As National Infertility Awareness Week continues we wanted to uncover the truth between infertility & depression, which often go hand in hand but are not openly discussed.
“Whenever people asked, “How are you?” by way of social nicety I lied through my teeth. “Not too bad,” I’d say. Or “Swings and roundabouts.” At least I didn’t say “Fine, thanks” or “A livid scar cuts across my very being.” [Julia Leigh. ‘Avalanche, A Love Story’. W W Norton Press 2016]
Problems with emotional wellbeing, such as clinical anxiety and/or depression, are a frequently encountered aspect of infertility. This is because the emotional stress associated with infertility is far greater than people commonly realise. In fact, the stress experienced by fertility patients has been equated with the same level of stress experienced by patients with heart disease, cancer and HIV, with some patients characterising it as the most upsetting experience in their lives.
Let’s not confuse depression with sadness. There is bound to be a normal emotional response to the challenge of infertility; for instance when a pregnancy test comes back negative, when treatment fails, or upon diagnosis of infertility. Women can also feel sadness when reminded of their conception struggles, like when a work colleague invites them to a baby shower or when a sister has a child. This is all normal.
Depression characterised clinically as major depressive disorder differs from normal feelings of sadness. Sadness is intermittent and generally lifts after a period of time, while depression is persistent, and involves other distinct symptoms, which interfere with leading a healthy life.
Symptoms of depression include:
- Persistent feelings of sadness
- Hopelessness and feelings of helplessness
- Eating disorders – over eating or low appetite.
- Loss of pleasure in life, possibly including a low interest in sex
- Frequent feelings of anxiety
- Frequent crying bouts
- Persistent anger and intolerance of friends, colleagues and family
- Lack of motivation at work and in the home
- Sleep disturbances: either sleeping too much, unable to sleep well (insomnia) or periods of unusual wakefulness (e.g. wakeful periods in the early hours)
- Thoughts of dying, self-harm, or suicide ideation (note: this last one is a serious symptom requiring immediate medical attention)
Depression is also not limited to females in couples struggling with infertility. A 2015 study investigated women undergoing fertility treatment, together with their partners, and found that 39% of the women and 15% of the men met the criteria for clinical depression within the 18-month period of the study. The difference between the higher female levels of depression in couples undergoing fertility treatment vs. male levels of depression is possibly explained because women have the additional issue of fluctuating hormone levels, as a function of their treatment to contend with.
Infertility and depression have some surprising dimensions. While it is not surprising to learn that infertility is associated with depression, it is also a fact that studies indicate women who experience depression are more likely to encounter fertility problems in later life. Although no one definitively knows whether depression itself can cause infertility.
Some experts have theorized that this may be due to an overlap in some of the hormonal issues involved in both conditions. Others have postulated that depression may lead to lifestyle habits that can negatively impact on fertility such as over-eating leading to obesity, or smoking/excess alcohol intake.
This all suggests patients and their partners would benefit from being routinely assessed for a history of depression prior to the start of assisted reproduction treatment in order that those who require help can benefit from psychosocial support and interventions.
So what can be done if YOU feel depressed while undergoing IVF?
- For severe depression consider talking to your dedicated health care professional about medication, some couples do not like the idea of taking medication for depression. However, providing that medication is directed by a medical professional there is no reason to dismiss the idea of medication out of hand. Some studies have even found that treating depression with antidepressants and counselling improved the chances of successful pregnancy.
- For milder depression other options can be considered such as counselling, support groups, holistic therapies including techniques like hypnosis. Many clinics offer such services in-house or have affiliated services, which are available to patients.
Your fertility doctor may also be able to adjust your fertility medications, giving ones less likely to affect mood, since fertility drugs can aggravate depression and cause mood swings.
The wealth of knowledge and advice in this area all points to the fact that couples who are experiencing depression during treatment are not alone and do not need to suffer in silence. If treatment for depression is needed, your dedicated fertility doctor and relevant members of your healthcare team should work together to help you decide the safest and most effective treatments for depression while you try to conceive.
