Not every medicine comes with a pregnancy warning, but many can interfere with female fertility by destroying ovarian eggs, stopping ovulation, raising prolactin, or thinning the uterine lining. We spoke to Dr Anuradha Panda, an expert obstetrician-gynaecologist from Apollo Hospitals, Hyderabad, and distilled the clinical takeaways. Learn how different drugs or substances affect fertility, who’s most at risk, and the fertility-sparing steps you can discuss with your clinician.

1. Chemotherapy (especially alkylating agents like cyclophosphamide)

Why it matters: These cancer drugs are the most destructive to the ovarian reserve; they can directly destroy oocytes (eggs) and permanently reduce ovarian function.

What to do: If cancer treatment is planned, ask about fertility preservation (egg or embryo cryopreservation) before chemo. When time is short, doctors may use GnRH analogue ovarian suppression during treatment to try to protect the ovaries.

2. Long-term use of dopamine-blocking drugs (e.g. domperidone, some antiemetics)

Why it matters: These medicines can raise prolactin levels. Elevated prolactin suppresses ovulation, shortens or stops periods, and can thin the uterine lining, making conception harder.

What to do: Review long-term use with your doctor. If high prolactin is suspected, get a blood test and discuss alternatives.

Related Story: 7 Myths About Female Fertility And Conception

3. Some psychiatric medications (antipsychotics, some antidepressants)

Why it matters: Several psychiatric drugs can increase prolactin or disrupt menstrual regularity, which may reduce ovulatory frequency.

What to do: Never stop psychiatric medication abruptly. Discuss risk versus benefit with your psychiatrist and gynaecologist; sometimes a medication change or dose adjustment is possible when planning pregnancy.

4. Recreational drugs and substance abuse (opioids, cocaine, cannabis, heavy alcohol, tobacco)

Why it matters: Substance abuse is strongly linked to ovulatory dysfunction and poorer fertility outcomes. Alcohol and smoking also negatively affect egg quality and the uterine environment.

What to do: Ideally, stop or radically reduce use before trying to conceive; seek support services if needed.

Related Story: How to Cut Back on Alcohol Without Losing Your Social Life

5. Spironolactone (used for hirsutism/PCOS management)

Why it matters: Spironolactone has anti-androgen effects that can interfere with fertility and is not recommended during pregnancy. Long-term use as an anti-hair growth treatment may reduce the chances of conception if not carefully managed.

What to do: If you’re using spironolactone and planning pregnancy, speak to your clinician about stopping it and switching to pregnancy-safe alternatives.

6. Certain diabetes medications (and metformin’s role)

Why it matters: Not all diabetic drugs are suitable for people planning pregnancy; some are withheld because of safety concerns rather than a direct effect on fertility. Conversely, metformin (commonly used in PCOS) can improve ovulation in many women.

What to do: Review your diabetes treatment plan with an endocrinologist or obstetrician-gynaecologist before trying to conceive.

Related Story: Managing Diabetes Naturally

7. Antiepileptic drugs

Why it matters: Some anti-seizure medications can alter menstrual cycles or slightly affect ovulation, and certain drugs carry pregnancy risks.

What to do: Work with your neurologist early — optimise seizure control on the safest effective medication and plan conception accordingly.

8. Migraine medications (vasoconstrictors and others)

Why it matters: Some migraine drugs (for example, strong vasoconstrictors) are avoided in pregnancy and may be cautioned against when planning pregnancy. They don’t necessarily cause permanent infertility, but are important to review.

What to do: Discuss safe migraine management strategies with your neurologist or GP when you’re planning pregnancy.

Related Story: 5 Lifestyle Changes to Manage Chronic Migraines

9. Over-the-counter NSAIDs (around ovulation)

Why it matters: Excessive NSAID (Nonsteroidal Anti-Inflammatory Drug) use can interfere with the ovulatory process. Medical teams sometimes advise avoiding NSAIDs during the fertile window or around ovulation during fertility treatment.

What to do: Use NSAIDs sparingly and avoid them near your expected ovulation day if you’re trying to conceive.

10. Overuse of acid-reducing/prokinetic agents

Why it matters: Certain gastric medicines taken chronically may raise prolactin that can disrupt the hypothalamic-pituitary-gonadal (HPG) axis, leading to decreased oestrogen levels.

What to do: If you use these medicines frequently, ask your clinician for alternatives or testing for prolactin.

Many commonly used drugs and substances can quietly affect female fertility, but most risks can be managed or mitigated with early planning and an informed medication review. If you’re planning pregnancy, have irregular cycles, or are facing treatments like chemotherapy, book a specialist consultation — our experts can review your medications, suggest fertility-sparing options, and map a safe, evidence-based plan tailored to you.

Ready to talk to an expert? Personalised guidance, real results. Book a consult with an expert and get the support you need.