Rooney, K. L., & Domar, A. D. (2018). The relationship between stress and infertility. Dialogues in clinical neuroscience, 20(1), 41-47. https://doi.org/10.31887/DCNS.2018.20.1/klrooney
Rooney KL, Domar AD. The relationship between stress and infertility. Dialogues in clinical neuroscience. 2018;20(1):41-47. doi:10.31887/DCNS.2018.20.1/klrooney
Rooney, Kristin L., and Alice D. Domar. "The relationship between stress and infertility." Dialogues in clinical neuroscience, vol. 20, no. 1, 2018, pp. 41-47.
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Infertility causes major distress, and stress as a cause is unsettled
A 2018 review of infertility studies finds that infertility brings deep distress, which the review calls definitive. Whether stress causes infertility is still unclear. The review also looks at psychological interventions. Meta-analyses disagree on whether they raise pregnancy rates.
Key Findings
In a 2004 study, 40% of 122 women interviewed before their first infertility clinic visit were diagnosed with anxiety, depression, or both.
In northern California infertility clinics, 56% of 352 women and 32% of 274 men reported significant symptoms of depression.
A review of the literature found psychiatric symptoms in 25% to 60% of infertile individuals, with anxiety and depression above the levels in fertile controls.
Among 501 US women trying to conceive, those in the highest quartile of baseline salivary α-amylase were twice as likely to subsequently experience infertility.
Meta-analyses of psychosocial interventions disagree: one meta-analysis of 39 studies reported significant effects on pregnancy rates, while a Cochrane review of 39 studies judged study quality too low for conclusions.
Interpretation
The article is a narrative review. The authors describe studies one by one and report no pooled analysis of their own. Many cited studies assessed patients at infertility clinics or in treatment. Treatment medicines are associated with anxiety, depression, and irritability, so mid-treatment mood is hard to assign to infertility alone. The authors say self-reports may be inaccurate, for example when women present themselves as healthier or feel optimistic at the start of treatment. Studies linking stress to pregnancy conflict, and the biomarker results are correlations. The Cochrane review judged study quality too low for conclusions.
RRM Context
The review notes that knowing the root cause of an infertility diagnosis can lighten the burden for patients. Unexplained infertility leaves them without an answer. RRM treats unexplained infertility as undiagnosed, and cause-based evaluation aims to supply that answer. Much of the distress data comes from people in ART treatment. IVF bypasses infertility without resolving why conception fails. The California men's depression figure shows distress belongs in couple-level care.
Our editorial summary of this paper, not the article's abstract.
Abstract
The relationship between stress and infertility has been debated for years. Women with infertility report elevated levels of anxiety and depression, so it is clear that infertility causes stress. What is less clear, however, is whether or not stress causes infertility. The impact of distress on treatment outcome is difficult to investigate for a number of factors, including inaccurate self-report measures and feelings of increased optimism at treatment onset. However, the most recent research has documented the efficacy of psychological interventions in lowering psychological distress as well as being associated with significant increases in pregnancy rates. A cognitive-behavioral group approach may be the most efficient way to achieve both goals. Given the distress levels reported by many infertile women, it is vital to expand the availability of these programs.
Lifestyle and Environment › Stress and Allostatic Load › Stress and Ovulation · Mental Health and Psychosocial Care › Infertility Distress › Anxiety and Depression in Infertility
Kristin L Rooney, Alice D Domar
K Rooney, A Domar
PMID 29946210 29946210 DOI 10.31887/DCNS.2018.20.1/klrooney 10.31887/DCNS.2018.20.1/klrooney Rooney et al. 2018, Rooney 2018
Keywords
IVF, anxiety, depression, distress, infertility, psychosocial support, quality of life
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