Infertility stress almost doubles the risk of depression in women

Women who suffer from stress linked to infertility when embarking on assisted reproduction are more likely to be prescribed antidepressants, according to new research.

The findings suggest that the likelihood of requiring medication for depression is almost double when a women's relationship or personal life are affected by infertility-linked stress, especially when failing to give birth following assisted reproductive technologies (ART).

The research, which is published in Human Reproduction, is the first long-term cohort study examining the association between infertility-related stress and later prescription of antidepressants.

Lead author Juliana Pedro from the University of Porto, Portugal, said the study provides 'strong evidence' for screening women at the outset of treatment, 'Mental health professionals must be included in fertility care to identify at-risk patients and provide psychological support'.

Pedro added: 'Infertility-related stress is preventable and this action - screening and support - might prevent worse mental health outcomes during and after treatment'.

The researchers analysed data from 1009 women who, at the start of the study, had been trying to conceive for an average of 3.45 years. None of the participants had previously been prescribed antidepressants.

The data came from two Danish cohort studies – the Copenhagen Cohort Multi-centre Psychosocial Infertility (COMPI) Infertility Cohort and the Danish National ART-Couple (DANAC) I Cohort, which includes all women and partners who received ART from January 1994 to September 2009.

Women from the COMPI study self-reported stress levels using the COMPI Fertility Problem Stress Scales (COMPI-FPSS) to assess the impact of infertility on personal and social life prior to beginning ART. COMPI-FSS also analysed how patients' marriages or relationships were affected.

Using each patient's unique personal identification number, the data were cross-linked to the DANAC I database, which allowed access to multiple national health data registries including the Danish National Prescription Registry. This enabled the researchers to combine information on redeemed prescriptions of antidepressant medication with self-reported data from the COMPI study.

Study participants were followed until they had redeemed their first prescription for antidepressants or until 31 December 2009.

The study showed that 14 percent (138) of women collected a first-time prescription of antidepressant medication in the 10-year follow up period. Infertility-related stress levels, including personal and marital stress, led to almost twice the incidence of later prescribed antidepressants – an effect that was markedly stronger for those who had remained childless. In contrast, social stress (defined as the impact of infertility on a person's relationship with friends and family) was not significantly associated with the need to redeem a prescription.

While important findings, the authors were clear about the study limitations, highlighting a lack of control for other negative life events that could influence the need for antidepressants. They further noted there was no guarantee that medication collected from pharmacies was ultimately used by the patients.