Mental health and fertility

This week is Mental Health Awareness Week in the UK, and we will be taking a little time to focus on aspects of mental wellness as it relates to fertility issues throughout the week.

It is not surprising that there are mental health issues associated with infertility when women have shouldered the ‘blame’ for the condition for centuries. Indeed, there are descriptions of the association of infertility with moral, spiritual and physical shortcomings of women going back to 400 BCE, with Hippocrates being one of the first physicians to point the finger of blame. It should come as no surprise therefore that the word ‘hysteria’, associated negatively with female anxiety and panic, comes from the Ancient Greek word for ‘womb’. It certainly seems a misnomer to name the common, shrill, panicky, momentary loss of emotional control that the word ‘hysteria’ denotes after the womb when a of the suffers don’t even have one!

Nowadays we know better than to blame women for infertility and its associated mental health issues, even if in some parts of the world, and in some communities, ignorance still prevails and there is much work still to be done. But that doesn’t mean that the psychological challenge of infertility is going away any time soon.

Indeed, parenthood and the non-fulfilled wish for a child is one of the major challenges in life for women AND men, and is accompanied with psychological consequences such as anger, depression, anxiety, marital problems and social isolation. Couples experience all of this together, however according to some studies -women show higher levels of stress than male partners. Interestingly, when it is the man that is found to have fertility problems, the male response to that stress approximates to the intensity of the female experience. So, given that male infertility is a problem in 40-50% of infertile couples, gender is no protection against mental health issues associated with infertility.

The common psychological consequences of infertility are depression and anxiety, which includes symptoms of what is commonly called stress. Stress has been shown to be much higher in infertile couples than in the fertile population. In fact, given the high incidence some studies have even looked at whether such symptoms might be a CAUSE of infertility? Many studies have shown that when stress levels go down, pregnancy rates go up.

It is difficult to separate out other issues commonly associated with stress that impact on fertility, such as heavy smoking, excess alcohol consumption, obesity, and lack of libido. However, given that stress, anxiety and depression can have a physiological impact on the body e.g. on levels of luteinizing hormone that regulates ovulation it may be that cumulative stress/recurrent depression MAY be a causative factor in infertility.

What is known is that the process of assisted reproduction is itself associated with increased levels of anxiety, depression and stress. A study in the 1990s found that women presenting for IVF were more depressed than a control group of fertile women, and they experienced a further increase in depression after a failed IVF cycle. This depression, and other psychological impacts, may even be a significant reason why some women/couples drop out of treatment.

The situation is even more complex when one considers that the outcome of fertility treatment may also be impacted by psychological factors. The majority of studies that have looked into this area have found that mental distress is associated with lower pregnancy rates among women undergoing fertility treatment.

With all of this in mind, it would certainly seem desirable to reduce the psychological stress, anxiety and depression that a significant population of couples experience as a result of infertility and the treatment they undergo for infertility.

So what can be done?

Firstly, several important research studies have suggested that psychotherapy and support groups can decrease stress and mood symptoms as well as increase fertility rates. In one study in 2000 the pregnancy rate was 55% in the support group compared to 24% in the group that received no psychological support, suggesting that the option of support was important. Most IVF clinics offer associated psychological support, help and counselling as part of their services.

Secondly, where advised by an appropriate healthcare professional, pharmacotherapy is an effective option for those who develop depression and/or anxiety in the context of infertility and its treatment. Many women avoid pharmacologic treatment for fear that medication may impact their fertility or may affect the outcome of their pregnancy. However, current data suggests that commonly used antidepressants do not affect fertility.

And finally, when undergoing fertility treatment, it is worthwhile considering ways of lowering one’s stress in terms of lifestyle. Apart from the usual advice on good diet, appropriate exercise, and attention to sleep patterns, the modern world offers some options for those enduring the stress of infertility that were not available to our forebears. Here are a couple apps that can enhance mental wellbeing during this period:

  • Mindscape: this is a new mental health app launched last year, developed by UK mental health charity, MIND, which combines voice technology, artificial intelligence and science-led music therapy. It is specifically aimed at people dealing with panic attacks and anxiety, and offers breathing exercises, advice on emotional states, tips on managing situations, and bespoke soundscapes tailored to the user
  • Moodrise: this app is all about ‘digital nutrition’ using positive content to help alleviate pain, boost emotional resilience and improve experiences. It focuses on 6 popular mood states, including confidence, concentration and happiness, and the related neurotransmitters that lead to that mood state. Content has been specifically created to help deliver the desired chemical reaction in the brain, backed by scientific research. The idea is that people can proactively manage their mental health through ‘digital pills’ to help them enhance their own emotional resilience.

Mental health is an important facet that needs to be considered when considering or undergoing treatment for infertility. Luckily, this common facet is well catered for in today’s modern IVF clinic services.

For further information:

Mindscape: download on Amazon Alexa

Moodrise: download on App Store and Google Play Store