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Infertility, impaired fecundity, and live birth/pregnancy ratio in women with epilepsy in the USA : Findings of the Epilepsy Birth Control Registry
Author(s) -
MacEachern Devon B.,
Mandle Hannah B.,
Herzog Andrew G.
Publication year - 2019
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.16312
Subject(s) - live birth , medicine , fecundity , pregnancy , infertility , obstetrics , confidence interval , epilepsy , assisted reproductive technology , gynecology , population , biology , psychiatry , genetics , environmental health
Objective To determine the current risks of infertility and impaired fecundity as well as the live birth/pregnancy ratio among women with epilepsy ( WWE ) in the USA and whether antiepileptic drug ( AED ) use is a factor. Methods These retrospective survey data come from the 2010‐2014 Epilepsy Birth Control Registry ( EBCR ) Web‐based survey of 1000 WWE in the USA , aged 18‐47 years, who provided demographic, epilepsy, AED , reproductive, and contraceptive data. We report risks of infertility and impaired fecundity, live birth/pregnancy ratio, and whether outcomes differ by AED use or category versus No AED . Results A total of 978 of the 1000 USA WWE reported reproductive data; 373 WWE had 724 pregnancies and 445 births. An additional 38 WWE (9.2%, 95% confidence interval [ CI ] = 6.7‐12.4%) tried to conceive but were infertile. A total of 72.5% had a live birth outcome for their first pregnancy, 89.0% had at least one live birth for their first two pregnancies, and 61.6% had two live births for their first two pregnancies. Eighty‐four of 406 WWE (20.7%, 95% CI = 17.0‐2.9%) had impaired fecundity. The risk of impaired fecundity trended higher on AED polytherapy than on No AED (risk ratio [ RR ] = 1.79, 95% CI = 0.94‐3.11, P = .08). The ratio of live birth/unaborted pregnancy (445/594, 74.9%) was similar among WWE on No AED (71.3%), AED monotherapy (71.8%), and polytherapy (69.7%). None of the AED categories differed significantly from No AED . Note that glucuronidated AED (lamotrigine), which had the highest ratio of live birth/pregnancy (89.1%), compared favorably to enzyme‐inhibiting AED (valproate), which had the lowest (63.3%; RR = 1.41, 95% CI = 1.05‐1.88, P = .02). Significance The EBCR finds 9.2% infertility risk and 20.7% impaired fecundity risk among WWE in the USA . Impaired fecundity trended higher on AED polytherapy than on No AED . Live birth/pregnancy ratio was higher with the use of lamotrigine than valproate. These findings may provide WWE a more objective basis for pregnancy planning.