Annual Meeting Abstracts: View

  • (Abst. 1.426), 2018
  • Infertility, Impaired Fecundity and Live Birth Rates in Women with Epilepsy in the USA: Findings of the Epilepsy Birth Control Registry
  • Authors: Devon B. MacEachern, Neuroendocrine Associates, P.C.; Hannah Mandle, Neuroendocrine Associates, P.C.; and Andrew Herzog, Neuroendocrine Associates, P.C.
  • Content:

    Rationale: There is debate as to whether women with epilepsy (WWE) are at increased risk of infertility and impaired fecundity and whether antiepileptic drug (AED) use is a factor.  However, there has been no recent large-scale, community-based investigation of these issues in the USA. Methods: These retrospective data come from the 2010-14 Epilepsy Birth Control Registry (EBCR) web-based survey of 1,144 WWE in the community, ages 18-47 years, who provided demographic, epilepsy, antiepileptic drug (AED), reproductive and contraceptive data.  We report infertility, impaired fecundity and live birth/unaborted pregnancy rates among the 1,000 USA participants and whether these outcomes relate to AED use.  We define infertility as the percent of WWE who had unprotected sex but did not achieve pregnancy by one year.  Impaired fecundity refers to the percent of WWE who were infertile or did not carry a pregnancy to live birth.  Note, the 41 WWE who had induced abortions as their only outcomes were excluded from impaired fecundity analysis and the 18% of pregnancies that terminated as induced abortions were excluded from live birth rate analysis. Results: 978 of the 1,000 USA WWE reported reproductive data.  373 WWE had 724 pregnancies between 1981 and 2013 (mean year of pregnancy ± SD: 2004 ± 6.6 years) and 422 births.  They averaged 2.15 ± 1.43 pregnancies with mean age of 24.9 ± 5.4 and range of 13-44 years.  An additional 38 WWE (9.2% [95% CI: 6.7-12.4%]) tried but were infertile. 222/306 (72.5%) WWE had a live birth outcome for their first pregnancy.  260/292 (89.0%) had at least one live birth for their first two pregnancies and 180/292 (61.6%) had two live births for their first two pregnancies.  84/373 (22.5% [18.6-27.0%]) had impaired fecundity.  The risk of impaired fecundity trended higher on AED polytherapy than on no AED: RR = 1.74 (95% CI: 0.92-3.31), p = 0.09 (Table 1).  The ratio of live birth/pregnancy (422/594, 71.0%) was similar among WWE on no AED (82/115, 71.3%), AED monotherapy (211/294, 71.8%) and polytherapy (129/185, 69.7%).  None of the AED categories differed significantly from No AED (82/115, 71.3%) in relation to live birth rate: EIAED - 92/137, 67.5%, GluAED - 41/46, 89.1%, NEIAED – 59/81, 72.8%, EnzInhAED (valproate) – 19/30, 63.3%, Poly – 129/185, 69.7%(Table 1).  GluAED (lamotrigine) which had the highest ratio of live birth/pregnancy (41/46, 89.1%) compared favorably to EnzInhAED (valproate) which had the lowest (19/30, 63.3%): RR = 1.41 (1.05-1.88), p = 0.02. Conclusions: The EBCR retrospective survey finds 9.2% (6.7-12.4%) infertility rate and 22.5% (18.6-27.0%) impaired fecundity rate among WWE in the USA.  As a point of reference, both are higher than the CDC cited general population infertility (6.0%) and impaired fecundity (12.1%) rates.  The studies differed, however, by demographics and operational definitions, thereby limiting the validity of a direct comparison.  Impaired fecundity trended higher on AED polytherapy than on no AED.  Live birth/pregnancy ratio was higher with the use of lamotrigine than valproate. Funding: Epilepsy Foundation and Lundbeck
  • Figures:
  • Figure 1