OBGYN.net.

CLINICAL UPDATE
Long-Term Depression May Decrease Fertility
By Jamie Habib | August 16, 2013
Psychological distress experienced over an extended period may lead to a longer time to first pregnancy,
according to data from a large, population-based study. The results of the study, which was conducted at
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the Karolinska Institute in Stockholm, Sweden, were presented on July 9, 2013, at the annual meeting of the
European Society of Human Reproduction and Embryology.
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The key finding was that time to conception was significantly longer in women with a first diagnosis of
depression made at least 6 years before pregnancy (adjusted odds ratio [OR], 1.25). For comparison, the
adjusted OR of time to conception with a diagnosis of depression less than 1.5 years, 1.5 to less than 3 years,
and 3 to 6 years before pregnancy were 0.81, 0.92, and 1.06, respectively. An additional finding of interest
was that for women with chronic depression, those who were not treated with a selective serotonin reuptake
inhibitor (SSRI) had more difficulty conceiving than those who were treated with an SSRI (adjusted ORs,
1.44 vs 1.37, respectively).
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The study included data on 1,147,655 women delivered of live infants between 1983 and 2009. Of these
women, 7322 reported a diagnosis of depression at their first prenatal visit, 7551 reported a diagnosis of
anxiety, and 2497 reported having both anxiety and depression. The rates of involuntary childlessness,
defined in this study as the inability to conceive for at least 1 year despite the desire to do so, were slightly
higher in women with depression (7.7%), anxiety (7.7%), or both depression and anxiety (7.5%) compared
with women without depression or anxiety (6.7%). However, these differences were not significant. In the
overall population, the rate of involuntary childlessness was 6.7%.

Previous studies have shown that women with increased levels of cortisol, or the stress hormone, are less
likely than other women to become pregnant. In addition, women with depression are more likely to have
elevated levels of cortisol. This is likely the result of a primitive body function related to the process of
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natural selection in which cortisol is released as a response to a threat of danger or death from which our
modern bodies have not evolved. The basic idea is that animals or humans with high levels of cortisol were
less likely to survive long enough to reproduce or to raise their offspring to independence.

Whether cortisol levels were elevated in the women in this study with long-term depression is unknown.
Pertinent Points:
- There is no association between a diagnosis of depression or anxiety and involuntary childlessness for at
least 1 year after a depression diagnosis.
- Long-term depression of at least 6 years results in a significantly higher time to conception.
OBGYN.net. Vol. No. August 16, 2013
http://hcp.obgyn.net/pregnancy-and-birth/content/article/1760982/2154733
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- It is unknown to what extent subfertility of infertility issues had on these results, because only women with
at least 1 child were included in the study.

1. Cesta CE, Olsson H, Cnattingius S, et al. Psychological distress and involuntary childlessness in women: a
register-based Swedish cohort study. Presented at: Annual Meeting of the European Society of Human
Reproduction and Embryology; July 9, 2013; London. 2. Freeman S. Long-term depression may affect ability
to conceive. July 31, 2013. Available at:
http://www.clinicalpsychiatrynews.com/specialty-focus/depression/single-article-page/long-term-depression-may-affect-ability-to-conceive/89c0a3455781539e5553493073e57c02.html.
Accessed August 6, 2013.
3. Raison C. Why stress, depression hurt fertility. August 13, 2010. Available at:
http://thechart.blogs.cnn.com/2010/08/13/why-stress-depression-hurt-fertility/. Accessed August 8, 2013.
OBGYN.net. Vol. No. August 16, 2013
http://hcp.obgyn.net/pregnancy-and-birth/content/article/1760982/2154733
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