In recent years, the number of couples seeking treatment for infertility has dramatically increased. While we still do not know the exact link between stress, depression, anxiety and infertility, a series of studies show that the impact of emotional wellbeing on fertility is hard to ignore.
Psychological Impact of Infertility
Parenthood is one of the major needs in adult life for both men and women.
Infertility can cause anger, depression, anxiety, marital problems, sexual dysfunction, feelings of worthlessness among parents and social isolation. Relationships also suffer, not only the primary relation between the couple but the relation with friends and family. In general among the infertile couples women show higher levels of stigma, distress, sense of loss, and diminished self-esteem. Both men and women experience a sense of loss of identity and have pronounced feelings of defectiveness and incompetence.
Stress and Infertility: Cause or Effect?
A number of studies have found that the incidence of depression in infertile couples presenting for infertility treatment is significantly higher than in fertile controls. The prevalence estimates of major depression in infertile couples ranges between 15%-54% and that of anxiety at 8%-28%.
The causal role of psychological disturbances in the development of infertility is still a matter of debate. But some research suggests that distress is associated with lower rates of pregnancy success among women pursuing infertility treatment.
Depression can also affect the reproductive ability of both partners. Depression could directly affect fertility via elevated prolactin levels, disruption of the hypothalamic-pituitary-adrenal axis, and thyroid dysfunction. Results of one study suggests that depression is associated with abnormal regulation of luteinizing hormone, a hormone that regulates ovulation. Further the behaviours associated with depression or anxiety such as low libido, smoking, alcohol use may interfere with reproductive success. Also a history of high levels of cumulative stress may also be a causative factor.
Psychological Distress and Infertility Treatment
The process of assisted reproduction is also associated with increased levels of anxiety, depression and stress due to repeated cycles of hope and failures. One of the most challenging aspects of infertility treatments is dealing with emotional ups and downs of medical treatment. The outcome of infertility treatment may also be influenced by psychological factors. A number of studies have examined stress and mood state as predictors of outcome in assisted reproduction. The majority of these studies support the theory that distress is associated with lower pregnancy rates among women pursuing infertility treatment.
When to seek help during infertility treatment?
Although feeling overwhelmed occasionally during the infertility treatment is a normal response, presence of following symptoms over a prolonged period may warrant psychological intervention:
Therapies that may help
Counselling: Referrals for short term counselling are very common to increase coping strategies and to help in decision making. Patients with prolonged and significant mood changes, anxiety and relationship issues should go for a more comprehensive psychological evaluation.
Psychotherapy: specific types of psychotherapy may be beneficial such as interpersonal therapy or CBT.
Several studies suggest that cognitive behavioral psychotherapy and support groups decrease stress and mood symptoms, as well as increase fertility rates.
In one study the effect of CBT , Support groups and no psychological intervention was compared in three groups undergoing assisted reproduction. The results revealed that viable pregnancy rates of women undergoing assisted reproduction were 55% for the cognitive behavioral group, 54% for the support group and 20% for the controls.
A another study the intervention group received couples counseling directed toward education and addressing stress throughout their IVF cycle and the control group received only routine medical care. It was seen that the intervention patients had lower anxiety and depression scores, in addition to significantly higher pregnancy rates.
Relaxation techniques: various methods like mindfulness meditation, deep breathing, guided imagery, and yoga promote stress management.
Medication: Pharmacotherapy may be needed for some women and men who develop depression in the context of infertility and its treatment. Many women avoid pharmacologic treatment due to fear that medication may impact their fertility or may affect the outcome of their pregnancy. However, there are no data to suggest that commonly used antidepressants negatively affect fertility.
Moreover research over the last decade suggests that certain antidepressants may be used safely during pregnancy.
Infertility Support Services
• Individual psychotherapy
• Couples counselling
• Treatment decision making consultation
• Crisis intervention
• Third party reproductive assessment ( for couples needing donor egg, donor sperm, or a gestational carrier)
• Medication management for stress, anxiety depression