Infertility therapy in seizure disorders: systematic review of literature
Ola Alshaqi1, Yazan Nofal4, Caroline Sane1, Alexandra Hergenrader2, Mathias Maisenbacher1, Cynthia schmidt3, Carly Jennings2, Olha Taraschenko1
1Neurology, 2Obstetrics and Gynecology, 3Leon S. McGoogan Health Sciences Library, University of Nebraska Medical Center, 4Neurology, Baylor College of Medicine
Objective:

We aimed to evaluate the impact of assisted reproductive technologies (ART) on seizure control in women with epilepsy and assess interactions of anti-seizure medications (ASMs) and ART.

Background:

The progressive increase in maternal age led to increase of infertility rates and higher demand for ART. Women with epilepsy face additional risks of potential interactions between ASMs and ART beside worsening of seizure control or pregnancy loss. The literature studying this subject is limited highlighting a knowledge gap in this field. 

Design/Methods:

We conducted a systematic search of MEDLINE, Embase, Scopus, CENTRAL, and CINAHL from inception to March 2025. The study outcomes included seizure burden, ASM usage, ASM interactions with ART, pregnancy rates, live birth rates and adverse reproductive outcomes in women with epilepsy undergoing ART.

Results:

There were 686 publications, of which 5 met the inclusion criteria (2 case reports, 1 case series, and 2 cohort studies). The reports included 1-12 subjects ages 25-46 years. Infertility treatments involved in-vitro fertilization (IVF), ovulation induction, and hormonal therapy. The patients were treated with 0-2 ASMs, including carbamazepine, lamotrigine, levetiracetam, oxcarbazepine, valproate, and zonisamide. Seizure outcomes varied from unchanged seizure counts to their worsening. The papers reported estrogen-induced lowering of lamotrigine levels in two patients: one had dose adjustment, and the other experienced breakthrough seizure. Other reported outcomes were seizure cluster in a patient treated with follitropin beta and a new onset seizure in a female treated with dehydroepiandrosterone.  Across all groups, 22 IVF attempts resulted in 12 pregnancies and 8 live births, with slightly better fertility outcomes in unmedicated women compared to those on ASMs.

Conclusions:

Many patients tolerated ART without worsening seizures. Concomitant usage of ASMs and ART may affect reproductive outcomes.  Despite the systematic approach, our search yielded a limited number of reports, underscoring the need for further investigation.

10.1212/WNL.0000000000216609
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