Psychological symptoms play a significant role in infertility. Some studies have examined the impact of psychological symptoms (e.g., anxiety, depression) on fertility status. Most of this research has focused on women with unsuccessful IVF treatment. Some have investigated the extent to which a woman’s psychological state during assisted reproductive therapy (ART, which includes in vitro fertilization (IVF)) interferes with the success of the treatment. ART itself has been shown in other studies to negatively impact a patient’s psychological well-being, with prolonged treatment associated with increased depression and anxiety.
However, little is known about whether the psychological symptoms associated with infertility and its treatment persist after successful fertility treatment.
A small number of studies have evaluated the persistence of psychological symptoms during the postpartum period in women who conceived through ART using various subjective measures. McMahon (1997) found that at four months postpartum, women who conceived singleton pregnancies with ART reported lower self-esteem and self-efficacy than women who conceived naturally, but found no differences between the groups in postpartum anxiety and depressive symptoms.
Klock and Greenfield (2000) evaluated psychological differences during pregnancy (12 and 28 weeks gestation) in women who conceived through ART compared with women who conceived naturally. These investigators found no difference in depressive symptoms between the two groups during pregnancy, but observed that the IVF group reported greater self-esteem and less anxiety toward the end of their pregnancy compared with the beginning of their pregnancy.
In a recent study published in Fertility and Sterility (Monti et al, 2008), researchers investigated the psychological symptoms of women in their third trimester through the postpartum period, comparing symptoms in women who conceived through ART to women who conceived naturally. They used a standardized measure of depression, the EPDS (Edinburgh Postnatal Depression Scale), a 10 question diagnostic with a score range from 0 to 30, with 10 often used as a cutoff for major depression. The study did not address differences in rates of depression pre-pregnancy by mode of conception, but the investigators reported no significant differences between the two groups in socio-demographic characteristics, including marital status, mode of delivery, and frequency of attendance in antenatal classes.
They found that the group that had conceived through ART reported a higher mean EPDS score during the third trimester (7.88 vs. 3.86) as well as 1 week postpartum (8.0 v. 4.5) than the group that conceived naturally. Additionally, women who conceived through ART reported feeling depressive symptoms more frequently during the third trimester than the women who conceived naturally, but the investigators found no significant difference during the postpartum period.
This study provides greater evidence that mild to moderate psychological symptoms associated with infertility may persist even after a woman conceives. These findings emphasize that infertility is a clinical condition with complex psychological issues, and suggest that conception through ART may be associated with an increased risk of depression symptoms during pregnancy and the postpartum period. Clinical decisions should take into account this increased risk; clinical care for women who are planning to conceive through ART should include psychological support, consultation, and, if necessary, intervention, even after they successfully conceive.
Erica Pasciullo, BA
Hadine Joffe, MD, MSc