Early mental health screening may improve infertility outcomes

According to a recent report, individuals and couples struggling with infertility should be assessed as early as possible for their mental health and emotional distress, to provide appropriate support and intervention that can ensure the best outcomes.

A recent study by researchers at the University of South Carolina, School of Medicine, Greenville/Prisma Health noted that many pharmacological treatments used in assisted reproductive technology (ART) can affect mental health. Additionally, the researchers noted that there is mixed evidence that depression, anxiety, and emotional distress can affect outcomes of ART and other infertility treatments.

“Regardless of the above facts, depression, anxiety, and emotional distress are common in the infertile population, and evidence-based treatment options should be offered,” note the authors of this review.

Infertility affects approximately 15% of couples of childbearing age in the United States. About 37% of infertility cases are attributed to female factors, 8% to male factors, 35% to combined factors and 20% are unknown. Additionally, ART interventions are increasing every year, with 42% to 76% of women seeking infertility treatment globally.

Many causes of infertility have been linked to psychiatric illnesses or symptoms, including polycystic ovary syndrome (PCOS), endometriosis, and autoimmune thyroid disorders.

PCOS is associated with higher rates of anxiety, depression, and eating disorders.

One study reported that the prevalence of infertility in women with PCOS was as high as 73%, compared to those without PCOS.

Another prospective cohort study in 2021 found higher incidences of anxiety, depression, and self-inflicted violence in women with endometriosis and endometriosis-associated back pain than in those without. had not.

Thyroid disorders are also known to affect mood, energy levels, anxiety, and depression.

Common screening tools, including the Patient Health Questionnaire (PHQ-9 and PHQ-2) and the PHQ-4, a tool comprised of both the PHQ-2 and Generalized Anxiety Disorder-2, allow rapid assessment and evaluation of new and existing and mental health issues that may be exacerbated by infertility.

“Because infertility is considered a chronic stressor and ART involves treatments with potential neuropsychiatric effects, thorough psychiatric screening is important for all people with infertility, with particular emphasis on the presence of symptoms during hormonal fluctuations, including the premenstrual and peripartum periods, and with the use of exogenous hormones,” the reviewers wrote.

Additionally, the results of antiretroviral and fertility treatment have also been found to affect an individual’s emotional distress and quality of life.

Treatment failure, unfulfilled desire to bear children, and poor coping mechanisms may be linked to emotional distress and poor quality of life for both men and women, particularly guilt, anger and a sense of isolation among women.

In one study, women associated feelings of emotional distress with childlessness and depression, while their partner associated feelings of emotional distress with dissatisfaction in their relationship and sexuality.

A 2019 study identified an association between high levels of physical, personal and marital stress in women on ART and the prescription of antidepressants as being strongest in those who did not give birth.

Women also frequently discontinue psychiatric medications with ART, resulting in higher relapse rates of depression, attributed to chronic treatment stress and occurring despite psychopharmacological intervention.

“There are concerns that psychotropic drugs increase the risk of infertility through downstream effects on prolactin levels, weight gain, insulin resistance, and thyroid function,” the reviewers wrote.

However, studies evaluating the use of psychotropic medications and associations with ART have shown insufficient evidence of negative impacts on ART outcomes.

“Psychotherapy is the first-line treatment for depression and anxiety in infertility, with multiple effective modalities including CBT, MBI, mindfulness, and others,” the reviewers wrote.

Reference

Hudepohl NS, Smith K. Infertility and its association with depression, anxiety, and emotional distress: a current review. Advances in Psychiatry and Behavioral Health. 2022;2(1):119-132. doi:10.1016/j.ypsc.2022.05.005