Q. My fiancé has had bipolar disorder since he was 25 years old. He is now 46. Though late in life (I am 44), we are planning to get married and have children. Are drugs such as Depakote, Zyprexa and Tamazapan known to damage sperm, thus greatly increasing the chances for birth defects?

A. There are not many studies in humans to answer your questions with confidence--and sometimes, there is a big difference between mice and men. However, based on studies in test animals, it is likely that the kind of medications you mention can affect the health of spermatozoa (sperm).

This doesn't necessarily mean, however, that these drugs greatly increase the chances for birth defects due to their effects on human sperm. (Depakote and other mood-stabilizing anticonvulsants certainly can cause birth defects when the mother and fetus are exposed to them during early pregnancy).

In one study of valproate [Depakote and others] in male rats, Soliman et al (Dtsch Tierarztl Wochenschr. 1999 Mar;106(3):110-3) found that the drug significantly increased the percentage of abnormal spermatozoa. Similarly, Baumgartner et al (Mutat Res. 2001 Jan 25;490(1):11-9) found that diazepam--a medication closely related to temazepam-- can cause abnormalities in the number of chromosomes in spermatozoa in both mice and humans.

I did not find studies of Zyprexa (olanzapine) and effects on human sperm; however, Hong et al (Eur J Clin Pharmacol. 1982;22(5):413-6) found that chlorpromazine--another antipsychotic agent--did reduce normal motility (movement) in human sperm.

None of these studies prove that these or similar agents can cause serious birth defects by virtue of their action on sperm; however, that possibility can't be ruled out. My advice: given your age, your fiance's medications, and other issues concerning the genetics of bipolar disorder, I would recommend seeking genetic counseling prior to your having children. You can find such counseling at most large, academic medical centers. I do hope things work out for you and your fiance.

Other Resources:

• More Questions on Bipolar Disorders
• More Questions on Medicines

January 2004

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