23 Jan Infertility and Stress
Infertility is a deeply troubling matter. Patients struggling with infertility may be extremely anxious and depressed. They may have feelings of isolation and loss of control. And many women may not share that with others, even their clinicians, which ultimately makes things worse. When a careful psychological history is taken, they often reveal a feeling of shame, guilt, and low self-esteem. Patients who undergo assisted reproductive treatment (ART) are also at an increased risk of psychiatric disorders and it is therefore very important to identify and address these issues and help these patients cope with their infertility diagnosis and treatment.
It is almost common knowledge that stress can hamper fertility. This raises the concern whether infertility causes stress or vice versa. The fact is that the relationship between distress and infertility is not quite clear. While is true that infertility leads to significant distress, the impact of distress on treatment outcome is less clear.
One important challenge with fully understanding the stress and infertility relationship is underreporting. Women suffering from infertility tend to not accurately report the level of their stress and unhappiness. Also, if the psychological assessments are performed earlier in the process, it may not take into account the growing unease and anxiety that occurs once the treatment begins.
In several studies, up to 40% of women with infertility issues were diagnosed as having anxiety, depression, or both. It is also important to note that the medications used to treat infertility, such as clomiphene, leuprolide, and gonadotropins, are associated with side effects of anxiety, depression, and irritability. Thus, it can be difficult to tell whether the psychological symptoms are an impact of infertility or the side effects of the medication. It has been noted that as the patients go further into treatment, they are more likely to show signs of depression and anxiety. Especially if the treatment fails, the levels of anxiety and the likelihood of depression significantly increase.
It has also been noted that when the infertile woman is depressed, she is less likely to start infertility treatment or more likely to drop out of it. In fact, discontinuation of fertility treatment is largely attributable to psychological reasons.
There is also an interesting relationship between the levels of stress prior to starting infertility treatment and the likelihood of success thereof. Some studies have shown that higher the level of stress and anxiety prior to and during treatment, the lower the pregnancy rates.
Getting pregnant from assisted reproductive techniques is not easy on the first cycle. Most women have to go undergo multiple cycles of ART and it still may not succeed. If the exact cause of infertility is accurately known, such as polycystic ovarian syndrome (PCOS), endometriosis, or male factor infertility, it can reduce the level of stress and improve their level of understanding and their ability to cope with treatment and its failure.
These patients are going through a lot and it can be overwhelming. It is very important for their stress levels, anxiety, and mood status to be properly addressed and accounted for. It not only improves their quality of life but also potentially increases the chance of therapeutic success.