The effects of cannabis on female and male reproduction

Products of the Cannabis sativa plant, including marijuana and hashish, are the most popular recreational drugs in North America. In October 2018, smoking recreational cannabis became legal in Canada. At that time British Columbia had the second-highest per capita cannabis consumption level in the country. With legalization, consumption levels in Canada and BC are expected to rise. This is concerning because both female and male reproductive function may be affected by the ability of cannabis to interfere with the body's natural endocannabinoid system. Cannabinoid receptors have been isolated in the hypothalamus, pituitary, ovary, endometrium, testes, and spermatozoa. Research to date suggests marijuana affects some of the central processes of reproduction, including the release of follicle-stimulating hormone and luteinizing hormone, ovulation, sperm motility, fertilization, and placentation. Although large-scale population surveys have yet to demonstrate a delayed time to pregnancy or a consistent increase in perinatal complications, it seems reasonable to avoid cannabis when attempting to conceive. The Society of Obstetricians and Gynaecologists of Canada believes there is sufficient evidence of harm to advise women to avoid cannabis when pregnant or breastfeeding. Until we have high-quality evidence that cannabis is safe, physicians cannot reassure users that consumption will not affect their fertility or their offspring. With the legalization of cannabis, patients may be more forthcoming about their consumption and researchers may be able to generate more accurate data on reproductive outcomes.