Hydroxyurea and Fertility: What You Need to Know

When you're trying to get pregnant—or planning to—you don't want surprises from the meds you're taking. Hydroxyurea, a chemotherapy drug used for sickle cell disease, certain cancers, and sometimes polycythemia vera. Also known as hydroxycarbamide, it works by slowing down rapidly dividing cells, which is why it's used in cancer and blood disorders. But that same mechanism can interfere with reproductive health. If you're on hydroxyurea and thinking about starting a family, you're not alone. Many people wonder: does it hurt fertility? Can you safely get pregnant while taking it? The answers aren't simple, but they matter.

For men, hydroxyurea can lower sperm count and reduce sperm quality. Studies show sperm production often drops within months of starting treatment, and in some cases, it takes over a year to bounce back after stopping. That doesn’t mean you’re permanently infertile—but if you’re trying to conceive, waiting 3 to 6 months after stopping hydroxyurea is a common recommendation. Some doctors even suggest freezing sperm before starting the drug, especially if treatment will be long-term. For women, the picture is more cautious. Hydroxyurea is classified as a pregnancy category D drug, meaning there’s clear evidence it can harm a developing fetus. Birth defects have been reported in babies exposed during early pregnancy, including problems with limbs, the heart, and the nervous system. If you’re a woman of childbearing age on hydroxyurea, using reliable birth control is essential. And if you’re planning pregnancy, talk to your doctor about switching to safer alternatives like hydroxyurea-free regimens for sickle cell disease.

It’s not just about getting pregnant—it’s about staying healthy while you do. Hydroxyurea doesn’t just affect sperm or eggs; it can change hormone levels and impact ovarian reserve. Some women report irregular periods or early menopause-like symptoms after long-term use. And for those already struggling with fertility, adding hydroxyurea into the mix can make things harder. That’s why it’s so important to connect with a specialist—not just your hematologist, but also a reproductive endocrinologist. They can help you map out a timeline, monitor your fertility markers, and explore options like IVF or donor sperm if needed. You’re not just managing a disease—you’re planning a future.

Below, you’ll find real-world guides that dig into how hydroxyurea compares with other treatments, what alternatives exist for fertility support, and how to protect your reproductive health while staying on necessary meds. These aren’t theoretical discussions—they’re practical, tested advice from people who’ve been there.