Associations of History of Infertility with Symptoms of Anxiety and Depression Among Parous Women During Midlife in Project Viva

Previous research has focused on the immediate psychological experiences of women and couples with infertility, yet little is known about the associations of infertility with anxiety and depressive symptoms years later during midlife, when anxiety and depressive symptoms are common.

Women enrolled in the Project Viva cohort 1999–2002 during early pregnancy completed the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) “Midlife Visit” questionnaire during 2017–2021, each of which we categorized into symptom scores of 0, 1–3, and ≥4. We performed adjusted multinomial logistic regression models to examine associations of lifetime history of infertility with anxiety and depressive symptoms among a parous sample in midlife.

Among the 746 participants who completed midlife PHQ-9 or GAD-7, 259 (35%) ever experienced infertility and mean (standard deviation) age at midlife visit was 50.9 ± 5.1. There was a slightly higher frequency of scores in the highest categories for both PHQ-9 (28% vs. 21%) and GAD-7 (21% vs. 20%) among those who had ever experienced infertility compared to those without a history of infertility. In a model adjusting for age at enrollment and race and ethnicity, a history of infertility was associated with a higher relative risk ratio (RRR) of a PHQ-9 score ≥4, versus the reference group of score 0 (RRR = 1.58, 95% confidence interval [CI] = 1.03, 2.43). A lifetime history of infertility was not associated with anxiety in midlife across models (e.g., when adjusted for age at enrollment and race and ethnicity, GAD-7 score ≥4 vs. score 0: RRR = 1.19, 95% CI = 0.78, 1.82).

Our findings suggest that based on the PHQ-9 categories defined according to the distribution of scores among our sample that the experience of infertility may be associated with greater depressive symptoms in midlife.