Medically-assisted reproduction not associated with negative psychiatric effects

Psychiatric issues in women who underwent medically-assisted reproduction (MAR) and remained childless are likely associated with involuntary childlessness and not treatment-related stress, according to a recent study published in the American Journal of Obstetrics & Gynecology.

A rise has been observed in the number of women seeking medically assisted reproduction as infertility treatments become more readily available. These include artificial insemination, ovulation induction, and assisted reproductive technology such as in vitro fertilization and intracytoplasmic sperm injection.

Concerns have arisen over negative effects to women’s psychological well-being because of MAR, leading to psychological distress, depression, and anxiety. However, data on this subject is limited. To evaluate the association between MAR and psychological effects, investigators conducted a study on the use of psychotropic medication among women who received MAR.

Women in the Finnish administrative registers born from 1950 to 1995 who were childless in 1995 and had their first child naturally or through MAR between 1996 and 2016 when aged 20 to 45 years were included. Women who received MAR treatments from 1995 to 2016 and were childless in 2017 were also included.

The primary outcome of the study was the use of psychotropic medications, with data on psychotropic medication purchases from January 1995 to December 2018 collected from the National Prescription Register. Psychotropic purchases before and after the date of conception were analyzed.

Women who conceived naturally (NC), conceived through MAR (MAR+), and were still childless following MAR (MAR-) made up the 3 main study cohorts. Women who received MAR were compared to those who conceived naturally. Follow-up occurred in 6-month intervals, with a value determining whether participants purchased psychotropics.

Healthcare, prescription, and birth registers were used to determine if participants underwent MAR. A link between purchases of fertility drugs and a child’s birthdate allowed a connection to MAR to be made.

Treatment length was defined as the time between the first and last MAR treatment, and a variable was created to note if treatment took more than 2 years. Available data allowed analysis on psychotropic purchases and MAR treatments up to 12 years before and after patients’ conception date.

Women aged under 20 years at conception, with triplet pregnancies, living abroad, and missing values in covariates were excluded. The final sample consisted of 575,921 women, 97.7% of which had a first birth from 1996 to 2016, and 2.6% of whom were childless following MAR treatments.

A purchase of psychotropics during follow-up was seen in 33.4% of women, 15% of which purchased a psychotropic in the 12 years before conception and 27.3% in the 12 years after. Psychotropic use was seen in 14.5% of NC women, 18.9% of MAR+ women, and 25% of MAR- women.

Purchases of psychotropics differed between women who conceived naturally and those who received MAR treatments up to 9 to 10 years before conception, with NC women being more likely to purchase psychotropics during this time than the MAR groups. The purchase of psychotropics rose in women in the MAR- group 5 years before conception.

While women who conceived naturally and those who received MAR had similar rates of psychotropic use from 3 years before to 4 years after conception, a gradual decrease was observed in MAR+ women from 2 years before conception onward. NC women did not see a shift in psychotropic use until right before conception.

A dramatic increase in psychotropic use was seen in MAR- women following the final MAR cycle, causing a large gap in psychotropic purchase between groups near the conception date. During this time, psychotropic purchases were seen in 9.82% of MAR- women, 2.83% of NC women, and 2.49% of MAR+ women. 

The gap between groups was lessened from an increase in psychotropic purchases among NC and MAR+ women immediately after childbirth. The gap between women with successful and unsuccessful childbirths stabilized 6 years after conception.

MAR- women were 45.69% more likely to purchase psychotropics 12 years after conception than MAR+ women and 59.48% more likely than NC women. This indicates involuntary childlessness is more likely to cause negative psychiatric effects than treatment-related stress.

Reference

Goisis A, Palma M, Metsä-Simola N, et al. Medically assisted reproduction and mental health: a 24-year longitudinal analysis using Finnish register data. American Journal of Obstetrics & Gynecology. 2023;228(3):311.E1-311.E24. doi:10.1016/j.ajog.2022.10.041