The mental health impact of failed fertility treatment has been explored in a recent study. Dr. Sofia Gameiro of Cardiff University, UK, and her team explored the factors that may affect women’s mental health more than a decade after unsuccessful fertility treatment.
They gave questionnaires to 7,148 women who had previously received fertility treatment at 12 hospitals in The Netherlands. Questionnaires were completed between 11 and 17 years after the treatment.
The questions included age, marital status, education, and whether the women had reached menopause. They were also asked whether the infertility was due to themselves or their male partner, both partners, or was of unknown cause. They indicated which type of treatment they had received: ovarian stimulation, intrauterine insemination, and in vitro fertilization/intra-cytoplasmic sperm injection.
A mental health questionnaire was completed, covering their feelings over the previous four weeks. The women also indicated whether they had children, and, if they did, whether they were their biological children or adopted (or both). They also were asked whether they still wished for children.
Most women said they had come to terms with the failure of their fertility treatment, but six percent still wanted children. This group was currently experiencing worse mental health.
“It was already known that people who have infertility treatment and remain childless have worse mental health than those who do manage to conceive with treatment,” said Dr. Gameiro.
“However, most previous research assumed that this was due exclusively to having children or not, and did not consider the role of other factors. We found that women who still wished to have children were up to 2.8 times more likely to develop clinically significant mental health problems than women who did not sustain a child-wish.
“The strength of this association varied according to whether women had children or not. For women with no children, those with a child-wish were 2.8 times more likely to have worse mental health than women without a child-wish.
“For women with children, those who sustained a child-wish were 1.5 times more likely to have worse mental health than those without a child-wish. This link between a sustained wish for children and worse mental health was irrespective of the women’s fertility diagnosis and treatment history.”
The results also indicated that women had better mental health if the infertility was due to male factors, or unknown factors. Those who started fertility treatment at an older age had better mental health than women who started younger, and those who were married or living with their partner had better mental health than those who were single, divorced, or widowed. Better mental health was also linked to a higher level of education.
Dr. Gameiro believes the study improves our understanding of why childless people have poorer adjustment. It indicates that it is strongly associated with their inability to let go of their desire to have children.
“It is quite striking to see that women who do have children but still wish for more children report poorer mental health than those who have no children but have come to accept it,” she points out.
“The possibility of treatment failure should not be avoided during treatment and a consultation at the end of treatment should always happen, whether the treatment is successful or unsuccessful, to discuss future implications,” Dr. Gameiro says.
“This would enable fertility staff to identify patients more likely to have difficulties adjusting to the long term, by assessing the women’s possibilities to come to terms with their unfulfilled child-wish. These patients could be advised to seek additional support from mental health professionals and patient support networks.”
The causes of individual differences between women’s ability to let go of their wish for a child is unknown. Having other meaningful life goals may be a relevant factor, Dr. Gameiro suggests.
“It is easier to let go of a child-wish if women find other things in life that are fulfilling, like a career. We live in societies that embrace determination and persistence. However, there is a moment when letting go of unachievable goals (be it parenthood or other important life goals) is a necessary and adaptive process for well-being.”
Finally, she states that these findings underline the importance of psychological care of infertility patients and, in particular, she calls for more attention on women’s long-term adjustment, whatever the outcome of the fertility treatment.
The study is published in the journal Human Reproduction.
Gameiro, S., et al. Do children make you happier? Sustained child-wish and mental health in women 11-17 years after fertility treatment. Human Reproduction, 10 September 2014 doi:10.1093/humrep/deu178