PTSD and anxiety affect fertility of women firefighters

Women firefighters who suffer from post-traumatic stress disorder (PTSD) and anxiety have lower levels of a hormone associated with the number of healthy eggs in the ovaries, a new study has found.

Previous research has shown that women firefighters have lower levels of anti-Müllerian hormone (AMH) and a higher risk of miscarriage and premature delivery than women in other occupations. The reasons for this were not previously understood. Now, an analysis of data from 372 women firefighters has revealed that those with clinical diagnoses of PTSD and anxiety were more likely to have levels of AMH low enough to impact their reproductive health.

'These findings highlight the negative effect that mental health conditions can have on health – specifically, reproductive health,' said Michelle Valenti, a PhD student in epidemiology at the University of Arizona's Mel and Enid Zuckerman College of Public Health and first author of the study.

Women in the USA who are seeking fertility treatment and who have been diagnosed with anxiety or PTSD are known to have a lower ovarian reserve. Firefighters, and women firefighters in particular, have a higher rate of anxiety and PTSD than the general population.

The study, published in the Journal of Women's Health, found that AMH levels in women firefighters with clinically-diagnosed or self-reported anxiety were 33 percent lower than their counterparts without a mental health diagnosis. For women with PTSD, AMH levels were 66 percent lower.

However, when women firefighters who had both PTSD and anxiety were excluded from the analysis, the link between anxiety alone and lower AMH levels was less pronounced. This suggests that PTSD may have a stronger impact on AMH levels than anxiety by itself.

The association between AMH and anxiety, depression, or PTSD was weaker among participants under the age of 35. This supports previous research suggesting that the impact of stress on AMH increases with longer exposure, the researchers said.

The study also found that lower AMH levels were present in women firefighters with depression, but the association was not statistically significant.

'These findings suggest one potential mechanism in which mental health conditions can lead to adverse reproductive outcomes... Moving forward, we need more collaborative research that identifies not only exposures that can be harmful to reproduction but also potential interventions that can mitigate these exposures,' Valenti told Healio.