New research focuses on the relationship between IVF and depression
The decision to start a family is a very important time in any couples lives. In many instances falling pregnant happens with relative ease. However, this isn’t always that case. Assisted fertilisation is often the only option for many couples.
The decision to undergo IVF is a significant financial and emotional investment. The fear of not being able to conceive or a failed pregnancy can place considerable pressure on couples. Consequently there are concerns surrounding mental health. In particular, how women cope with the emotional aspect of IVF.
There have been concerns that anxious women undertaking IVF are at a greater risk of failed conception. Or that if IVF is unsuccessful, women are more prone to depression. There is also the suggestion that women who have babies conceived via IVF are more susceptible to post-natal depression. What does the research show? Are there links between depression and IVF?
The complexity of conception
Falling pregnant is a complicated process. Being able to have a baby relives on a number of factors:
- The production of healthy sperm
- The production of healthy eggs
- Unblocked fallopian tubes
- The ability to fertilise the egg
- The ability of the embryo to become implanted
- Sufficient embryo quality
A breakdown at any of these stages can make it very difficult or impossible to fall pregnant. This is why many couples have to turn to IVF.
Does stress and anxiety during IVF impact conception chances?
Stress is not a cause of infertility. However, it can disrupt ovulation by interfering with hormone production[1. “Meller WH, Zander KM, Crosby RD, Tagatz GE. (1997). Leuteinizing hormone pulse characteristics in depressed women. American Journal of Psychiatry. Volume 154, (pp. 1454-5.”]. Certain hormones are needed to help stimulate ovulation, facilitate conception and support a healthy pregnancy.
In 2001 Klonoff-Cohen and colleagues published a paper that investigated the effects of stress in women undergoing IVF. They found that women who were highly anxious and depressed before IVF treatment were 93% less likely to conceive compared with less stressed women[2. “Klonoff-Cohen H, Chu E, Natarajan L, Sieber W. (2001) “A prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer. Fertility and Sterility. Volume 76, Issue 4, (pp.675-687).”]. One hundred and fifty-one women across seven clinics in Southern California participated in this study.
What the current research tells us
One American study focussed on 202 women undertaking IVF. Researchers investigated if pre-IVF psychological distress was a precursor to failed conception[3. “Pasch, L. et.al. (2012). Psychological distress and in vitro fertilization outcome. Fertility and Sterility, Volume 98, Issue 2, (pp. 459-64).”]. Pasch and colleagues concluded that stress or anxiety associated with IVF treatments didn’t have a bearing on whether a women was able to successfully conceive.
In another UK based study, researchers investigated the impact of stress, anxiety, and depression on women attempting to conceive naturally. Of the 339 women that participated in the study, 61% became pregnant within six months. Successful conception was not associated with the mental well-being of the women[4. “Lynch, et.al. (2012). Are increased levels of self-reported psychosocial stress, anxiety, and depression associated with fecundity? Fertility and Sterility, Volume 98, Issue 2, (pp. 453-8).”].
The findings of these studies reflect the current research. Feeling stressed, anxious, or depressed when trying to have a baby does not necessarily reduce your chances of conceiving naturally or through IVF.
Can unsuccessful IVF treatments increase the risk of depression?
One of the secondary findings from the research by Pasch and colleagues was that IVF failure lead to subsequent psychological distress. Researchers found that women unable to conceive through IVF had a higher rate of consequent anxiety and depression. A clinical anxiety disorder was diagnosed in 60% of failed IVF cases. Furthermore, clinical depression accounted for 44% of cases.
However, current research suggests that women are not at a significant risk of clinically diagnosed depression following unsuccessful assisted reproductive fertility treatments. This latest study investigated the effects of failed conception on the mental health of 41,000 Danish women[5. “Sejbaek C. et.al (2015). Are repeated assisted reproductive technology treatments and unsuccessful outcome risk factors for unipolar depression in infertile women? Acta Obstetrics and Gynecology Scandinavia DOI: 10.1111/aogs.12705”.].
With such a large number of women participating in this research, it’s reasonable to conclude that Sejbaek and colleagues findings are significant and valid.
What is perhaps more significant is that this research identified a correlation between successful assisted reproduction and post-natal depression.
Motherhood and depression
Analysis of the data compiled by Sejbaek and colleagues revealed that becoming a mother was a significant trigger of clinically diagnosed post-natal depression among women who conceived following fertility treatment. This is despite the child being a long-awaited and a desired addition to the family.
Researchers found that the stress associated with having a baby is more of a factor in having depression compared with actually undertaking fertility treatments.
Post-natal depression is a very complex issue and one that’s not well understood. It’s not only women that undertake IVF and other assisted reproduction that are at risk. All new mothers may experience some form of ‘baby blues’. This can lead to longer periods of depression and impaired mental health.
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According to the NHS, approximately 1 in 7 women will suffer from some level of depression following childbirth. However, these figures are not conclusive. Insufficient screening and poor diagnoses mean that the true extent of post-natal depression is not clearly understood. There also remains an ongoing stigma surrounding mental health. This can lead to new mothers ‘suffering in silence’. This can further exacerbate the situation. Mental health can further deteriorate without treatment.
With calls for more national funding and better screening mechanisms, it’s hoped that the support for mothers experiencing depression following childbirth can be significantly improved. More research, earlier intervention, and removing mental health sigma will all go a long way to help mothers cope with a new baby.
Where to go from here
It’s important to keep mental health in check. This applies whether you’re trying to conceive naturally or through assisted reproduction. Don’t be afraid to talk to your doctor or fertility specialist. Discuss any stress or anxiety you may be experiencing. Keep communication open. Acknowledge the important tell-tale signs of depression.
Remember, you’re never alone. There is always assistance available. Many fertility treatments offer counselling programs to support couples through assisted reproduction. There are also other community organisations that offer support. For more information, contact your doctor or a local fertility clinic.
References
Dr. Kooner is Deputy Director of The Advanced Fertility Center of Chicago and has been a Specialist in Fertility Treatment since 1999.
As well as the areas that the clinic specialises in general, he is particularly interested in managing oocyte donation, female same-sex couples, single women having sperm donation and those considering egg freezing.
Dr. Kooner regularly speaks at fertility meetings. He has published in national journals and constantly contributes to the fertility research and publications from Advanced Fertility Center of Chicago.
