Does Adderall Affect Fertility?

What is Adderall? What is Adderall Used For?

Adderall is a prescription drug consisting of two active ingredients: amphetamine and dextroamphetamine [1]. The drug comes in two formulations: Adderall® and Adderall-XR®, which has an extended-release period [1]. Adderall is considered a central nervous system stimulant and is most often prescribed to individuals diagnosed with attention deficit hyperactivity disorder (ADHD). Such individuals frequently display difficulties with concentration, task completion, time management, impulsivity, or fatigue. Less common symptoms of ADHD include problems with eye contact, aphantasia, or even hypermobility.

ADHD symptoms may be mitigated through a combination of behavioural supports and medications such as Adderall [1]. Because Adderall is a stimulant, it may also be used in individuals with narcolepsy to help them stay awake during the day [1].

It should be noted that Adderall has a high potential for addiction and abuse. Accordingly, it is classified as a Schedule II drug in the United States and must be prescribed by a physician [1]. In recent years, increasing numbers of individuals—particularly students—have begun to use Adderall recreationally in order to enhance their focus and productivity. Such a practice is not only dangerous, but also may not have the desired effect. Research suggests that individuals who take psychostimulants without a valid medical indication may show increased motivation for work, but that the quality of work completed is often diminished [2].

How Does Adderall Work?

Adderall functions by increasing the availability of catecholamine neurotransmitters within the synaptic cleft between neurons [3]. Specifically, Adderall increases the concentration of dopamine and norepinephrine in the extracellular space, which augments dopamine and norepinephrine binding and activation of postsynaptic neurons [3]. Increases in dopamine and norepinephrine signalling can promote various cognitive and executive functions and regulate individuals’ responses to risk/reward stimuli [3]. Such effects are particularly beneficial for patients with ADHD when it comes to tasks that require sustained attention.

Side Effects of Adderall

Dopamine and norepinephrine are involved in a variety of physiological processes. Because Adderall boosts the concentrations of these neurotransmitters, the drug can elicit non-specific and potentially adverse effects. In particular, norepinephrine modulates various pathways in peripheral organs via binding to α2 adrenergic receptors [3]. As such, significant increases in norepinephrine availability can lead to a host of physiological disruptions.

Risks and side effects of Adderall include [3, 4]:

• Tachycardia
• Increased blood pressure
• Cardiac arrhythmia
• Cardiovascular complications (ischemia, myocardial infarction, stroke)
• Weight loss
• Insomnia
• Dizziness
• Seizure
• Headache
• Nervousness or anxiety

Can Adderall Affect Fertility?

Due to its impact on noradrenergic signalling, Adderall can lead to a host of non-specific physiological changes. While the hormone norepinephrine does not act on reproductive organs directly, the hypothalamic-pituitary-adrenal (HPA) axis—which includes norepinephrine—can modulate the activities of the female reproductive system [5]. As such, some individuals taking Adderall may have concerns regarding the medication’s potential impact on their reproductive physiology. In the sections that follow, we examine current evidence surrounding noradrenergic signalling and its impact on reproductive organs.

Can Adderall Cause Infertility?

Individuals who are seeking to conceive may be concerned about whether Adderall can cause infertility. While there is some evidence linking Adderall to changes in reproductive organs [6, 7], most studies have been conducted in animal models or are based on single-case reports. Hence, the claim that Adderall causes infertility is unjustified based on current evidence. Ultimately, further research is needed to explore any potential relationship between Adderall and disruptions to reproductive health.

Does Adderall Affect Sperm?

A handful of animal and human studies have suggested that Adderall and/or similar drugs may affect sperm counts and sperm motility. For example, one study treated male mice with methylphenidate, a similar drug to Adderall which is used to treat ADHD [8]. Prolonged administration of methylphenidate was associated with significantly reduced numbers of Leydig (testosterone-producing) cells, serum testosterone levels, and sperm motility [8]. Given that testosterone is an important hormone in spermatogenesis, significant reductions in this hormone can contribute to male infertility. A retrospective cohort study of adult males also reported an association between ADHD stimulant use and reductions in motile sperm count and semen volume [9]. The authors of this study concluded that physicians and mental health providers should counsel male patients on the potential impacts of ADHD medication on sperm quality and volume, particularly if such patients are trying to start a family.

Does Adderall Affect Pregnancy?

There is extremely limited evidence to support the claim that Adderall affects pregnancy. A singular study conducted in early- and late-pregnancy female guinea pigs did report that injection with norepinephrine was associated with changes in blood flow within the genital tract and placenta [6]. Specifically, female guinea pigs in the late-stages of pregnancy experienced reduced blood flow to the placenta, cervix, and vagina, which the authors attributed to norepinephrine’s capacity to enhance vasoconstriction [6]. Seeing that Adderall increases circulating norepinephrine levels, one might be tempted to extrapolate from this finding and speculate that Adderall could theoretically disrupt blood flow to the fetus. However, such a claim would not be substantiated by data, considering that 1) the reported effects only occurred using high concentrations of pure norepinephrine (rather than physiologically relevant doses of Adderall); 2) this study has not been replicated; 3) the study was conducted in guinea pigs rather than humans. It is crucial to consider such contextual factors to faithfully interpret scientific studies.

Despite the lack of evidence regarding the effect of Adderall on pregnancy, physicians may nonetheless counsel pregnant women against taking Adderall because safety tests have not been conducted to assess potential risks to the fetus. Pregnant women should always inform their physicians of any medications they are taking and follow medical advice.

Conclusion

Adderall is a type of stimulant medication that is most frequently used to treat ADHD and narcolepsy. Adderall is a type of amphetamine and functions by increasing levels of dopamine and norepinephrine. Adderall has been associated with various off-target effects, including cardiovascular disruptions, weight loss, and changes in sleep. Some evidence suggests that Adderall or similar medications can lead to reduced sperm counts and motility in men, though further analyses are needed to strengthen this conclusion. Currently, there is not sufficient evidence to determine whether Adderall has an effect on female fertility or pregnancy; research on this topic would be beneficial to women with medicated ADHD who are seeking to conceive.