What considerations do you take regarding using valproic acid in men who are hoping to conceive with a partner?

A recent cohort study (Meng et al., PMID 41733407) utilizing national databases in Norway and Taiwan examined associations between exposure to paternal valproate monotherapy during the 90 days preceding conception and incidence of neurodevelopmental disorders (NDDs) among offspring after at least 6 ...

It is a balance between patient stability and potential concerns with kids. However, I do not use VPA frequently due to multiple side effects.

I also find Depakote to be problematic because of problems with tolerance, as well as difficulty getting patients to follow through with lab work. I would lean towards switching to a different medication but would leave the ultimate decision to the patient.