired fertility in rats, there are no human data available (Nudell et al., 2002). Epilepsy has been associated with decreased testosterone levels and increased estrogen levels leading to reductions in libido and to erectile dysfunction. Medications used to treat epilepsy (eg, valproate, oxcarbazepine, and carbamazepine) may worsen hormonal abnormalities and have been associated with some sperm morphologic defects (Isojarvi et al., 2004).
