While medical treatment of hypertension is important, urologists treating male infertility must be knowledgeable about the agents that cause the most significant impairments in testicular function such as production of testosterone. Inhibited production of testosterone may result in reduced libido, erectile dysfunction, and significantly decreased sperm production. While fertility remains desirable, men using these medications can often be switched to another class of antihypertensive medications while attempting pregnancy.
Depending on the class of the antihypertensive drug and its effect over endothelium mediators, the impact on erectile dysfunction could be positive or negative. Most antihypertensive agents exert a deleterious effect on fertility by impairing sexual function. However it is important to keep in mind that hypertension occurs more commonly in the older population, a group known to have a higher incidence of erectile dysfunction in general. The use of antihypertensives in conjunction with vascular insufficiency may exacerbate inadequate blood flow to the male genitals.
Further research found beta blockers reduced semen volume, semen concentration and mobility.
Some older medications used to treat high blood pressure (such as methyldopa) can raise prolactin levels and interfere with ovulation. If ovulation is disturbed, egg is not released, so fertilization could be prevented.