Dear Dr. Roach: My daughter is in her 30s and has been experiencing infertility for several years. She and her husband have been tested, and the issue is her egg quality. She has had several rounds of in vitro fertilization with no success.
At age 19, she was prescribed Accutane for her acne. She had to take a monthly pregnancy test in order to take this medication. I researched this medication at the time and was aware of the depression side effects. I was also aware that if a pregnancy occurred while taking this drug, it would have to be terminated. The situation was not a concern at the time.
Now, years later, her fertility doctor says she has eggs, but they are of poor quality. What is your medical opinion on this medication affecting fertility? I read that Accutane was banned in 2009.
C.M.
Isotretoin (Accutane) is the most effective treatment for acne, but it has potential for serious side effects and can only be given after a thorough review of its risks.
I have to correct two misapprehensions. Although brand-name Accutane was discontinued in 2009, generic isotretoin was not banned and still remains an extremely beneficial treatment that is safe when used appropriately. Secondly, there is no obligation while on this medicine to commit to a pregnancy termination.
Great care needs to be taken to prevent pregnancy with repeatedly negative pregnancy tests before starting therapy, as well as two forms of birth control in any person who could get pregnant (unless they are abstinent). There is a high likelihood that a baby who is exposed to isotretoin will have severe damage or be stillborn. If a pregnancy occurs while on isotretoin, the drug must immediately be stopped, and the person needs to be referred to an expert in reproductive toxicity. A pregnancy termination should be discussed, but the decision is always up to the patient (except where prohibited by law).
Although isotretoin can cause severe damage to the developing fetus if taken during pregnancy, a study showed that any effect on fertility was gone by 18 months after treatment. There are many reasons why a woman can have difficulty getting pregnant due to eggs that are less likely to get fertilized. Age is a major factor, but many genetic conditions, chemotherapy, radiation, viruses (including COVID-19), and autoimmune diseases are known causes.
I wish your daughter the best of luck. I have had several patients give up after several rounds of IVF, only to conceive a healthy baby naturally.
Dear Dr. Roach: In a recent column, a reader mentioned that they were having problems coming up with words and wondered if a supplement would help. They mentioned taking medication for neuropathy. Some of the medications for neuropathy have brain fog as a side effect.
P.A.
I appreciate your writing. Of all of the causes for people to have memory and concentration problems, a side effect from medication is one of the most common and is easily reversible. You are right that many medications used for neuropathy, especially gabapentin and pregabalin, can cause difficulty concentrating. Many people describe this as brain fog. It’s worthwhile to discuss any medication, even over-the-counter ones and supplements, with your doctor to see if any of these might be causing this symptom.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
