A new study shows that depression and anxiety may be associated with a reduced chance of pregnancy and live birth following in vitro fertilization (IVF). While the findings are complex regarding the role of antidepressants in this connection, the researchers say that the results ultimately point to depression and anxiety as the main underlying factors.
Within the last few decades, antidepressant treatments, particularly selective serotonin re-uptake inhibitors (SSRIs), have increased both in the general population and among women of reproductive age. However, little is known about the effect of these drugs on the ability to conceive.
“We found that women undergoing their first IVF treatment who either had been diagnosed with depression or anxiety or had been dispensed an antidepressant had lower rates of pregnancy and live birth rates compared to women who did not suffer from these conditions or take antidepressants before beginning their IVF treatment,” said first author Carolyn Cesta, doctoral student at the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet in Sweden.
“Importantly, we found that women with a depression or anxiety diagnosis without a prescription of antidepressants had an even lower chance of becoming pregnant or having a live birth.”
SSRIs are the most commonly prescribed type of antidepressant. In the large group of women in the current study taking SSRIs, there was no difference in pregnancy or live birth rates following IVF treatment.
However, the small group of women taking antidepressants other than SSRIs, who had more complex cases of depression and anxiety, had reduced odds of pregnancy and live birth as well as an increased risk for miscarriage following their IVF treatment.
“Taken together, these results indicate that the depression and anxiety diagnoses may be the underlying factor leading to lower pregnancy and live birth rates in these women,” said principal investigator Dr. Anastasia Nyman Iliadou, associate professor at the Department of Medical Epidemiology and Biostatistics.
The study, which involved more than 23,000 women, is the largest so far to look for any connections between depression, anxiety and antidepressants and the outcome of IVF.
The researchers used anonymized data on all IVF procedures performed in Sweden from 2007 and onwards, taken from the Swedish Quality Register of Assisted Reproduction. They linked it to information on depression, anxiety and antidepressant prescription dispensations from the nationwide Swedish Patient and Prescribed Drug Registers.
Of all the participants, 4.4 percent had a depression or anxiety diagnosis in the two years prior to the start of their IVF cycle and/or an antidepressant prescription in the six months prior to the cycle start. The researchers compared the rates of pregnancy, live birth and miscarriage in these women to rates in women without a diagnosis or antidepressant dispensation.
Nyman cautions that since the study was not randomized the results could also be explained by unmeasured lifestyle and/or genetic factors associated with depression and anxiety.
The findings are published in the journal Fertility & Sterility.
Source: Karolinska Institutet