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Si S, Zhao G, Song G, Liu J. Assisted reproductive technologies and postpartum depressive symptoms: A meta-analysis. J Affect Disord 2024; 356:300-306. [PMID: 38583599 DOI: 10.1016/j.jad.2024.03.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/08/2024] [Accepted: 03/29/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Assisted reproductive technologies (ARTs) have become the main treatment for infertility. ART treatment can be a stressful life event for infertile females. Whether there is an association between ARTs and postpartum depressive symptoms (PDS) has not been established. METHODS PubMed, MEDLINE, EMBASE, PsycINFO, and CNKI were searched. The pooled outcome was the difference in incidence of PDS within 1 year postpartum between ARTs and the spontaneous pregnancy group. RESULTS A total of 12 cohort studies, which were conducted in eight developed countries and two developing countries, were involved. In total, 106,338 pregnant women, including 4990 infertile females with ARTs treatment and 101,348 women with spontaneous pregnancy, were enrolled in our final analysis. ARTs women had a lower incidence of PDS compared to the spontaneous pregnancy group according to a random effect model (OR = 0.83, 95 % CI: 0.71-0.97, p = 0.022, I2 = 62.0 %). Subgroup analyses indicated that studies on late PDS (follow-up: 3-12 months postpartum) were more heterogeneous than those on early PDS (follow-up: <3 months postpartum) (I2 = 24.3 % vs. I2 = 0 %, interaction p-value < 0.001). There was a strong relationship between ARTs and late PDS (OR = 0.65, 95 % CI: 0.55-0.77, p < 0.001). Therefore, the possible source of heterogeneity was the postpartum evaluation time, which was confirmed by post-hoc meta-regression. LIMITATIONS Some underlying confounders, such as previous psychiatric illness, the limited availability of ARTs, and ethnic disparities, cannot be ignored and may have biased interpretation of the results. CONCLUSION The available data suggested that ARTs were associated with lower incidence of PDS, especially when follow-up lasted over 3 months. However, these findings should be interpreted with caution. Better-designed trials are needed to confirm this association.
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Affiliation(s)
- Si Si
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, China
| | - Ge Zhao
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Liu
- Department of Obstetrics, The First Hospital of China Medical University, Shenyang, China.
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Szigeti F J, Sexty RE, Szabó G, Kazinczi C, Kéki Z, Sipos M, Ujma PP, Purebl G. The SCREENIVF Hungarian version is a valid and reliable measure accurately predicting possible depression in female infertility patients. Sci Rep 2024; 14:12880. [PMID: 38839780 PMCID: PMC11153651 DOI: 10.1038/s41598-024-63673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 05/31/2024] [Indexed: 06/07/2024] Open
Abstract
Infertility patients, often in high distress, are entitled to being informed about their mental status compared to normative data. The objective of this study was to revalidate and test the accuracy of the SCREENIVF, a self-reported tool for screening psychological maladjustment in the assisted reproduction context. A cross-sectional, questionnaire-based online survey was carried out between December 2019 and February 2023 in a consecutive sample of female patients (N = 645, response rate 22.9%) in a university-based assisted reproduction center in Hungary. Confirmatory factor analysis and cluster and ROC analyses were applied to test validity, sensitivity and specificity in relation to Beck Depression Inventory (BDI) scores. Model fit was optimal (chi-square = 630.866, p < 0.001; comparative fit index = 0.99; root-mean-square error of approximation = 0.018 (90% CI 0.013-0.023); standardized-root-mean-square-residual = 0.044), and all dimensions were reliable (α > 0.80). A specific combination of cutoffs correctly predicted 87.4% of BDI-scores possibly indicative of moderate-to-severe depression (χ2(1) = 220.608, p < 0.001, Nagelkerke R2 = 0.462, J = 66.4). The Hungarian version of the SCREENIVF is a valid and reliable tool, with high accuracy in predicting BDI-scores. Low response rate may affect generalizability. The same instrument with different cutoffs can serve various clinical goals.
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Affiliation(s)
- Judit Szigeti F
- Institute of Behavioral Sciences, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary.
- Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary.
| | - Réka E Sexty
- Department of Psychology, University of Graz, Dachgeschoß - 2, Stock, 2, 8010, Graz, Austria
| | - Georgina Szabó
- Doctoral School of Mental Health Sciences, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
- Department of Psychiatry, North Buda Saint John's Hospital Center and Outpatient Clinic, Diós Árok 1-3, 1125, Budapest, Hungary
| | - Csaba Kazinczi
- Department of Clinical Psychology, Semmelweis University, Budapest, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, 6722, Szeged, Hungary
| | - Zsuzsanna Kéki
- Directorate for Human Reproduction, National Directorate General for Hospitals, Buda-part tér 2, BudaPart Gate Irodaház A. ép. 406, 1117, Budapest, Hungary
| | - Miklós Sipos
- Department of Obstetrics and Gynecology, Assisted Reproduction Center, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
| | - Péter Przemyslaw Ujma
- Institute of Behavioral Sciences, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
| | - György Purebl
- Institute of Behavioral Sciences, Semmelweis University, Üllői út 26, 1085, Budapest, Hungary
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Wang Z, Xiao T, Qi G. The moderating effect of dietary selenium intake on the risk of infertility-associated depressive symptoms in female. J Obstet Gynaecol Res 2024; 50:899-908. [PMID: 38423990 DOI: 10.1111/jog.15912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
AIM To analyze the associations between infertility or dietary selenium intake and depressive symptoms as well as the role of selenium intake on the association between infertility and depressive symptoms in women. METHODS This study retrieved the data of 4949 women from National Health and Nutrition Examination Survey (NHANES) database. Univariable and multivariable weighted logistic regression analyses were applied to assess the associations of selenium intake or infertility with the risk of depressive symptoms as well as the regulation of selenium intake on the risk of depressive symptoms related to infertility. RESULTS The elevated risk of depressive symptoms was found in participants with infertility (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.11-2.15). The risk of depressive symptoms was reduced in women with selenium intake ≥55 μg (OR = 0.64, 95%CI: 0.46-0.90). Compared with women without infertility who had selenium intake <55 μg, those with infertility and had selenium intake <55 μg were associated with elevated risk of depressive symptoms after adjusting for confounding factors (OR = 2.01, 95%CI: 1.03-3.90). The risk of depressive symptoms was not significantly increased in women with infertility who had selenium intake ≥55 μg in comparison with subjects without infertility who had selenium intake ≥55 μg (p > 0.05). CONCLUSION Selenium intake regulated the association between infertility and depressive symptoms.
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Affiliation(s)
- Zhuran Wang
- Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Shenzhen, China
- Department of Traditional Chinese Medicine, Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen Zhongshan Obstetrics & Gynecology Hospital (formerly Shenzhen Zhongshan Urology Hospital), Guangzhou, China
| | - Ting Xiao
- Department of Traditional Chinese Medicine, Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen Zhongshan Obstetrics & Gynecology Hospital (formerly Shenzhen Zhongshan Urology Hospital), Guangzhou, China
| | - Guanglan Qi
- Department of Traditional Chinese Medicine, Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Shenzhen Zhongshan Obstetrics & Gynecology Hospital (formerly Shenzhen Zhongshan Urology Hospital), Guangzhou, China
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Wasilewska A, Grabowska M, Moskalik-Kierat D, Brzoza M, Laudański P, Garley M. Immunological Aspects of Infertility-The Role of KIR Receptors and HLA-C Antigen. Cells 2023; 13:59. [PMID: 38201263 PMCID: PMC10778566 DOI: 10.3390/cells13010059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/17/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
The mechanisms of immune tolerance of a mother against an antigenically foreign fetus without a concomitant loss of defense capabilities against pathogens are the factors underlying the success of a pregnancy. A significant role in human defense is played by killer immunoglobulin-like receptor (KIR) receptors, which regulate the function of the natural killer (NK) cells capable of destroying antigenically foreign cells, virus-infected cells, or tumor-lesioned cells. A special subpopulation of NK cells called uterine NK cells (uNK) is found in the uterus. Disruption of the tolerance process or overactivity of immune-competent cells can lead to immune infertility, a situation in which a woman's immune system attacks her own reproductive cells, making it impossible to conceive or maintain a pregnancy. Since the prominent role of the inflammatory response in infertility, including KIR receptors and NK cells, has been postulated, the process of antigen presentation involving major histocompatibility complex (MHC) molecules (HLA) appears to be crucial for a successful pregnancy. Proper interactions between KIR receptors on female uNK cells and HLA class I molecules, with a predominant role for HLA-C, found on the surface of germ cells, are strategically important during embryo implantation. In addition, maintaining a functional balance between activating and inhibitory KIR receptors is essential for proper placenta formation and embryo implantation in the uterus. A disruption of this balance can lead to complications during pregnancy. The discovery of links between KIR and HLA-C has provided valuable information about the complexity of maternal-fetal immune interactions that determine the success of a pregnancy. The great diversity of maternal KIR and fetal HLA-C ligands is associated with the occurrence of KIR/HLA-C combinations that are more or less favorable for reproductive success.
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Affiliation(s)
- Anna Wasilewska
- Laboratory of Immunogenetics, University Clinical Center, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.W.)
| | - Marcelina Grabowska
- Laboratory of Immunogenetics, University Clinical Center, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.W.)
| | - Dominika Moskalik-Kierat
- Laboratory of Immunogenetics, University Clinical Center, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.W.)
| | - Martyna Brzoza
- Laboratory of Immunogenetics, University Clinical Center, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.W.)
| | - Piotr Laudański
- Department of Obstetrics, Gynecology and Gynecological Oncology, Medical University of Warsaw, 02-091 Warsaw, Poland
- Women’s Health Research Institute, Calisia University, 62-800 Kalisz, Poland
- OVIklinika Infertility Center, 01-377 Warsaw, Poland
| | - Marzena Garley
- Department of Immunology, Medical University of Bialystok, 15-269 Białystok, Poland
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Riddle JN, Hopkins T, Yeaton-Massey A, Hellberg S. No Baby to Bring Home: Perinatal Loss, Infertility, and Mental Illness-Overview and Recommendations for Care. Curr Psychiatry Rep 2023; 25:747-757. [PMID: 37878138 DOI: 10.1007/s11920-023-01469-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE OF REVIEW Update readers on the state of the research on mental health, perinatal loss, and infertility with a focus on providing a comprehensive overview to empower clinicians in treating this population. RECENT FINDINGS Rates of psychiatric illness are increased in people that experience perinatal loss and infertility. The research remains largely below the clear need for focused screening, prevention, and treatment. Clinicians and researchers need to remain attuned to the impact of perinatal loss and infertility on the mental health of patients and families. Screening, referral, and expanded therapeutic and psychiatric resources are imperative to improving the well-being of these patients and families.
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Affiliation(s)
- Julia N Riddle
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, USA.
| | - Tiffany Hopkins
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Amanda Yeaton-Massey
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA
| | - Samantha Hellberg
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, USA
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