Mental health's intricate role in fertility, infertility and parenthood

The connection between mental health and the journey to parenthood is gaining recognition as a critical aspect of overall wellbeing. The profound influence of a person's mental health during the perinatal period, which encompasses both the preconception phase, during pregnancy and postpartum, is becoming increasingly clear. The impact of mental health alone has the potential to affect several different aspects of couples'/individuals' journeys to parenthood, with no two journeys the same.

There needs to be an importance placed on the understanding of this impact across all these critical timepoints. Adequate access to support individuals during investigations and treatment for infertility, the emotional intricacies of pregnancy and the potential postpartum issues that may occur, will help to alleviate the burden that so many people, often silently, go through. Broadly speaking, it is these three timepoints that poor mental health has its impact in individuals'/couples' journeys to parenthood.

Mental health and infertility treatment: The silent battle

The desire to conceive a child can often be fraught with emotional turmoil. Infertility, which affects around one in six couples, is not just a physical challenge but also a mental one. There is often a silent struggle within individuals and couples who are undergoing infertility treatments.

Research has shown that within the general population, rates of anxiety and depression is high in infertile couples. Additionally, on top of the fact that roughly between ten and 20 percent of women develop a mental illness during pregnancy or within the first year after having a baby, this issue is not insignificant.

In addition to this, studies have shown a link between mental health disorders and reduced fertility, with mechanisms ranging from disrupted hormone pathways and differing immune responses. Perhaps the most shocking is a report published by the BMJ in 2022, highlighting maternal suicide as the leading direct cause of death of mothers between six weeks and one year after pregnancy. Of equal note, women who remain childless after failed infertility treatments are a significantly vulnerable group even later in life.

However, even when fertility treatment results in a pregnancy, there is still a necessity for continued psychological support and societal understanding as mental health issues after fertility treatment can continue during pregnancy and post-partum. Advocating for greater awareness, research, and support for those navigating this intricate and emotionally taxing journey is undoubtedly going to help to improve the lives of many individuals.

Mental health during pregnancy: A critical phase

Following conception, particularly after fertility treatment, poor mental health can continue to exert an influence. After completing fertility treatment, patients can go from private care – with a high level of medical attention and supervision – into NHS maternity services. It is also within this period that they may develop mental health issues, such as anxiety and depression.

The effects of poor mental health on the developing fetus are becoming increasingly clear. Research in animals suggest that poor mental health has the potential to increase the prevalence of premature birth and subsequent implications such as low birth weight and associated risk factors. Further research also translated this early work to humans and showed that elevated cortisol levels, a stress-associated hormone, can impact the mental health of the offspring. It is crucial for mental health support to encompass various stages of an individual's pregnancy journey and the postpartum period.

Postpartum mental health: Beyond birth

Postnatal depression, a widely underestimated condition, is a prevalent mental health challenge that can affect approximately one in ten women within the first year after giving birth. The onset of this condition is often gradual, proving challenging to diagnose and address.

A baby can be seen as a life goal for many women undergoing fertility treatment. As such, after a successful pregnancy they may become overwhelmed, which can result in postnatal depression. Hence, adequate mental health support during the postpartum period is essential to mitigate the effects of postnatal depression and related challenges. This encompasses not only clinical intervention but also the importance of establishing a strong support system comprising family, friends, and healthcare professionals. Furthermore, societal awareness and destigmatisation of postnatal depression are paramount. Dispelling misconceptions and fostering understanding around the prevalence and impact of this condition can encourage affected individuals to seek timely help and support.

The importance of comprehensive support: Creating a safety net

Recognising the intricate interplay between mental health, fertility treatment and beyond helps to determine that comprehensive support is paramount. Mental health and its impact through the perinatal period is an important issue in society. This issue clearly needs tackling. A study has indicated that infertile couples are subject to greater stress and have an increased risk of developing psychological disorders, including anxiety and panic attacks, compared with other couples.

All clinics licensed by the Human Fertilisation and Embryology Authority must offer all patients the opportunity to talk to a counsellor before they start treatment. Yet, seeing a counsellor is not mandatory. A recent Progress Educational Trust event shed some light on the intricate nature of fertility counselling by gathering a panel of speakers to provide insight into infertility counselling (see BioNews 1194).

In contrast, perinatal mental health services do exist, and thankfully the NHS announced the 'Perinatal Mental Health Community Services Development Fund', piloting in 2016; a second wave was announced with the aim of pregnant women and new mothers experiencing mental health difficulties to be able to access specialist mental health community services everywhere by April 2019. However, having access to care is only successful if the condition is diagnosed. Unfortunately, the National Childbirth Trust's report 'The Hidden Half' found that around half of new mothers' mental health problems don't get picked up by a health professional and subsequently treated.

Where does that leave us?

It is crucial for mental health support to encompass all stages of an individual's fertility journey, from the fertility clinic, through pregnancy and the postpartum period. In moving forward, recognising, and addressing this critical issue could significantly enhance the well-being of both parents and subsequent children. Accessible and accurate diagnosis and robust support systems should be prioritised. Valuable resources from organisations such as the Fertility Network UK, Tommy's, and Mind offer essential support for individuals seeking assistance. Ultimately, an integrated approach that combines medical, psychological, and societal efforts is essential to support individuals throughout their fertility treatment and parenthood journey to ensure a healthier and happier future for families and individuals seeking them.