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Case-based care for pre-existing or new-onset mood disorders in patients undergoing infertility therapy

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Abstract

The inability to conceive is an immensely stressful event in a woman’s life. Thus, it is no surprise that women with infertility have twice the rates of depressive symptoms as women without infertility. Incidence of depression in the general female population is approximately 20% compared to almost 40% in infertile females. Based on this information, we expect many individuals with infertility to have pre-existing mood disorders requiring ongoing treatment. In addition, we expect a subset of women to develop a mood disorder during infertility treatment due to related stressors. The reproductive endocrinology team must understand the impact of stress on pregnancy outcomes, the types of treatment options, and the safety and use of various medications. The goal of this case-based commentary is to summarize information on the relationship between stress and infertility and to offer a guide for a range of treatment options that include non-pharmacologic and pharmacologic therapies.

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References

  1. Chen TH, Chang SP, Tsai CF, Juang KD. Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Hum Reprod. 2004;19(10):2313–8.

    Article  PubMed  Google Scholar 

  2. Domar AD, Broome A, Zuttermeister PC, Seibel M, Friedman R. The prevalence and predictability of depression in infertile women. Fertil Steril. 1992;58(6):1158–63.

    Article  PubMed  CAS  Google Scholar 

  3. Volgsten H, Skoog Svanberg A, Ekselius L, Lundkvist O, Sundstrom Poromaa I. Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Hum Reprod. 2008;23(9):2056–63.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Newton CR, Hearn MT, Yuzpe AA. Psychological assessment and follow-up after in vitro fertilization: assessing the impact of failure. Fertil Steril. 1990;54(5):879–86.

    Article  PubMed  CAS  Google Scholar 

  5. Lok IH, Lee DT, Cheung LP, Chung WS, Lo WK, Haines CJ. Psychiatric morbidity amongst infertile Chinese women undergoing treatment with assisted reproductive technology and the impact of treatment failure. Gynecol Obstet Investig. 2002;53(4):195–9.

    Article  Google Scholar 

  6. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51(1):8–19.

    Article  PubMed  CAS  Google Scholar 

  7. Lepine JP, Gastpar M, Mendlewicz J, Tylee A. Depression in the community: the first pan-European study DEPRES (Depression Research in European Society). Int Clin Psychopharmacol. 1997;12(1):19–29.

    Article  PubMed  CAS  Google Scholar 

  8. Domar AD, Smith K, Conboy L, Iannone M, Alper M. A prospective investigation into the reasons why insured United States patients drop out of in vitro fertilization treatment. Fertil Steril. 2010;94(4):1457–9.

    Article  PubMed  Google Scholar 

  9. Campagne DM. Should fertilization treatment start with reducing stress? Hum Reprod. 2006;21(7):1651–8.

    Article  PubMed  Google Scholar 

  10. Whirledge S, Cidlowski JA. Glucocorticoids, stress, and fertility. Minerva Endocrinol. 2010;35(2):109–25.

    PubMed  PubMed Central  CAS  Google Scholar 

  11. Schenker JG, Meirow D, Schenker E. Stress and human reproduction. Eur J Obstet Gynecol Reprod Biol. 1992;45(1):1–8.

    Article  PubMed  CAS  Google Scholar 

  12. Sanders KA, Bruce NW. A prospective study of psychosocial stress and fertility in women. Hum Reprod. 1997;12(10):2324–9.

    Article  PubMed  CAS  Google Scholar 

  13. Ebbesen SM, Zachariae R, Mehlsen MY, Thomsen D, Hojgaard A, Ottosen L, et al. Stressful life events are associated with a poor in-vitro fertilization (IVF) outcome: a prospective study. Hum Reprod. 2009;24(9):2173–82.

    Article  PubMed  CAS  Google Scholar 

  14. Williams KE, Marsh WK, Rasgon NL. Mood disorders and fertility in women: a critical review of the literature and implications for future research. Hum Reprod Update. 2007;13(6):607–16.

    Article  PubMed  Google Scholar 

  15. Jonsson SA. Marriage rate and fertility in cycloid psychosis: comparison with affective disorder, schizophrenia and the general population. Eur Arch Psychiatry Clin Neurosci. 1991;241(2):119–25.

    Article  PubMed  CAS  Google Scholar 

  16. Odegard O. Fertility of psychiatric first admissions in Norway 1936-1975. Acta Psychiatr Scand. 1980;62(3):212–20.

    Article  PubMed  CAS  Google Scholar 

  17. Harlow BL, Wise LA, Otto MW, Soares CN, Cohen LS. Depression and its influence on reproductive endocrine and menstrual cycle markers associated with perimenopause: the Harvard Study of Moods and Cycles. Arch Gen Psychiatry. 2003;60(1):29–36.

    Article  PubMed  Google Scholar 

  18. Nillni YI, Wesselink AK, Gradus JL, Hatch EE, Rothman KJ, Mikkelsen EM, et al. Depression, anxiety, and psychotropic medication use and fecundability. Am J Obstet Gynecol. 2016;215(4):453.e1–8.

    Article  Google Scholar 

  19. Ramezanzadeh F, Noorbala AA, Abedinia N, Rahimi Forooshani A, Naghizadeh MM. Psychiatric intervention improved pregnancy rates in infertile couples. Malays J Med Sci. 2011;18(1):16–24.

    PubMed  PubMed Central  Google Scholar 

  20. Domar AD, Gross J, Rooney K, Boivin J. Exploratory randomized trial on the effect of a brief psychological intervention on emotions, quality of life, discontinuation, and pregnancy rates in in vitro fertilization patients. Fertil Steril. 2015;104(2):440–51. e7

    Article  PubMed  Google Scholar 

  21. Pedro J, Sobral MP, Mesquita-Guimaraes J, Leal C, Costa ME, Martins MV. Couples’ discontinuation of fertility treatments: a longitudinal study on demographic, biomedical, and psychosocial risk factors. J Assist Reprod Genet. 2017;34(2):217–24.

    Article  PubMed  Google Scholar 

  22. Frederiksen Y, Farver-Vestergaard I, Skovgard NG, Ingerslev HJ, Zachariae R. Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis. BMJ Open. 2015;5(1):e006592.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Facchinetti F, Tarabusi M, Volpe A. Cognitive-behavioral treatment decreases cardiovascular and neuroendocrine reaction to stress in women waiting for assisted reproduction. Psychoneuroendocrinology. 2004;29(2):162–73.

    Article  PubMed  CAS  Google Scholar 

  24. Smith JF, Eisenberg ML, Millstein SG, Nachtigall RD, Shindel AW, Wing H, et al. The use of complementary and alternative fertility treatment in couples seeking fertility care: data from a prospective cohort in the United States. Fertil Steril. 2010;93(7):2169–74.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Zheng CH, Huang GY, Zhang MM, Wang W. Effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization: a systematic review and meta-analysis. Fertil Steril. 2012;97(3):599–611.

    Article  PubMed  Google Scholar 

  26. Domar AD, Rooney KL, Wiegand B, Orav EJ, Alper MM, Berger BM, et al. Impact of a group mind/body intervention on pregnancy rates in IVF patients. Fertil Steril. 2011;95(7):2269–73.

    Article  PubMed  Google Scholar 

  27. Oron G, Allnutt E, Lackman T, Sokal-Arnon T, Holzer H, Takefman J. A prospective study using Hatha Yoga for stress reduction among women waiting for IVF treatment. Reprod BioMed Online. 2015;30(5):542–8.

    Article  PubMed  Google Scholar 

  28. Nulman I, Rovet J, Stewart DE, Wolpin J, Gardner HA, Theis JG, et al. Neurodevelopment of children exposed in utero to antidepressant drugs. N Engl J Med. 1997;336(4):258–62.

    Article  PubMed  CAS  Google Scholar 

  29. Nulman I, Rovet J, Stewart DE, Wolpin J, Pace-Asciak P, Shuhaiber S, et al. Child development following exposure to tricyclic antidepressants or fluoxetine throughout fetal life: a prospective, controlled study. Am J Psychiatry. 2002;159(11):1889–95.

    Article  PubMed  Google Scholar 

  30. Alwan S, Bandoli G, Chambers CD. Maternal use of selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. Clin Pharmacol Ther. 2016;100(1):34–41.

    Article  PubMed  CAS  Google Scholar 

  31. Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL, et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med. 2006;354(6):579–87.

    Article  PubMed  CAS  Google Scholar 

  32. Wichman CL, Moore KM, Lang TR, St Sauver JL, Heise RH Jr, Watson WJ. Congenital heart disease associated with selective serotonin reuptake inhibitor use during pregnancy. Mayo Clin Proc. 2009;84(1):23–7.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Levinson-Castiel R, Merlob P, Linder N, Sirota L, Klinger G. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med. 2006;160(2):173–6.

    Article  PubMed  Google Scholar 

  34. Kallen BA, Otterblad Olausson P. Maternal use of selective serotonin re-uptake inhibitors in early pregnancy and infant congenital malformations. Birth Defects Res A Clin Mol Teratol. 2007;79(4):301–8.

    Article  PubMed  CAS  Google Scholar 

  35. Malm H, Artama M, Gissler M, Ritvanen A. Selective serotonin reuptake inhibitors and risk for major congenital anomalies. Obstet Gynecol. 2011;118(1):111–20.

    Article  PubMed  Google Scholar 

  36. Williams M, Wooltorton E. Paroxetine (Paxil) and congenital malformations. CMAJ. 2005;173(11):1320–1.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Einarson A, Pistelli A, DeSantis M, Malm H, Paulus WD, Panchaud A, et al. Evaluation of the risk of congenital cardiovascular defects associated with use of paroxetine during pregnancy. Am J Psychiatry. 2008;165(6):749–52.

    Article  PubMed  Google Scholar 

  38. Furu K, Kieler H, Haglund B, Engeland A, Selmer R, Stephansson O, et al. Selective serotonin reuptake inhibitors and venlafaxine in early pregnancy and risk of birth defects: population based cohort study and sibling design. BMJ. 2015;350:h1798.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Huybrechts KF, Palmsten K, Avorn J, Cohen LS, Holmes LB, Franklin JM, et al. Antidepressant use in pregnancy and the risk of cardiac defects. N Engl J Med. 2014;370(25):2397–407.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. ACOG. Practice Bulletin No. 92: use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2008;111(4):1001–20.

    Article  Google Scholar 

  41. Akioyamen LE, Minhas H, Holloway AC, Taylor VH, Akioyamen NO, Sherifali D. Effects of depression pharmacotherapy in fertility treatment on conception, birth, and neonatal health: a systematic review. J Psychosom Res. 2016;84:69–80.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors acknowledge Judy T. Walsh (Department of Obstetrics and Gynecology, University of Florida College of Medicine) for her editorial assistance.

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Correspondence to Dikea Roussos-Ross.

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Roussos-Ross, D., Rhoton-Vlasak, A.S., Baker, K.M. et al. Case-based care for pre-existing or new-onset mood disorders in patients undergoing infertility therapy. J Assist Reprod Genet 35, 1371–1376 (2018). https://doi.org/10.1007/s10815-018-1222-5

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  • DOI: https://doi.org/10.1007/s10815-018-1222-5

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