Depression and Fertility

Intervention: #21 Depression
 
Fact Check
  • There is a high incidence of depression in patients with fertility problems.
  • Women with depression are less likely to pursue treatment.
  • Patients with a history of depression are at higher risk of relapsing during fertility treatment.
  • Mindfulness based cognitive therapy (MBCT) and cognitive behavioural therapy (CBT) can be more effective than medication.
It is normal to feel sad or even depressed occasionally. However, when these feelings persist over time and affect a person’s quality of life, they may be experiencing depression.

A diagnosis is made when there are 5 or more of the following symptoms:

  • depressed mood for most of the day on most days
  • loss of interest in most activities, even those a person once enjoyed
  • weight loss or gain not due to deliberate dieting or a health condition
  • sleeping too much or too little
  • feeling physically agitated or slow most days
  • having low energy most days
  • feeling worthless, guilty, or ashamed
  • trouble thinking clearly or concentrating
  • frequent thoughts of death or suicide

Fertility & Depression

Fertility problems often lead to increased levels of anxiety and depressive symptoms.

  • A study found that infertile women had significantly higher depression scores and twice the prevalence of depression than controls.
  • In another study the prevalence rates of anxiety and depression were 49.6% and 33.0%, respectively.
  • Patients with ≥ 5 years infertility duration were more likely than others to have anxiety and depressive symptoms.

Depression and Fertility Treatment


A study found that 39.1% of women and 15.3% of men undergoing treatment met the criteria for major depression.

Another study found that women undergoing treatment with past diagnoses of major depressive disorder or bipolar depression were at considerable risk of relapse. Medication continuation was not sufficient prevention.

Another study found that women who screened positive for depression were less likely to pursue treatment with oral medications or IVF, as compared to women who did not screen positive for depression.


Strategies to Manage Depression


A study found that women experiencing infertility are at greater risk of first-time prescription of antidepressants due to fertility specific stress.

A different study compared the effectiveness of antidepressant medication and psychological intervention on depression symptoms in women with infertility. Improvement in depressive symptoms was greater with psychotherapy interventions than medication (bupropion).

Psychotherapy interventions included mindfulness-based cognitive therapy (MBCT), relaxation training, behavior sex therapy, and a booklet of tranquility and mindfulness.

Another study found CBT was not only a reliable alternative to pharmacotherapy, but also superior to fluoxetine in resolving and reducing infertility stress.