Mental Health and Psychosocial Care · Infertility Distress
RRM Academy Synopsis
Failed ART treatment is linked to higher depression and anxiety
Depression and anxiety scores were higher after a failed ART treatment, and depression scores were lower after a success. A 2016 review pooled 12 of its 21 studies, which measured women and men before and after treatment (IVF or ICSI). After failure, the gap shrank over time but remained at six months or more.
Key Findings
- The review included 21 studies; 12 contributed to the pooled analysis of depression and anxiety scores before and after treatment.
- After failed treatment, depression scores were higher by a pooled standardized mean difference of 0.41 (95% CI: 0.27, 0.55). Anxiety scores were also higher, by 0.21 (95% CI: 0.13, 0.29).
- After successful treatment, depression scores were lower by a pooled standardized mean difference of -0.24 (95% CI: -0.37,-0.11). Anxiety scores before and after successful treatment did not differ significantly.
- Six months or more after a failed procedure, depression stayed above baseline at 0.27 (95% CI: 0.11, 0.43) and anxiety at 0.11 (95% CI: 0.02, 0.20).
- The other studies also reported negative outcomes for marital satisfaction and general well-being after failure. Some found no negative effect on the relationship.
Interpretation
This is a systematic review and meta-analysis, which pools results from earlier studies. Every included study compared scores before and after treatment with no control group. The authors state that this design gave the studies little power to establish causation. Most studies measured outcomes within four weeks of failed treatment. The authors found it difficult to tell one failed cycle from a full course of failed treatment. Complete data covered 1345 women and 279 men in the failed-treatment groups.
RRM Context
All 21 studies followed IVF or ICSI. These bypass the reproductive system without finding why conception is not happening. The review measures depression and anxiety scores after a bypass fails. Restorative reproductive medicine puts evaluation of the cause first, so couples start with a diagnosis.
Abstract
Objective
Our study examined the psychological outcomes associated with failed ART treatment outcomes in men and women.
Search Strategy
A systematic search for studies published between January 1980 and August 2015 was performed across seven electronic databases.
Study Eligibility Criteria
Studies were included if they contained data on psychosocial outcomes taken pre and post ART treatment.
Data Extraction and Synthesis
A standardised form was used to extract data and was verified by two independent reviewers. Studies were meta-analysed to determine the association of depression and anxiety with ART treatment outcomes. Narrative synthesis identified factors to explain variations in the size and directions of effects and relationships explored within and between the studies.
Main Results
Both depression and anxiety increased after a ART treatment failure with an overall pooled standardised mean difference (SMD) of 0.41 (95% CI: 0.27, 0.55) for depression and 0.21 (95% CI: 0.13, 0.29) for anxiety. In contrast, depression decreased after a successful treatment, SMD of -0.24 (95% CI: -0.37,-0.11). Both depression and anxiety decreased as time passed from ART procedure. Nonetheless, these remained higher than baseline measures in the group with the failed outcome even six months after the procedure. Studies included in the narrative synthesis also confirmed an association with negative psychological outcomes in relation to marital satisfaction and general well-being following treatment failure.
Conclusion
Linking ART failure and psychosocial outcomes may elucidate the experience of treatment subgroups, influence deliberations around recommendations for resource allocation and health policy and guide patient and clinician decision making.