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Subfertility May Precede Mental Illness, Study Shows

— June 8, 2022

Subfertility may increase a women’s chance of having a mental health diagnosis.

New mothers who have a history of subfertility are at a greater risk of developing postpartum mental illness compared to those who conceived spontaneously, according to a new study that published in the Canadian Medical Association Journal Open on May 17.  Researchers examined whether mothers diagnosed with any type of mood or anxiety disorder, psychotic disorder, substance use disorder (SUD), self-harm behavior, or other mental health condition (i.e., an eating disorder or an obsessive-compulsive disorder) also had a history of subfertility.

Subfertility refers to the delay in conceiving while infertility refers to not being able to conceive at all. Common causes, according to a study published in Best Practice and Research in Clinical Obstetrics and Gynecology, include “ovulatory disorders, tubal disease, peritoneal adhesions, endometriosis, uterine abnormalities, abnormalities of sperm and advancing female age.”

Subfertility May Precede Mental Illness, Study Shows
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“Subfertility with or without in vitro fertilization (commonly referred to as IVF) or other treatment seemed to be associated with anywhere from a 10% to 14% higher relative risk of any mental health diagnosis only after accounting for factors like age, income, immigrant status, living in a rural area, having had previous births, and medical health conditions like high blood pressure, obesity, and diabetes,” said lead author Natalie Dayan, MD, director of obstetric medicine at McGill University Health Centre in Montreal, Canada. “These factors play an important role in an individual’s risk of postpartum mental health issues and seem to equalize the effects of infertility and its treatment.”

The research team examined 800,000 births reported in an Ontario birth database called the Better Outcomes Registry and Network (BORN).  They identified mothers who had delivered without any reported preexisting mental illness.  They had a live birth or stillbirth at twenty weeks or more in a medical facility setting in the eight-year span between April 1, 2006, and March 31, 2014.  This population included “786,064 deliveries to 589,598 individuals (including 196,466 repeat deliveries to 172,633 individuals),” the team noted.  They also found, “the adjusted relative risk (RR) for postpartum mental illness was 1.14 in women with subfertility, compared with women without reproductive assistance.  The magnitude of increased risk varied by whether the women had sought treatment and by whether treatment was invasive.”

From the same database, the researchers found “688,970 incidences of spontaneous conception (the reference group), and 78,823 deliveries to mothers with subfertility but no treatment.”  The second group had an infertility consultation within two years prior to the expected conception date.  Moreover, there “were 9178 deliveries to mothers who had conceived with noninvasive infertility treatment (ovulation induction or intrauterine insemination only), and 9633 deliveries to those who received invasive infertility treatment (IVF or intracytoplasmic sperm injection).”

Emergency department visits, longer term hospital stays and/or two or more outpatient visits treating mental illness was used to determine whether these mothers suffered from a subsequent disorder.  The team concluded that “with untreated subfertility (62.1 per 1000 births; adjusted RR, 1.14) and those with noninvasive infertility treatment had increased incidence (65.8 per 1000 births; adjusted RR, 1.12) of mental illness.”


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