Importance of baseline psychological screening in infertility for men & women

By identifying psychological concerns early in the infertility treatment process, patients can be referred for behavioral health interventions rather than allowing conditions to emerge, worsen, or further impact their health. The aim of this study was to assess the psychological impact of infertility over time for men and women.

Longitudinal prospective cohort study.

Couples and individuals with a reproductive specialist consultation were recruited to complete two questionnaires: prior to initial consultation and at 12 months. PROMIS Anxiety and Depression 4-item short forms and Fertility Quality of Life (FertiQoL) were administered at both time points. We analyzed the relationships between FertiQoL, Anxiety, and Depression at 12 months, fertility-related events and outcomes (infertility diagnoses, medical treatments for infertility, pregnancy/parenting status), and sociodemographic characteristics (gender, age, race, education, relationship satisfaction) using hierarchical linear modeling to account for nonindependence of the participants who were part of a couple. We considered a two-tailed alpha level of 0.05 to be significant.

A total of 88 women and 63 men provided data at both time points; mean age 34 years. At baseline, mean (SD) anxiety scores were 50.6 (8) for women, 48.4 (8) for men; depression scores were 46.8 (6) for women and 44.9 (4) for men. Baseline FertiQoL scores were 68.9 (15) for women and 79.8 (12) for men. By 12 months, 54% of participants were pregnant or parenting a child (birth or adoption/fostering). Those who were pregnant/parenting by 12 months reported significantly better FertiQoL scores and had lower depression at 12 months. Higher anxiety at 12 months was related to baseline anxiety and lower relationship satisfaction. Likewise, higher depression at 12 months was related to baseline depression and lower relationship satisfaction. Neither infertility diagnoses (male-factor, femalefactor, or unexplained) nor invasive medical treatments (IUI or IVF) were related to anxiety, depression, or FertiQoL scores at 12 months.

Baseline psychological status is predictive of subsequent anxiety and depression during ongoing infertility treatment, with scores worsening over time. It is imperative that early identification of needs and provision of treatment resources be provided to patients. Embedding behavioral health services within the clinic promotes ease of access to care and reduces stigma of seeking treatment. After this research was conducted, the addition of a clinical health psychologist in the clinic has afforded opportunities to implement screening measures and promote early intervention.