As we are going through World Infertility Awareness month, we should again point out that fertility issues are more common than you think. It is not only a woman’s issue and it should definitely not be considered a taboo. 1 in 8 couples struggle with infertility, and we should all be informed and raise awareness for them and for everyone.
In our latest article, we will study the correlation between depression and infertility, and how the one affects the other. It’s easy to assume that when someone experiences fertility issues it is more likely to feel negative emotions that eventually lead to depression. What’s a little less clear is how depression can influence fertility. Yet, there is some evidence that it does.
To be 100% clear, depression doesn’t cause infertility, it can influence it though.
Let’s start with some basics. What are the most common symptoms of depression?
A study of 58 women by Dr. Lapane (she leads the PHARE Study Group and is Associate Dean and Director of the Doctoral Program in Clinical and Population Health Research) and colleagues reported a 2-fold increase in the risk of infertility among women with a history of depressive symptoms; however, they were unable to control for other factors that may also influence fertility, including cigarette smoking, alcohol use, decreased libido and body mass index (Lapane 1995).
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. One study of 10 depressed and 13 normal women suggests that depression is associated with abnormal regulation of luteinizing hormone (LH), a hormone that regulates ovulation (Meller 1997). Changes in immune function associated with stress and depression may also adversely affect reproductive function (Haimovici 1998). Further studies are needed to distinguish the direct effects of depression or anxiety from associated behaviors (e.g., low libido, smoking, alcohol use) that may interfere with reproductive success. Since stress is also associated with similar physiologic changes, this raises the possibility that a history of high levels of cumulative stress associated with recurrent depression or anxiety may also be a causative factor.
It needs a lot of mental strength when someone tries to become a parent, and when fertility problems arise it may become unbearable to overcome. The stigma around infertility adds up to the situation, and there are times you will feel disappointed in your body, ashamed, and alone. On top of that, fertility treatments can cause extra stress, because they are physically uncomfortable, expensive, time-consuming, and tiring. That extra stress can trigger depression, research shows. In fact, studies show that a large percentage of people with infertility — between 25 and 60 percent — have depression symptoms.
A growing number of research studies have examined the impact of fertility treatments at different stages, with most focusing on the impact of failed IVF trials. Hynes and colleagues assessed women at presentation for IVF and then following the failure of IVF. They found that women presenting for IVF were more depressed, had lower self-esteem and were less confident than a control group of fertile women and, after a failed IVF cycle, experienced a further lowering of self-esteem and an increase in depression relative to pre-treatment levels (Hynes 1992). Comparisons between women undergoing repeated IVF cycles and first-time participants have also suggested that ongoing treatment may lead to an increase in depressive symptoms. The data, however, is still controversial since other studies have found minimal psychological disturbance induced by the infertility treatment process or IVF failure.
The outcome of infertility treatment may also be influenced by psychological factors. Several 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.
What about treatment medication?
If you have developed depression after starting a fertility treatment, there is a high chance of your symptoms being related to the treatment hormones. Researchers in 2020 looked at multiple studies of people with infertility and found that those whose treatment involved ovarian stimulation had more depression symptoms than people who didn’t take medication to stimulate their ovaries. Some of the medications commonly used to treat infertility can cause depression symptoms, 2018 research says. These include:
Medication side effects might also get worse if the fertility treatment doesn’t result in a successful pregnancy.
Health conditions associated with infertility and depression at the same time.
Conditions that lower the chances of a successful pregnancy such as PCOS, endometriosis, thyroid conditions, rheumatoid arthritis, high blood pressure, etc. have been known to also affect the psychological behavior of patients. Up to 50% of those with autoimmune diseases show an impairment of health-related quality of life and exhibit depression-like symptoms. The immune system not only leads to inflammation in affected organs but also mediates behavior abnormalities including fatigue and depression-like symptoms, according to a 2017 study.
Are there ways to battle depression?
It is essential to try and lead a steady and healthy life, especially when trying to conceive. You have to correctly prepare your body and mind to maximize your chances.
One way to ease the symptoms of depression is medication, but the decision of starting medication while on a fertility treatment is not a decision you should make alone. Your fertility specialist is the one who will help you along the way and give you the right guidelines. Different kinds of antidepressants work in different ways, so the risks vary from drug to drug.
Research on the safety of antidepressants is still inconclusive. The most commonly prescribed class of antidepressants is selective serotonin reuptake inhibitors (SSRIs). Some studies, such as one from 2020, have suggested that SSRIs may interfere with your ability to get pregnant. On the other hand, a 2021 study found that sertraline, citalopram, and escitalopram had the lowest risk. Researchers in that study expressed concern about the safety of fluoxetine. Some studies have found that non-SSRI and the SSRI antidepressant, fluoxetine may raise the risk of having an early pregnancy loss, but more research is essential for conclusions. There is also another important finding: a 2020 analysis of multiple studies showed that using some antidepressants early in pregnancy may raise the risk of a variety of birth defects, including problems with the heart. Always consult with your doctor before starting any prescription.
Mindful-cognitive behavioral therapy (CBT)
Mindfulness is the key to unlocking your mind’s full potential. More specifically, CBT focuses on recognizing thoughts that aren’t accurate and reframing them so they don’t harm your mental health. In one study from 2020 women in IVF treatment who participated in mindfulness-based CBT had lower depression rates than those who didn’t.
In 8 of these 90-minute sessions, participants learned how to:
There is also a simple way to learn the above, via meditation. There are many apps with meditation exercises that you can do at your own pace and space.
Another solution is psychotherapy. Struggling with infertility and depression at the same time is a great burden, and there will be days where you’ll feel like a complete failure. On these days, you need to talk it through. If you don’t want to open up to your loved ones, there are always professionals that can help. Nowadays you can also do online consultations -thanks to Covid-19- and decide which way suits you best. In one Dutch study from 2016, women using ART had access to online therapy early in their treatment, and while not everyone opted to participate, many of those who did had fewer anxiety and depression symptoms.
Fertility support groups: Last but not least, there are several fertility communities with people who experience issues just like you and want to share their emotions, help, and be helped. They can turn out to be your safe space to open up and talk about everything that happens to your life, during that difficult time of yours. Examples are the national infertility association, resolve.org, complete fertility etc.
Bottom line is that most often, infertility and depression go hand to hand. The struggle is real, but solutions do exist as long as you wake up every morning and say “ I am strong, today will be a good day”. Your mental health state is important in this journey, and you know what else is important? Your safety, and for that you have MEDIPASS! We offer you the safest and most personalized fertility journey, in cooperation with top-notch clinics and doctors. Where? In Greece! In the country that for many is considered one of the top destinations for fertility treatment. Because of the highly-skilled doctors, the low prices, the good legislation, and the most beautiful cities and islands you can visit!
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