Is blood pressure medicine to blame for fertility issues?

I'm 53 and remarried a couple of years ago.

- DR ROSEMARY LEONARD

Q My wife is a bit younger than me, and we'd like to have a family. We've been unsuccessfully trying to conceive for the past year, and have discovered my sperm count is slightly low. I'm on amlodipine for my blood pressure, and am wondering if this could be to blame, and if so, is there a more 'fertility friendly' treatment I could switch to?

A Quite a lot of commonly used medications can affect male fertility, and this includes drugs used to treat high blood pressure. Beta blockers, such as atenolol, can decrease sperm volume, concentration and motility, and there is also some evidence that calcium channel blockers, such as the amlodipine you are taking, can also reduce sperm concentration and motility. They may also interfere with the sperm's ability to fertilise an egg.

Research on the effect of ACE inhibitor drugs, such as ramipril and lisinopril, is conflicting, and while some studies have suggested they can cause lower semen volume and motility, a study of men taking lisinopril with zinc and folic acid found they had slightly higher sperm counts compared to men taking the supplements alone.

Research on the other main group of drugs used to treat high blood pressure, ARB's, such as losartan or candesartan, has also given mixed results, with some suggesting they lower semen motility and volume, while others have shown they either have no effect or cause a slight improvement in sperm count.

You may wish to talk to you doctor about switching to an ACE inhibitor or an ARB.