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).

Women with minimal, mild, or moderate depression who did not have plans to undergo assisted reproduction during study participation were included. Subjects were randomized to 10 weekly two hour group CBT sessions, 90 days of treatment with fluoxetine (20mg), or no treatment. The CBT used in the study addressed causes of infertility and aimed to teach participants to identify and challenge negative thoughts and dysfunction or irrational beliefs.

Researchers used a General Health Questionnaire to investigate improvement in psychological distress across four domains: physical symptoms, anxiety, social dysfunction, and depression. Both CBT and fluoxetine improved overall psychological distress between the beginning and the end of the study. The researchers found that compared to the control group, the CBT group showed significant improvement in all four, while the fluoxetine group only showed significant improvement in social function and depression.

The women in the CBT and fluoxetine groups, but not the control group, experienced decreases in depression scores after treatment as measured by the Beck Depression Inventory (BDI). The authors reported that 79.3% of the CBT group, 50% of the fluoxetine group, and 10% of the control group experienced a successful treatment of depression. Because of this study’s use of a control group, it represents an expansion upon the existing literature regarding depression in infertile women.

These data indicate that CBT may be a reliable alternative to pharmacotherapy for the treatment of depression in infertile women. The group-based CBT used in this research study may serve as a source of support for women dealing with infertility, as it allows them to meet and share with women dealing with similar issues. CBT may be especially attractive to women who are concerned about potential fetal exposure to medications as they attempt to conceive. This study is limited, however, as it did not include infertile women with severe depression (defined as BDI score >47), and it is thus unknown whether or not CBT is as effective as pharmacotherapy for the treatment of severe depression in this population.  More study is needed to determine the efficacy of CBT compared to antidepressants in infertile women suffering from depression. In the interim, women should review the data on efficacy, safety, and side effects of treatments with their physicians when making decisions related to the treatment of depression in the context of infertility.

Suzanna Fowler, BA

Christina Psaros, PhD

1.         Chen TH, Chang SP, Tsai CF, Juang KD. Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Hum Reprod 2004;19:2313-8.

2.         Williams KE, Marsh WK, Rasgon NL. Mood disorders and fertility in women: a critical review of the literature and implications for future research. Hum Reprod Update 2007;13:607-16.

3.         Cwikel J, Gidron Y, Sheiner E. Psychological interactions with infertility among women. Eur J Obstet Gynecol Reprod Biol 2004;117:126-31.

4.         Hammerli K, Znoj H, Barth J. The efficacy of psychological interventions for infertile patients: a meta-analysis examining mental health and pregnancy rate. Hum Reprod Update 2009;15:279-95.

5.         Faramarzi M, Kheirkhah F, Esmaelzadeh S, Alipour A, Hjiahmadi M, Rahnama J. Is psychotherapy a reliable alternative to pharmacotherapy to promote the mental health of infertile women? A randomized clinical trial. Eur J Obstet Gynecol Reprod Biol 2008;141:49-53.