Mental health and fertility

Infertile couples often silently struggle. But anxiety, depression, isolation, and loss of control are common outcomes of such struggles. It has been estimated that 1 in 8 couples or 12% of women have mental distress to get pregnant or sustain their pregnancy.  Psychological vulnerability among infertile women is increasing because the majority of them face hesitation to share their problems with family and friends.

Fertility mental health

The inability to reproduce naturally can cause feelings of shame, guilt, and low self-esteem. These negative feelings may lead to varying degrees of depression, anxiety, distress, and a poor quality of life. Clinical investigations also reported that infertile couples who have undergone assisted reproductive treatment (ART) often experiencing psychiatric disorders. Therefore, nowadays psychological counseling is an integral part of ART to recognize, acknowledge, and assist patients to cope up with their infertility diagnosis and treatment.

One of the main challenges in assessing the distress levels in women with infertility is the accuracy of self-report measures. It is possible that women “fake good” in order to appear mentally healthier than they are. It is also possible that women feel a sense of hopefulness/increased optimism prior to initiating infertility treatment, which is when most assessments of distress are collected. Some early studies concluded that infertile women did not report any significant differences in symptoms of anxiety and depression than fertile women.

A scientific literature review reported that the prevalence rate of psychological symptoms among infertile couples ranges from 25% to 60%. It has also found that the levels of anxiety and depression are significantly higher than the control fertile group.

A number of different medications like clomiphene, gonadotropins, and leuprolide are prescribed to treat infertility. These medicines can induce psychological symptoms such as anxiety, depression, and irritability. Therefore, it is often difficult to judge whether the psychological issues occur due to infertility or the side effects of the prescribed medications.

Research studies performed under the guidance of the American College of Obstetricians and Gynecologists (ACOG) reported that almost 10% to 25% miscarriage is a common incidence among all clinically diagnosed pregnancies. Loss of pregnancy occurs due to different pathophysiological reasons. The chromosomal abnormality of the fetus is one of the leading causes of miscarriage. Post-traumatic stress disorders including anxiety and depression are common findings in patients who experience a pregnancy loss.

Relatively a novel medical advancement known as pre-implantation genetic screening (PGS) gives the opportunity to detect chromosomal abnormality among patients who opt for ART. But PGS is an expensive diagnostic tool that increases the overall cost of the treatment. Moreover, opting for PGS increases the waiting period till the result will not come out.

Infertile patients are often anxious as they do not the reason for their infertility. Unexplained infertility makes them psychologically obsessed.  It has been found that knowing the underlying cause of infertility often settles this anxiety, though the result always ends up with a broken heart. However, lifestyle modifications in terms of exercise, diet, caffeine intake, and sleep may alter the mild infertility issues and reverse the diagnosis. Some individuals get benefitted from these lifestyle changes jointly with ART treatment and achieve pregnancy, though these modifications may not give successful results to all infertile couples. However, different psychological interventions like Mind/Body Program and/or a self-administered cognitive coping and relaxation intervention for women with infertility have the potential to decrease anxiety and depression and may lead to significantly higher pregnancy rates.




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