While many women complain of psychological distress during infertility treatment, it has been somewhat unclear if the anxiety and depression women may experience is related to having to undergo infertility treatment or to the hormonal agents that are used as part of the treatment, or a combination of the two.   While we know that changing levels of gonadal hormones, like estrogen, may affect mood and anxiety levels, we have very little information on the psychological effects of the hormone-modulating drugs used in assisted reproductive technology (ART).

In a recent study, Danish researchers examined emotional changes in a group of 83 women randomized to receive fertility treatment using either a gonadotropin-releasing hormone (GnRH) agonist or antagonist.  Women received recombinant follicle-stimulating hormone (Puregon) and the GnRH antagonist (Orgalutran), or they were treated with the GnRH agonist, Synarela, and FSH (Puregon).  All participants completed the self-reported Profile of Mood States, the Perceived Stress Scale, the Symptom Checklist-92-Revised, and the Major Depression Inventory questionnaires, at baseline, at ART cycle day 35, on the day of oocyte retrieval, and on the day of HCG testing.

ART, with either the GnRH agonist or antagonist, did not induce changes in any of the measures of psychological distress. However, when the researchers looked at women with higher levels of neuroticism at baseline, the results were a bit different.  (What is neuroticism? This is a personality trait characterized by more negative affective states and anxiety; those with high neuroticism tend to stressful situations.)  In this study, women with higher neuroticism scores at baseline were more likely to experience both more distress and more-pronounced mood fluctuations, regardless of which infertility treatment they received.

While this is a relatively small study, it is reassuring that most women are able to tolerate the hormonal manipulations associated with ART and do not experience any significant psychological symptoms. It appears that some women – those with higher levels of neuroticism – are more vulnerable.  It may be helpful to screen for women with this personality trait prior to infertility treatment, but because neuroticism is strongly correlated with certain psychiatric disorders, we might expect that infertility treatment carries a greater burden for women with histories of mood and anxiety disorders.

To better understand the impact of infertility treatment on mood, we are now conducting an observational study that tracks women’s mood symptoms over the course of infertility treatment.  Those eligible for the study include all women with a history of major depression or bipolar depression currently in remission who are planning or are undergoing infertility treatment.  Study participation includes monthly visits to the Center for Women’s Mental Health and infertility treatment diaries to be completed at home.  Read more about the study here.

 

Ruta Nonacs, MD PhD

Stenbæk DS, Toftager M, Hjordt LV, et al.  Mental distress and personality in women undergoing GnRH agonist versus GnRH antagonist protocols for assisted reproductive technology.  Hum Reprod. 2014 Nov 14. [Epub ahead of print]

 

Symptom Tracking in Assisted Reproductive Technologies (START study)