Psychiatric disorders in women and men up to five years after undergoing assisted reproductive technology treatment – a prospective cohort study

Risks of Long-Term Psychiatric Disease in Women with a History of Primary Infertility: A Historical Cohort Study

To examine the risks of long-term de novo psychiatric disease in women with primary infertiltiy compared to age-matched referrent women. Retrospective, population-based cohort of 1,001 women with primary infertility and 1,001 age-matched (± 1 year) referent women aged 18-50. The "index date" was date of first clinical note for infertility and included visits fromJanuary 1, 1980 to December 31, 1999. Baseline characteristics were collected by chart review. Outcome data was evaluated through December 31, 2020. Primary outcomes were baseline prevalence and de novo rates of subsequent psychiatric disorders including depression, anxiety, bipolar disorder, substance abuse, suicidality, and somatization evaluated by Cox proportional hazards modeling. Among women with primary infertility and referent women, the median duration of follow-up was 23.7 years. The risk of de novo psychiatric disorders was not significantly different between groups. Additionally, the risk of de novo psychiatric disorders did not significantly differ between those with isolated male factor versus isolated female factor infertility. Among women with primary infertility, the cumulative incidence of de novo depression and anxiety was significantly higher among women diagnosed with primary infertility in the 1990s compared to the 1980s. Women with primary infertility, in a historical population-based cohort, do not have a significantly different long-term risk of de novo psychiatric diagnoses compared to age-matched referent women. Our findings support the notion that infertility diagnosis and treatment present an acute period of stress and for some psychologic distress, neither of which persist or increase the risk for development of future psychiatric disease.

Global prevalence of major depressive disorder, generalized anxiety, stress, and depression among infertile women: a systematic review and meta-analysis

BACKGROUND

In recent years, the global prevalence of infertility has increased among women (Talmor and Dunphy, Best Pract Res Clin Obstet Gynaecol 29(4):498-506, 2015) and is considered as a public health concern. One of the impacts of infertility is mental health problems in the patients, which can lead to complications such as stress, anxiety, and depression. The aim of this study is to investigate the global prevalence of major depressive disorder, general anxiety, stress, and depression in infertile women through a systematic review and meta-analysis.

METHODS

To identify studies that have reported the prevalence of major depressive disorder, generalized anxiety, stress, and depression in infertile women, the PubMed, Scopus, Web of Science, Embase, ScienceDirect, and Google Scholar repositories were systematically searched. Articles published up until February 2023 were included, while no lower time limit was imposed in the search strategy. Heterogeneity of studies was examined using the I2 test and, thus, random-effects model was used to perform the analysis. Data analysis was conducted within the Comprehensive Meta-Analysis (v.2) software.

RESULTS

In the review of 44 studies with a sample size of 53,300 infertile female patients, the overall prevalence of major depressive disorder (clinical depression), generalized anxiety, stress, and depression was found to be 22.9%, 13.3%, 78.8%, and 31.6% respectively. It was also found that mental health complications are more prevalent among infertile women in Asia (continent).

CONCLUSION

Considering the prevalence of mental disorders among infertile women, health policymakers can use the results of the present meta-analysis to pay more attention to the mental health of infertile women and devise suitable interventions and programs to reduce and prevent the spread of psychological disorders among infertile women.

The link between infertility-related distress and psychological distress in couples awaiting fertility treatment: a dyadic approach

While there is broad evidence to suggest that individual stress increases, and that high couple relationship quality reduces the risk for psychological distress, our understanding of these associations in couples dealing with infertility remains limited. In this cross-sectional study, we used dyadic data-analysis (Actor-Partner Interdependence Model; APIM) to examine the effects of infertility-related distress (experienced as an individual risk factor) and couple relationship quality (experienced as a couple-based resource), on psychological distress in a sample of 116 infertile couples. 59% of women and 23% of men reported clinical levels of psychological distress, 71% of women and 45% of men reported infertility-related distress, and 3% of participants reported low couple relationship quality. Infertility-related distress predicted psychological distress at the individual level ('actor effects') while men's infertility-related distress predicted women's psychological distress (partner effect'). Women without medically assisted reproduction (MAR) treatment exposure reported significantly higher couple relationship quality than women with MAR exposure, and men without treatment exposure reported significantly lower infertility-related distress than men with exposure. The level of psychological distress depended on whether both or neither of the partners, or only one partner reported infertility-related distress. Couple relationship quality was not associated with distress, which may imply that dyadic dimensions other than overall satisfaction could be relevant in supporting couples facing infertility.

Bedarfsorientierte kognitiv-behaviorale Intervention für Paare mit Infertilität (FERTIFIT): Eine Pilotstudie zur Entwicklung, Durchführbarkeit und Akzeptanz

Einleitung Weltweit schwankt die Prävalenz für Infertilität zwischen 4–17% und in westlichen Ländern ist rund eins von sieben Paaren mit Kinderwunsch betroffen. Das Erleben einer Infertilität ist mit einer erhöhten Wahrscheinlichkeit für psychische und partnerschaftliche Belastungen assoziiert, wobei sich Partner einer Paarbeziehung in ihrem Befinden gegenseitig beeinflussen. Dennoch ist die Versorgungslücke für betroffene Paare groß. In dieser Pilotstudie wird eine praktikabel umsetzbare, bedarfsorientierte und kognitiv-verhaltenstherapeutische Intervention für Paare mit Infertilität vorgestellt, die die partnerschaftliche Bewältigung typischer Problembereiche fördern und einer zunehmenden Belastung entgegenwirken soll.

Material und Methoden Insgesamt nahmen 21 heterosexuelle Paare an dieser Studie mit Eigen-Warte-Kontrollgruppendesign teil. Die Intervention beinhaltete bedarfsabhängig 5–10 paartherapeutische Sitzungen. Die psychische und infertilitätsbedingte Belastung, die Partnerschaftsqualität, sowie die Anwendung von individuellen und partnerschaftlichen Ressourcen wurden zu vier Messzeitpunkten (M1=vor Wartekontrollphase, M2=vor Intervention, M3=nach Intervention, M4=nach Katamnese) mittels Fragebögen erhoben.

Ergebnisse Bei Frauen besserten sich die psychische und infertilitätsbedingte Belastung, und sie griffen auf mehr Ressourcen zurück, die zum Wohlbefinden und zur aktiven Problembewältigung und Emotionsregulation beitragen. Während des Interventionszeitraumes kam es bei Männern zu einem zunehmenden Erleben hilfreicher Unterstützung, und sowohl bei Männern als auch bei Frauen zu einem häufigeren Einsatz partnerschaftlicher Copingstrategien. Die Evaluation zeigte, dass die Teilnehmenden sehr zufrieden waren mit der Intervention insgesamt und mit der erhaltenen Unterstützung.

Diskussion Die Befunde deuten auf eine gute Durchführbarkeit und Akzeptanz dieser Intervention in der psychotherapeutischen Praxis hin und liefern erste Hinweise auf mögliche erwünschte Effekte, die allerdings aufgrund des Studiendesigns und der vorliegenden Limitationen nicht eindeutig auf die Intervention zurückgeführt werden können.

Schlussfolgerung Die Stärke der vorliegenden Studie liegt in der Vorstellung eines in der psychotherapeutischen Praxis gut anwendbaren paartherapeutischen Konzepts, das bedarfsgerecht angeboten werden kann. Für die Überprüfung der gefundenen Effekte ist eine anschließende größer angelegte klinische Studie mit randomisiert-kontrolliertem Design notwendig.

An mHealth App to Support Fertility Patients Navigating the World of Infertility (Infotility): Development and Usability Study

Background

The experience of infertility and its treatment engenders considerable stress and is often described as an emotional rollercoaster. A mobile health (mHealth) app may be a novel solution to address the psychoeducational and psychosocial support needs of fertility patients because of its potential to reduce stress and increase patient empowerment. There are a few fertility-related apps that provide information and support to both men and women undergoing fertility treatment; however, none have documented their development and evaluation process.

Objective

This study aims to describe the development and evaluation process of a bilingual mHealth app, Infotility, designed to meet the psychoeducational and psychosocial support needs of men and women undergoing fertility treatment.

Methods

To develop the Infotility app, we adhered to the Medical Research Council guidelines for the development and evaluation of complex interventions. First, we conducted literature reviews and needs assessment surveys of fertility patients and health care providers who informed the content and design of the app. Second, we tested the intervention with a small group of end users who provided feedback on the design and appropriateness of the app’s content. Third, we evaluated the uptake and usability of the app using a pre-post study design. Finally, we updated the app’s content based on participants’ feedback and searched for partners to disseminate the app to the broader public.

Results

This study is the first to describe the development and evaluation process of an mHealth app for men and women undergoing fertility treatment. The app met its goal in providing fertility patients with a clinician-approved, portable resource for reliable information about medical and psychosocial aspects of infertility and its treatments and a confidential peer support forum monitored by trained peer supporters. Participants rated the engagement, functionality, information, and esthetics of the app positively, with an overall app quality mean score of 3.75 (SD 0.53) and a star rating of 3.43 (SD 0.75), with a total possible score and star rating of 5.00.

Conclusions

By documenting the systematic development and evaluation of the mHealth app for men and women undergoing fertility treatment, this paper can facilitate the replication of the study intervention and the development of similar mHealth apps.

'I felt less alone knowing I could contribute to the forum': psychological distress and use of an online infertility peer support forum

Background

Feelings of loss, shame and stigmatization, reduced quality of life, isolation and loneliness are common among men and women with infertility. Fertility patients may seek peer mentoring and support, specifically through the use of online forums, to fulfil their needs for shared experience and guidance through the fertility treatment process.

Objective

To assess the use and benefits of an online fertility-related peer support forum through two research questions: (1) do socio-demographics, stress, and anxiety differ between posters on the forum, lurkers who read messages but did not post, and people who chose not to use it?; and (2) how did forum users describe their experiences?

Design

A sample of 220 male and female fertility patients aged 23–54 years old (M = 35.51, SD = 4.94) were recruited at fertility clinics in Montreal and Toronto, Canada, to test a mobile application called ‘Infotility’. They answered questionnaires before and after being given access to Infotility for eight weeks. The peer support forum was accessible through the Infotility dashboard.

Main Outcome Measures

Psychological distress was measured through the 4-item Perceived Stress Scale and the Generalized Anxiety Disorder 7-item Scale. Experiences using the forum were assessed through open-ended questions and in-depth interviews.

Results

Participants with heightened psychological distress were more likely to become posters rather than lurkers or non-users and reported less distress after using the forum. Forum users appreciated the opportunity to share their experiences with others in similar situations.

Conclusion

The forum reduced loneliness and allowed participants to learn new ways to manage stress. It was particularly beneficial for those with heightened psychological distress.

Is in vitro fertilization (IVF) associated with perinatal affective disorders?

BACKGROUND

Since mothers who undergo in vitro fertilization (IVF) may experience more anxiety and depressive symptoms than mothers who conceive naturally, a review of the literature was conducted to investigate whether IVF may be considered a risk factor for the development of anxiety or depression during pregnancy and post-partum.

METHODS

A thorough search of articles in Pubmed, PsycINFO and Isi Web of Knowledge was performed in order to produce a comprehensive review regarding the potential association of in vitro fertilization and anxiety/depression.

RESULTS

The search resulted in a total of 10 articles. Contradictory results were reported in the articles about the possible association between IVF and the occurrence of anxiety and depressive symptoms both during pregnancy and postpartum period. Three studies found that women who resorted to IVF showed less anxiety and depressive symptoms than those who conceived naturally especially with the progression of pregnancy and in the postpartum.

LIMITATIONS

Vulnerability to affective disorders of women affected by infertility may be independent from the outcome of IVF. Other limits are the limited research in this area, the small sample sizes, the heterogeneity of the tools used to assess affective symptoms.

CONCLUSIONS

The available data indicate that IVF is not associated with perinatal affective symptoms. Women who resorted to IVF could have less perinatal depressive symptoms as the result of a positive outcome of the technique and the satisfaction of the desire to become mothers. Further studies are necessary in order to draw definitive conclusions about this topic.