Infertility and Mental Health

Remote Enrollment Initiated in MGH Study Assessing Mood Symptoms Across Infertility Treatment

We are pleased to announce the recent launch of an exciting new research initiative that is being conducted by the Massachusetts General Hospital Center for Women’s Mental Health.  The Symptom Tracking in Assisted Reproductive Technologies study (START study) will focus on understanding the risk factors for depressive relapse in women undergoing infertility treatments.  There has been a growing request in our clinical work to address the needs of women undergoing infertility treatments.  It is our hope that such a study will provide important information on the course and risk of depression in women undergoing fertility treatment and thus inform clinical care.

Dr. Lee Cohen: Using SSRIs in Pregnancy

Over the last decade, attention in the medical literature has gathered logarithmically to focus on potentially efficacious treatments for perinatal depression. Studies of relevant databases, editorials, and various reviews have addressed the reproductive safety concerns of antidepressant treatments, particularly selective serotonin reuptake inhibitors (SSRIs) on one hand, and the impact of untreated maternal psychiatric illness on fetal and maternal well-being on the other.

SSRIs and Pregnancy: Putting the Risks and Benefits into Perspective

Prozac hit the market in 1988, the first selective serotonin reuptake inhibitor (SSRI) antidepressant approved by the FDA for the treatment of depression.  Because it was safer and more tolerable than the antidepressants that preceded it, Prozac was soon the most commonly prescribed antidepressant in the United States.

Infertility Increases Risk of Serious Psychiatric Illness

Multiple small studies have demonstrated a link between infertility and psychological distress, reporting high rates of anxiety and depressive symptoms among women with infertility.  These studies have evaluated psychiatric symptoms or psychological distress; however, less is known about the prevalence of more significant psychiatric disorders in this population.  

Acupuncture Helpful for Reducing Anxiety in Women Undergoing IVF

Most women undergoing infertility treatment experience increased anxiety.  In a randomized clinical trial, researchers explored the effectiveness of acupuncture in diminishing anxiety in a group of women undergoing IVF.  43 patients undergoing IVF received either active acupuncture (n=22) or sham treatment (n=21).  Women with a history of psychiatric illness and those using antidepressants and/or anxiolytic drugs were excluded from the study.  Anxiety levels were assessed before and after treatment using the Hamilton Anxiety Rating Scale (HAS). 

Infertility Treatment is Stressful: But Does Stress Affect the Chances of Getting Pregnant?

It is common for women experiencing infertility and undergoing fertility treatment to experience significant emotional distress.  Many women, reasoning that their emotional health influences their physical functioning, worry that the stress and anxiety they experience in this context may hinder their ability to become pregnant.

Metformin May Help to Treat Menstrual Irregularities in Women Treated with Antipsychotics

Menstrual irregularity is a common side effect of antipsychotic treatment in women, occurring more commonly in those treated with risperidone and the older antipsychotic medications. New research presented at the APA earlier this month indicated that the addition of metformin at 500 mg bid resolved menstrual irregularities in most women treated with antipsychotic medications. (Metformin is a medication used alone or with other medications, including insulin, to treat type 2 diabetes.) In addition, women receiving metformin lost an average 2.4 kg of weight after 6 months of treatment.

Serotonin Reuptake Inhibitors and Fertility (Part 2): What Can Basic Science Tell Us?

Serotonin (5-HT) is one of the neurotransmitters involved in mood regulation and has been implicated in the development of mood and anxiety disorders.  Serotonin transporters (SERT) facilitate the transfer of serotonin into neurons; serotonin reuptake inhibitor (SSRI) antidepressants bind to these transporters and appear to exert their effect on mood by inhibiting the reuptake of serotonin and thus increasing the levels of this neurotransmitter at the synapse.

Serotonin Reuptake Inhibitors and Fertility (Part 1): A Clinical Perspective

We previously reported that paroxetine, a selective serotonin reuptake inhibitor (SSRI), may affect sperm motility and may thus have a negative impact on male fertility.  Many women who are planning a pregnancy question whether SSRIs and other antidepressants may affect fertility; this is obviously a particularly important issue for those who are having difficulty conceiving.

Cognitive-Behavioral Therapy for Infertile Women: Is it Better than Medication?

Research indicates that women undergoing infertility treatment experience high rates of psychological distress (1). Additionally, it is believed that stress and depression have an impact on fertility, as it has been shown that certain psychological interventions may improve pregnancy rates in infertile women (2-4). In a recent study, Faramarzi and colleagues compared the effects of group cognitive behavioral therapy (CBT), fluoxetine, and no treatment on the mental health of infertile women who had been trying to conceive for at least 2 years (5).