A 66-year-old man has been treated with lithium (Lithionit) 5 tablets per day for one year. Now he

Fråga: A 66-year-old man has been treated with lithium (Lithionit) 5 tablets per day for one year. Now he is planning to have child.

What is known about sperm function in connection with lithium treatment?

Sammanfattning: Lithium can be detected in the ejaculate at relatively high concentrations after oral administration. However, in vivo studies have not shown any effect of lithium on sperm function after long term treatment. Results from in vitro studies are contradictory concerning lithium effects on sperm motility. Even if lithium treatment affects male fertility there is no report of fetal damage or malformation.

Svar: Lithium is distributed into seminal fluid after oral administration. In 13 patients treated with lithium for four (0.5-10) years the mean lithium level in the ejaculate (1.48 mE/l) was more than double that in the blood (0.64 mE/l). However, compared with values from healthy subjects, the amount of ejaculate, number of sperms per millilitre, percentage of motile sperms, percentage of defective ones, and velocity after one and five hours respectively were all within normal ranges except one subnormal finding in the number of sperms per millilitre and three borderline values in velocity (1). This study suggested that long-term treatment with lithium does not seem to impair sperm function.

In another in vivo study including 24 psychiatric patients who had been drug-free for at least 7 days and 36 volunteer semen donors as control subjects, there were no significant differences in sperm count, viability, or motility between the two groups. Nine patients then received continuous therapy for three weeks with desipramin (n=5; 200 mg daily) or lithium (n=4; at a dosage maintaining a plasma concentration of 0.6-1.4 mE/l). These patients had a significant decrease in sperm viability but no significant change in sperm count or motility (2).

Results from in vitro studies on the effect of lithium on sperm motility are conflicting (2,3). Levin and co-workers (2) reported that lithium carbonate had no effect on motility, while Raoof et al (3) using another method have observed that lithium, at concentrations comparable with those reported in semen after oral administration, inhibited human sperm motility. 1 Raboch J Jun, Smolik P, Soucek K, Raboch J, Krulik R: Spermiologic findings during longterm lithium therapy. Activ Nerv Sup (Praha) 1981; 23: 274-275 2 Levin RM, Amsterdam JD, Winokur A, Wein AJ: Effects of psychotropic drugs on human sperm motility. Fertil Steril 1981; 36: 503-506 3 Raoof NT, Pearson RM, Turner P: Lithium inhibits human sperm motility in vitro. Br J Clin Pharmacol 1989; 28: 715-717