Magazine article Clinical Psychiatry News

Infertility and Mood Disorders: Breaking the Cycle

Magazine article Clinical Psychiatry News

Infertility and Mood Disorders: Breaking the Cycle

Article excerpt

Infertility and its treatment can be an emotional minefield for couples, and the psychological implications can cut across multiple domains.

According to the American Society of Reproductive Medicine, infertility--defined as an inability to conceive after 12 months of frequent, unprotected intercourse among reproductive-age nulliparous women--affects an estimated 10%-15% of couples in the United States. The experience of infertility has been associated with significant emotional distress in both partners, attributable to feelings of anger, despair, grief, hopelessness, helplessness, and embarrassment.

Treatment for infertility can exacerbate these emotions manyfold. The invasiveness of certain procedures, financial cost, time burden, social isolation, and devastation of failed attempts can lead to marital problems, as can the mechanizing of the sexual relationship. Fertility drugs, through their effects on estrogen and progesterone, also may independently influence mood. The gonadotropin-releasing hormone agonists, for example, have been associated with depression, emotional lability, and irritability, and some of the possible psychiatric side effects of the dopamine receptor agonists include depression, anxiety, and nervousness.

Infertility has a psychological impact on men and women, but research has shown that women tend to experience more distress than their male partners do. For example, a Canadian study designed to evaluate gender differences in psychosocial responses to infertility demonstrated that male and female partners in infertile couples were significantly more distressed than population norms, and that infertile women had more distress than their partners on a global measure of psychiatric symptoms and on subscale measures of anxiety, depression, hostility, cognitive disturbances, stress, and self-esteem (Fertil. Steril. 1991;55:100-8).

For some men and women struggling with infertility, these normal emotional reactions are sustained and can eventually lead to disabling psychiatric morbidity. In an often-cited study looking at the prevalence, severity, and predictability of depression in infertile women by Alice Domar, Ph.D., executive director of the Domar Center for Mind/Body Health and director of mind/body services at Boston IVF in Waltham, Mass., scores on the Beck Depression Inventory (BDI) among the study's 338 infertile women were significantly higher than those of the normal controls, and the prevalence of major depressive disorder was twice as high (Fertil. Steril. 1992;58:1158-63).

More recently, a study from a university-affiliated medical center in Taiwan showed that, of 112 women attending an assisted reproduction clinic who were assessed before treatment using the Mini-International Neuropsychiatric Interview (MINI), 40.2% met criteria for a psychiatric disorder. The most common diagnosis was generalized anxiety disorder, followed by major depressive disorder and dysthymic disorder (Hum. Reprod. 2004;19:2313-8).

The causal relationship between infertility and mood disorders may be bidirectional. Studies have shown that depressed women may be less fertile than nondepressed women. In one case-control study consisting of 339 female survey respondents, 58 women reported a history of depression, and of these, 24% had experienced infertility. Among the nondepressed respondents, 13% reported infertility. After controlling for confounding factors, women with a history of depression were almost twice as likely as their nondepressed counterparts were to report infertility (Psychosom. Med. 1995;57:509-13).

Although the precise pathway by which depression might contribute to depression has not been identified, "proposed mechanisms through which depression could directly affect infertility involve the physiology of the depressed state, such as elevated prolactin levels, disruption of the hypothalamic-pituitary-adrenal axis, and thyroid dysfunction," according to Dr. …

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