Does Sertraline (Zoloft) Affect Fertility?

What does the evidence say about Zoloft and sertraline before trying to conceive while trying to conceive?

1. Whether sertraline itself makes it harder to get pregnant isn't established: one study found women taking sertraline or other SSRIs had a slightly lower chance of getting pregnant, but depression itself can lower fertility, so it's unclear how much of that effect comes from the medication versus the underlying condition. 1
2. Most studies have not found a higher chance of birth defects when sertraline is used in pregnancy. 2
3. In a small study of women with first-episode depression, taking an SSRI (mostly sertraline) for six months was linked to measurable shifts in ovarian-reserve markers, including higher FSH and estradiol and lower AMH and antral follicle counts, though the researchers had no comparison group of women not on medication and couldn't separate the drug's effect from depression's own effect. 3
4. Stopping an antidepressant during pregnancy carries its own risk: in one study, women who discontinued were nearly three times more likely to have a major depressive relapse or need hospitalization than women who kept taking their medication. 4
5. Reviews of well-controlled studies have found many previously reported risks of antidepressant use in pregnancy are no longer statistically significant once confounding factors like maternal depression itself are accounted for, supporting an individualized decision with a provider rather than automatically stopping. 5

What to know about Zoloft and sertraline before trying to conceive while trying to conceive

• If you're just starting to try to conceive while taking sertraline, there's no established need to stop: current evidence doesn't show a clear fertility harm from the medication itself, and stopping suddenly carries its own risks.
• If you've been trying for a while and are timing intercourse around ovulation, don't stop or change your dose on your own. Loop in the prescriber who manages your sertraline so any adjustment is planned rather than abrupt.
• If conception is taking longer than expected and you're working with a fertility specialist, mention your sertraline use and dose. It's one more data point they'll factor in, not an automatic reason to switch medications.