Anti-hypertensives:
Essential hypertension is thought to affect 0.6 to 2.7% of pregnancies
and is more common in older populations and obese women (42). Treatment
of high blood pressure is essential to reduce the risk of cardiovascular
complications such as stroke and heart disease, but also to reduce the
perinatal complications of pre-eclampsia, placenta abruption and
intrauterine growth restriction. This literature review used the four
most common classes: calcium channel blockers, ACE inhibitors, diuretics
and beta blockers and found no papers on the drugs used prior to and
during ART treatment effects on ART outcomes. Prevalence of hypertension
is also increasing so it is important the effects of these medications
are analysed, especially as there is such little data available.
Similarly essential hypertension affects almost 25% of men aged 35 to
44 years (43) and research suggests that the diagnosis of hypertension
in men is associated with impaired semen quality; lower semen volume,
lower sperm count and reduced motility (44). Lu et al. performed a
retrospective analysis of semen results used for ART during a two-year
period (1999-2001) and found no impact on sperm quality following
treatment with beta blockers (45). Another study analysed high blood
pressure and treatment with anti-hypertensives and their effect on semen
quality (46). They found that men with hypertension were more likely to
have one or more semen abnormalities compared to men without
hypertension. In terms of treatment, beta blockers were associated with
lower semen volume, sperm concentration and motility. There were also
isolated differences observed in men taking either ACE inhibitors,
Calcium Channel Blockers and Angiotensin Receptor Blockers, with
diuretics providing no statistically significant differences. These
studies suggests that it may be the underlying diagnosis of hypertension
that leads to the sperm parameter anomalies as opposed to the medication
and if the high blood pressure is well controlled, the impact on
fertility is minimal (46) . However, given the results are conflicting,
larger, high-quality randomised control trials are required to clarify
the associations with treatment for high blood pressure and reproductive
outcomes.