INFERTILITY SECONDARY TO VALPROATE

Valproic acid (VPA) is generally thought to be more benign in terms of fertility effects in patients with epilepsy than carbamazepine (CBZ) or phenytoin (PHT) due to its lack of liver-enzyme-inducing properties . We report a patient treated with VPA for partial seizures, previousl y fertile on CBZ. When conception failed while taking VPA, semen analy sis revealed a decreased number of sperm, reduced motility, and altere d morphology. Endocrinologic studies and evaluation of the patient's w ife were all normal. Successful pregnancy was achieved and abnormal sp erm indices reverted to normal when VPA was discontinued and CBZ reins tituted. It is probable that a direct gonadal or sperm membrane effect of VPA is the responsible mechanism for this rare phenomenon.