Opioid Use and Infertility
Opioid use in the United States has produced immeasurable damage to families and communities. In addition to the immense cost of addiction, loss of financial production and early deaths, there is also an unseen cost—loss of unborn children. Considering the visceral horrors of opioid abuse that are so apparent, it is easy to understand why so little attention is paid to the infertility that opioids cause.
The Epidemic of Opioid Use in the United States
It is difficult to overestimate the scope of the opioid epidemic in the United States. The US Department of Health and Human Services reports that there were more than 214 million prescriptions for opioids written in 2016; that enough for two-thirds of the U.S. population to have a prescription. It is estimated that almost 11 million Americans abused prescription opioids in 2016.
The toll on the economy and health care sector has been staggering. Almost 1,000 people visit an ER daily due to an overdose, and almost 64,000 Americans died of opioid abuse in 2015. It is estimated that the total cost of opioid abuse including lost work, health care and criminal justice every year exceeds $78 billion.
Is Opioid Use Going Down?
Considering the enormous spotlight on opioids in American communities, it might be expected that the worst effects of this epidemic are over, but the reality is that it may take years before there is any visible improvement. Although health care providers and policymakers are working to make opioid use safer, there is still a raging public health crisis.
Although more physicians are limiting the number of opioid prescriptions they write, this is leading to a surge in opioid-related deaths. At least in part, this is due to more opioid users turning to illicit drugs like heroin to satisfy their cravings. The rise in deaths is also fueled by more use of very potent opioids like fentanyl that can be fatal even in very small doses.
The number of opioid prescriptions has fallen since 2010, but the prescribing rate is still three times as high as in 1999, when the opioid crisis first started. The problem is that although more doctors are shortening the time patients stay on opioid painkillers, in many cases, even these periods are often enough to create addiction. Furthermore, more people are using friends and family as sources for opioids.
How Opioids Affect Fertility
Since 2016, U.S. life expectancy has dropped every year. Although suicides have played a large role in this sustained decline, much of the blame is also attributable to drug overdoses. Lower life expectancy is also linked to a shrinking population, especially among young people. This has important implications for the economy and U.S. society. Without a robust class of working Americans, the U.S. population will skew older, and the elderly are sicker and more costly to sustain.
There is an unseen threat feeding this population change—opioid-related infertility. Unfortunately, many women of child-bearing age are also on opioid painkillers, but few physicians are recognizing this overlap. In 2015, almost 40 percent of U.S. women aged 15 to 44 were on a prescription opioid.
New research also indicates that long-term opioid use in men and women can lead to loss of libido, depression and sexual dysfunction. These conditions can interfere with fertilization and a successful pregnancy.
It is also overlooked that many women who undergo procedures to overcome infertility like egg retrieval for in vitro fertilization are often prescribed opioids to manage their pain. Studies show that, on average, about 12 percent of women given an opioid prescription after a fertility procedure will fill it. While this may seem like only a minor population, those who do fill their opioid prescription tend to get a large number of pills, suggesting that there may be some drug-seeking behavior. Furthermore, since most women following this procedure do not seek out painkillers, it may be unnecessary to make opioids available.
Infertility Related to Substance Use Disorder
Patients struggling with infertility issues are at particular risk for substance use disorder (SUD). Many of these patients have an elevated risk of anxiety or depression which can make them susceptible to SUD. Unfortunately, high-risk patients may continue to use opioids after the recommended cutoff time and raise the likelihood that they experience infertility, complicate pregnancy or encounter other medical problems.
While developing opioid abuse problems is a major issue for infertile patients, there are also many issues for addicts who may want to get pregnant. Many recovering addicts may be on methadone, a type of opioid, for their treatment, but methadone may affect their ability to produce a child. There are some alternatives to methadone that do not so adversely affect fertility.
Opioid Biochemistry
Current medical research suggests that opioids may interfere with male and female reproductive systems in several ways. Studies show that opioids affect the endocrine system, specifically the hypothalamus and pituitary. This leads to a drop in gonadotropins like follicle stimulating hormone and luteinizing hormone. Opioids also diminish testosterone production, a key hormone in male and female reproduction.
In females, opioids may harm many parts of the ovary including ovarian follicles, oocytes, endometrium and myometrium. Interference in hormones may also play a large role in the following fertility issues
- Menstrual irregularities
- Miscarriages
- Difficulties becoming pregnant
- Pre-term births
- Low birth weight
- Birth defects
- Slower infant development
Long-term opioid use has a significant effect on testosterone levels. One study found that among long-term, high dose, male opioid users, almost one in five had sexual dysfunction. It also estimated that there is a similar percentage of female opioid users with testosterone-related libido issues. However, there is little evidence that short-term use of opioids produces the same conditions, so acute pain management should be vigorously monitored.
Advice for Those Who Want to Get Pregnant
If you want to get pregnant, then you should honestly discuss your opioid use with your fertility specialist. Also discuss any conditions like menstrual irregularities, or erectile dysfunction with your doctor. If you are currently on opioids, ask you physician for safer alternatives.
Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care
M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees. The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship. Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA and you should not post any of your private health information.