How Do Illegal Drugs Affect Women’s Fertility?

A few weeks ago, we ran a piece about how illegal dr​ugs ​affect​ sperm. The diagnosis was pretty grim: basically, all the drugs that are fun to take have an adverse effect on sperm quality, count, or mobility, meaning it's harder to shoot those little swimmers where they need to go. There was some good news, though: after a period of a few months or so, men regenerate their sperm, so abstaining from drugs for a little while allows their fertility to rebound.

But what about women? Fellas are sperm factories, but ladies are born with all the eggs they'll ever have. No second chances for us. Can drug use damage these eggs permanently? And once you conceive is it really that bad to use drugs during those super lame months of lugging a baby in your belly? These might seem like idiotic questions, but pregnant women get high a lot more than you'd expect: In one survey, nearly ​5 ​percent of them admitted illicit drug use within the past 30 days, and in a drug screening of pregnant women in New Orleans, 19 perce​nt of pregnant women tested positive for at least one naughty substance.

To find out what's

bad and what's really bad to take when you're expecting, I spoke with Dr. Ri​cardo Yazigi, a fertility doctor at Shady Grove Fertility Center in Maryland; Dr. Gillian Loc​kwood, the medical director of the Midland Fertility Clinic in England; and Dr. Dimitrios Mastrogiannis, incoming director of maternal-fetal medicine at the University of Illinois in Chicago, whose forthcoming literature review on drug addiction and pregnancy addresses these topics extensively.

Marijuana

Now that it's becoming legal to light up a joint pretty much anywhere you like, the marijuana market is courting women customers. And whether it's in the form of social activism ( Moms ​for Marijuana) or a social club (the Bever​ly Hills Cannabis Club), stoner moms are definitely a thing. But what about getting stoned when you want to become a mom?

"There's a very old stu​dy, published in the Journal of Epidemiology in 1990, that reported that women smoking marijuana had an elevated risk for infertility due to lack of ovulation," said Dr. Yazigi. It's unclear exactly what caused ovulation to stop, but it appeared to be an interference with the HPO axis, which regulates hormones between the hypothalamus, pituitary gland, and the ovaries. Marijuana use can cause a drop in the levels of luteinising hormone, which you need if you want to ovulate.

Dr. Yazigi explained that "the risk was greater among women who had used marijuana within a year of trying to become pregnant than among those who had used it in the past, but there was no clear consistency between the frequency and duration of the use with the effect." That said, it appeared that the effect was muted in women who used marijuana regularly compared to those who only lit up occasionally, perhaps because regular users had built up a tolerance to the drug.

Marijuana can also slow the movement of the egg through the oviduct, which can prevent implantation in the uterus. "There is a small window of time for implantation of the embryo," Dr. Yazigi told me. "An embryo that attempts to implant earlier or later may have a difficulty in doing so, and therefore the pregnancy may not occur."

That said, once you've got a little bun in the oven, a little MJ isn't the worst thing you could do. The research goes back and forth; some studies have correlated marijuana use during pregnancy with lower memory functioning in children, others claim there's no effect. But as Dr. Mastrogiannis pointed out, "The American Academy of Pediatrics has reviewed the data and has concluded that there are no adverse neonatal outcomes with the use of marijuana." He qualified that by adding that we don't know for sure that there isn't a negative outcome, since there hasn't been a whole lot of research on this particular subject, but it doesn't seem to be particularly dangerous. That's a good thing: at Temple University Hospital in Philadelphia, where Dr. Mastrogiannis used to be the director of the department for maternal-fetal medicine, 17.5 percent of pregnant patients test positive for marijuana.

Cocaine

When I was in college, I knew a lot of girls who had coke habits to help them party all night and make them​ skinny. That also explains why it's difficult to measure cocaine's effect on fertility: There are a lot of side effects of the coke-blowing lifestyle, including drinking heavily and maintaining a low body weight, that can compromise fertility on their own.

But the studied effects of cocaine's impact on fertility are pretty sobering. Dr. Lockwood explained that, like marijuana, cocaine use can "suppress ovulation altogether by interfering with the subtle feedback loops which control the ovarian cycle." Dr. Yazigi added that cocaine can also increase the hormone prolactin, which disrupts the hormonal balance and the menstrual cycle, and studies have shown that tubal abnormality (damage to the fallopian tubes) increases with cocaine use.

"But the question is, what is the abnormality? We don't know," said Dr. Yazigi. "We know that cocaine decreases fertility; we just don't know exactly what the mechanisms are."

The studies are somewhat muddled because, as Dr. Mastrogiannis so eloquently put it, "It's not ethical to take a pregnant woman, or any woman, for that matter, and give her cocaine."

What we do know from the studies out there is that cocaine is not good for fertility, and it's not good for pregnancies either. Dr. Mastrogiannis said, "We have found premature delivery, ruptured membranes, and placental abruption" - that's basically when the placenta becomes detached from the uterus, which can cause serious blood clots in the mother and premature birth or death of the baby - in studies involving cocaine use. That's because cocaine can easily cross the placental barrier and can be stored in the placental membranes, causing profound consequences. Data from the National Birth Defects Preve​ntion Study also noted a correlation between cocaine use and the risk of clef palate.

Of course, it depends on how much cocaine you're using. Just like binge drinking during pregnancy is far worse than having an occasional beer once in a while, going on a coke binge could be worse than using just a little teensy-tiny smidgen of blow. Still, probably best to forgo that bump if you've got a baby bump.

Opiates

Opiate use has become a real epidemic, and the numbers are steadily creeping up for women users: in the past decade, the number of women who died from opiate painkillers increased tenfo​ld. In Vermont, where opiate addiction is rampant, about 40 out of every ​1,000 babies are exposed to opiates in the womb.

Opiate addiction is complicated when you're pregnant, since you're essentially shooting up for two. "Since the fetus shares the mothers blood supply, these drugs will be delivered to the unborn baby at doses that may be lethal and will result in the baby developing severe withdrawal symptoms upon birth," said Dr. Lockwood. Opiate-addicted women are put in a bind when they become pregnant: If they get too high, their babies can easily overdose; if they go cold turkey, their babies can die from withdrawal.

Methadone maintenance is the preferred alternative, since taking methadone is less harmful than taking heroin while pregnant. Even then, Dr. Mastrogiannis said, methadone can cause complications after birth: premature babies, low birth weight, and developmental delays, and that's if the baby even makes it to term. "Opiate use is related to pre-term abruption of the membrane, premature delivery, and stillbirth," said Dr. Mastrogiannis.

And, of course, getting pregnant in the first place is complicated by opiate use. In one study, opiate use was correlated with hypogonadism (dysfunction of the gonads) in both men and women, causing a slew of hormonal issues. In women, symptoms include missed periods and infertility. Opiates are also known to dull sexual urge (in men, it's called "dope dick"), so the chance of having sex altogether is lower.

Amphetamines

We're lumping in all amphetamines here, including MDMA/ecstasy, methamphetamine, and speed, because the research doesn't adequately distinguish between various types of amphetamines. Obviously, that makes it difficult to determine whether it's preferable to use meth or molly during your prenatal months, so we'll make it simple: Probably best to just have a glass of red wine instead.

Dr. Yazigi said there wasn't any good research on how amphetamines compromise fertility in women, which is possibly because most amphetamine users are the I-like-to-party types who use other drugs too. That said, getting pregnant and continuing to use amphetamines is definitely not good for either the mother or the baby: prenatal meth use can cause arrhythmia, hypothermia, seizures, and stroke.

One study of 65 Swedish women who used amphetamines during pregnancy showed that their babies' were smaller, lighter, and had smaller heads than a control group. But in 2005, an expert panel suggested that there was "insufficient evidence" to demonstrate adverse outcomes from prenatal amphetamine use, since none of the studies could adjust for poor prenatal case in general. Which basically just goes to show that if you're addicted to amphetamines, you probably shouldn't be having a baby.

LSD

Ready for some (relatively) good news? There hasn't been any evidence that LSD adversely affects your chances of conceiving, or that it causes adverse effects in utero. That doesn't mean that acid tripping throughout your childbearing years is necessarily harmless, but, as of now, the jury's out about whether or not it has serious consequences on fertility.

"We've done a lot of studies, looked at patients, we have not seen any [pregnant mothers using] LSD," Dr. Mastrogiannis. It should be mentioned that none of the doctors I spoke to gave any drugs the "all clear" as safe to use during pregnancy or pre-pregnancy periods. In other words, it's true what they say about being a woman: You really can't have it all.

Illustrations by Stephanie Hurtado.

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