The intersection of epilepsy and assisted reproduction: A review of therapeutic approaches and considerations

Abstract

Objective: Women with epilepsy (WWE) have unique reproductive problems due to interactions among seizures, antiseizure medications (ASMs), and endocrine changes. These interactions can cause infertility, menstrual dysfunction, and an increased risk for reproductive endocrine disorders. Assisted reproductive technologies (ART), offer a hope for WWE seeking pregnancy but raise questions about seizure control, drug interactions, and pregnancy outcomes. This review aims to discuss the challenges associated with the use of ART in WWE. Methods: A narrative review was conducted through PubMed, MEDLINE, and ISI Web of Science. Inclusion criteria were original research, cohort studies, case series, randomized trials, and systematic reviews incorporating ART outcomes, ASM interactions, and hormonal therapies in WWE. Animal studies and abstracts without full text available were excluded. Results: The data about the use, most appropriate protocols and success rate of ART in WWE is scarce. Current findings suggest that ART is effective in WWE, with live birth rates comparable to those of women without epilepsy. Most WWE with well-controlled epilepsy have seizure stability during ART, but sporadic cases of seizure worsening, have been reported. ART hormonal treatments can interact with ASMs, necessitating therapeutic drug level monitoring and dose adjustment, especially for lamotrigine. Enzyme-inducing ASMs can reduce the efficacy of hormonal treatments, requiring augmented doses of progesterone for luteal support. WWE remain at higher risk of pregnancy complication, but ART does not yet appear to contribute to these risks when appropriately managed. Conclusion: Based on the limited current studies, ART might be an acceptable and safe fertility treatment for WWE, provided that seizure control is optimized and ASM-hormone interactions are carefully managed. ASM choice, therapeutic drug monitoring, and multidisciplinary care need to be tailored to maximize reproductive and neurological outcomes. Frozen embryo transfer protocols and progestin-only contraception may also enhance safety. Continued research and clinical monitoring are needed to further develop management strategies and long-term outcomes in WWE undergoing ART.