Epilepsy and planning a pregnancy

Epilepsy and male fertility

Many men with epilepsy father healthy children. But epilepsy can sometimes cause problems for men who are trying to conceive.

Epilepsy, and some medications that are used to manage it, can reduce testosterone levels. This can cause:

• loss of interest in sex
• trouble getting or staying aroused (known as impotence)
• fertility problems.

Some epilepsy medications can also:

• reduce the amount of sperm produced
• affect the quality of sperm that’s produced.

If you or your partner have any concerns about epilepsy and sexual problems, or fertility, speak to your doctor. They may refer you to an epilepsy specialist.

Epilepsy treatment and pregnancy risks

Some drugs carry risks in pregnancy. This can depend on the type and the dose you are taking.

Taking certain epilepsy medications during pregnancy can increase the risk of birth defects for a baby, such as:

• spina bifida
• heart abnormalities
• cleft lip.

There may also be an increased risk of problems with the baby’s learning and development, such as:

• lower intelligence
• poor language skills (speaking and understanding)
• memory problems
• autistic spectrum disorders
• delayed walking and talking.

This doesn’t mean you should stop taking these medications. Doing so may be more harmful to your unborn baby than if you carry on taking them, because it may cause uncontrolled seizures in pregnancy.

Some epilepsy medications are safer than others during pregnancy. Ask your doctor or specialist to review your medication before you try to get pregnant, to find the safest option for you and your baby.

Never stop taking medication without talking to your doctor.

Valproate medications

Valproate medicines include sodium valproate (Epilim, Episenta, Epival, Depakote) and valproic acid (Convulex).

If you are taking valproate medicines and could become pregnant, you need to use an effective method of birth control (contraception) that has been recommended by a health care provider. You’ll need to use this at all times during your treatment with valproate. This is to reduce the risk of an unplanned pregnancy as valproate can cause birth defects and developmental difficulties in babies.

You will be offered a yearly review to confirm that valproate remains the most effective medication to control your epilepsy, and to talk about whether you want to become pregnant or not in the next year.

Doctors in the UK have been advised not to prescribe valproate to anyone who is or could become pregnant, unless no other epilepsy medicines work for them.

In 2024 the Medicines and Healthcare products Regulatory Agency (MHRA) launched new measures to tighten prescribing of valproate medications for both women and men with epilepsy (and bi-polar conditions). 

The measures say that Valproate should not be started by patients aged under 55 years unless two specialists have agreed that their condition does not respond to other treatments and the benefits of valproate outweigh the risks.

You can read more about these measures and what they may mean for you here.

You can also read about sodium valproate on the NHS website here.
 

If you’re taking valproate and want to get pregnant, speak to your GP before stopping contraception. This is to make sure you have time to switch to another treatment before you come off contraception. Don’t stop taking your medicine, unless you are advised to.

If you think you are pregnant while taking valproate, request an urgent appointment with your GP. They will be able to refer you to your health care specialist.

Valproate may cause infertility in men. This may get better after use of the medicine is stopped. Even though it may affect fertility, valproate is not a contraceptive. 

Topiramate

Topiramate is another epilepsy medication that increases risks of birth defects and developmental difficulties for a child if taken during pregnancy. If you’re taking it and want to try for a baby, speak to your GP before stopping contraception. 

You will be offered a yearly review to confirm that topiramate remains the most effective medication to control your epilepsy, and to talk about whether you want to become pregnant or not in the next year. 

You will need to use contraception at all times when taking topiramate to prevent unplanned pregnancy. If you know you’d like to become pregnant, speak with your health care provider about reviewing the option to switch to an alternate epilepsy medication with lower risks.

Topiramate doesn’t reduce fertility. You’ll need to keep using contraception until your doctor advises it’s safe to stop. 
 

What should happen to my epilepsy treatment before I conceive?

If you’re planning to have a baby, your doctor or specialist should review your treatment before you start trying. The aim will be to manage your condition as well as you can during pregnancy.

This means finding a treatment that will control your seizures, with the least possible risk of harm to your baby’s development in the womb.

This may involve making changes to the medication you’re taking. This should be done before you conceive.

Folic acid and epilepsy medication

If you’re planning a pregnancy, you should take folic acid. You should aim to start 2 to 3 months before you conceive and keep until keep taking it until you’re at least 12 weeks pregnant.

If you’re taking medication to control your epilepsy, you will need to take a higher dose – 5mg – of folic acid.

This can help protect your baby against neural tube defects, such as spina bifida.

Your doctor will need to prescribe these to you, because 5mg tablets aren’t available over the counter.

Will folic acid affect my epilepsy medication?

Folic acid can affect the following epilepsy medications:

• phenytoin
• phenobarbital
• Primidone.

If you take any of these, you could be more at risk of a seizure if you start taking folic acid. Speak to your doctor first.

Vitamin D

Before and during pregnancy, you may need a higher dose of Vitamin D supplements, especially if you take certain epilepsy medications referred to as enzyme-inducing.

These medications are linked with lower vitamin D blood levels and can reduce bone health. Having a good vitamin D level is important for a developing baby.

Your doctor and epilepsy specialist can give advice and prescribe vitamin D. Sometimes they might check your level of vitamin D with a blood test. 
 

The UK Epilepsy and Pregnancy Register

The UK Epilepsy and Pregnancy Register is a nationwide project looking at which epilepsy treatments are the lowest risk for babies. Any pregnant birthing people or women with epilepsy can join.

When you register, you'll be asked to tell them about the treatment you're taking. This will help doctors give the best advice to you and others who are thinking of getting pregnant.

Join the The UK Epilepsy and Pregnancy Register.

More support and information

Epilepsy Action works to raise awareness of epilepsy, campaigns for accessible healthcare services, and provides information about care and treatment.

The NHS also has information on living with epilepsy.

Thinking about trying for a baby? Use our online pregnancy planning tool to see if you’re ready to conceive.