Long-Term Depression May Decrease Fertility
By Jamie Habib | August 16, 2013Psychological 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
the Karolinska Institute in Stockholm, Sweden, were presented on July 9, 2013, at the annual meeting of theEuropean Society of Human Reproduction and Embryology.
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, theadjusted 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 interestwas that for women with chronic depression, those who were not treated with a selective serotonin reuptakeinhibitor (SSRI) had more difficulty conceiving than those who were treated with an SSRI (adjusted ORs,1.44 vs 1.37, respectively).
The study included data on 1,147,655 women delivered of live infants between 1983 and 2009. Of thesewomen, 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 slightlyhigher in women with depression (7.7%), anxiety (7.7%), or both depression and anxiety (7.5%) comparedwith women without depression or anxiety (6.7%). However, these differences were not significant. In theoverall 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 lesslikely than other women to become pregnant. In addition, women with depression are more likely to haveelevated levels of cortisol. This is likely the result of a primitive body function related to the process of
natural selection in which cortisol is released as a response to a threat of danger or death from which ourmodern bodies have not evolved. The basic idea is that animals or humans with high levels of cortisol wereless 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 atleast 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