Advertisements

Recognizing the Psychological Toll of Infertility in Women

Advertisements

Infertility, clinically defined as the inability to conceive after at least one year of regular unprotected heterosexual intercourse (1), is common and associated with increased anxiety and depressive symptoms (2). Yet the psychological needs of many people with infertility remain unmet. Infertility and the psychological effects of infertility affect both men and women and people of all genders, albeit differently. While the effects on men and people of all genders are equally important to understand and address, this blog focuses on the effects on cisgender women.

Infertility is common. About 19% of married (heterosexual) nulliparous women aged 15 to 49 in the US have infertility (3). Like a miscarriage, infertility is often not discussed in social circles, and women suffer in silence. They see pregnant women and women with newborn babies, but not the other women suffering from infertility with them. Women may not realize that others close to them also have infertility and may feel shame associated with infertility. It is estimated that one third of infertile heterosexual couples have female-related infertility, another third male-related infertility, and the remaining third a combination of factors (4). But even when infertility in a heterosexual couple is due to the man, women undergo much of the medical fertility treatment that is physically and emotionally draining.

Many women struggling with infertility experience anxiety and depressive symptoms (2). As many as 21-52% of these women suffer from depression (5), suggesting that women with infertility need urgent access to psychiatric care. Women with infertility who feel depressed are also less likely to seek infertility treatment (6). Additionally, the stress experienced during infertility treatment can cause many couples to discontinue infertility treatment (4). Treating depression or stress can help people make an informed decision about whether to seek infertility treatment. Depression and anxiety can also make conception difficult (7, 8). Providing support and psychological treatment to women suffering from infertility and conditions can improve fertility outcomes.

Advertisements

Some women with infertility choose assisted reproductive technology (ART). The ART process itself can be stressful and puts at-risk women at risk for depression (9). The frequent and timed appointments for ART can be stressful to balance with other responsibilities, and the procedures can feel physically invasive for a woman. Waiting for a cycle to succeed can be painful, as can the news that it failed. In fact, many people cite stress as a reason for stopping ART (4). When women with infertility after ART conceive, their rates of anxiety and depressive symptoms are again similar to those of naturally pregnant women (2). While the ART process may put some women at risk for depression, unsuccessful ART and childlessness with continued desire to conceive after ART are also associated with depression and anxiety compared with women who have found other meaningful life goals (10). For others, financial costs may prohibit ART even if desired. This underscores the importance of screening and access to psychosocial support, psychotherapy and, when appropriate, pharmacological treatment for women struggling with infertility, including women undergoing ART or women who have failed ART.

See also  Practice Attunement to Feel Seen and Nurtured in Your Relationships?

The psychological toll of infertility is evident in the literature and in clinical practice. However, there are evidence-based treatments, such as cognitive behavioral therapy, that can improve depression and anxiety in women dealing with infertility who are not undergoing fertility treatment and in women undergoing ART (11, 12).

The high prevalence of anxiety and depression in women with infertility underscores the importance of collaboration between infertility clinics and specialized mental health providers. However, many women seeking treatment for infertility who suffer from depression or anxiety remain unable to access mental health services (10, 13). In primary care, embedding mental health care has improved access to and utilization of mental health care and improved mental health outcomes (14). While the literature indicates an increasing role for embedding mental health care in fertility clinics (10, 14, 15), this is even less studied.

Advertisements

There is currently an unmet mental health need for women experiencing infertility. Embedded mental health care could help bridge this gap by providing access to fertility clinic care, an environment that could be more convenient and comfortable for women. Currently, the American Society for Reproductive Medicine recommends that all practices offering ART have access to a psychologist who specializes in fertility counseling (16). It is important to identify women struggling with infertility and depressive or anxious symptoms in order to provide appropriate support and evidence-based mental health treatment. Finally, most of the literature focuses on the psychological impact of infertility on straight cis women. It is imperative to study the psychological impact of infertility on a variety of genders and people trying to conceive.

references

  1. Carson SA, Kallen AN. Diagnosis and Treatment of Infertility: A Review. JAMA 2021;326:65-76.
  2. Salih Joelsson L, Tydén T, Wanggren K, Georgakis MK, Stern J, Berglund A et al. Anxiety and depression symptoms in subfertile women, pregnant women after infertility treatment and naturally pregnant women. EUR Psychiatry 2017;45:212-9.
  3. Infertility. Important statistics. Im. Vol. 2022. National Family Growth Survey. Center for Disease Control: National Center for Health Statistics, 2021.
  4. Cousineau TM, Domar AD. Psychological effects of infertility. Best Practice Res Clin Obstet Gynaecol 2007;21:293-308.
  5. Kiani Z, Simbar M, Hajian S, Zayeri F. The prevalence of depression symptoms in infertile women: a systematic review and meta-analysis. Fertil Res Pract 2021;7:6.
  6. Crawford NM, Hoff HS, Mersereau JE. Infertile women who screen positive for depression are less likely to initiate fertility treatments. Hum Reprod 2017;32:582-7.
  7. Cesta CE, Viktorin A, Olsson H, Johansson V, Sjölander A, Bergh C et al. Depression, anxiety and antidepressant treatment in women: association with outcome of in vitro fertilization. Fertil Steril 2016;105:1594-602.e3.
  8. Nillni YI, Wesselink AK, Gradus JL, Hatch EE, Rothman KJ, Mikkelsen EM et al. Depression, anxiety and psychotropic drug use and fertility. Am J Obstet Gynecol 2016;215:453.e1-8.
  9. Freeman MP, Lee H, Savella GM, Sosinsky AZ, Marfurt SP, Murphy SK et al. Predictors of depressive relapse in women undergoing infertility treatment. J Womens Health (Larchmt) 2018;27:1408-14.
  10. Patel A, Sharma PSVN, Kumar P. The psychiatrist’s role in infertility clinics: A review of past, present, and future directions. J Hum Reprod Sci 2018;11:219-28.
  11. Faramarzi M, Alipor A, Esmaelzadeh S, Kheirkhah F, Poladi K, Pash H. Treatment of depression and anxiety in infertile women: cognitive behavioral therapy versus fluoxetine. J Affect Disord 2008;108:159-64.
  12. Abdolahi HM, Ghojazadeh M, Abdi S, Farhangi MA, Nikniaz Z, Nikniaz L. Effect of cognitive behavioral therapy on anxiety and depression in infertile women: A meta-analysis. Asian Pacific Journal of Reproduction 2019:2(1):68-75.
  13. Pasch LA, Holley SR, Bleil ME, Shehab D, Katz PP, Adler NE. Addressing the needs of fertility treatment patients and their partners: are they informed about and receiving mental health services? Fertil Steril 2016;106:209-15.e2.
  14. Sax MR, Lawson AK. Emotional Support for Infertility Patients: Integrating Mental Health Professionals into the Fertility Care Team. Women 2022;2:68-75.
  15. Limp WD, Braverman AM. Introduction: The role of mental health professionals in the care of infertile patients. Fertil Steril 2015;104:249-50.
  16. American Society for Reproductive Medicine PaCotSfART Practice Committee and Society of Reproductive Biologists and Technologists Practice Committee. Electronic address: [email protected] Minimum standards for practices offering assisted reproductive techniques: a committee opinion. Fertil Steril 2021;115:578-82.
See also  Sex and Mental Health Issues

This blog post is sponsored by the ADAA Women’s Mental Health Special Interest Group.

Advertisements
Advertisements

Leave a Reply

Your email address will not be published.