A 28-year-old man taking sodium valproate for migraines is planning to start a family. Which reproductive effect is a known side effect of valproate in men?

• A. Impaired sperm quality
• B. Decreased testosterone levels
• C. Increased fertility
• D. No effect on fertility

Answer: (A)

Valproate can affect male reproductive function, and the best-supported effect is impaired sperm quality. In men taking valproate, some experience changes in semen parameters such as lower sperm concentration and reduced motility, and occasionally altered morphology. This can contribute to fertility challenges, though the extent varies and effects may be reversible after stopping the drug in some individuals. While hormonal changes like testosterone levels can be affected in theory, the more consistent and directly observed reproductive effect in men is impaired sperm quality. Increased fertility or no effect on fertility are not the generally recognized consequences of paternal valproate exposure.