Infertility may increase risk of mental disorders

Not being able to have children when you desperately want them can be understandably stressful. It is known that this experience can lead to anxiety and depression. Yet we may only be beginning to understand the magnitude of the problem for women who struggle with infertility but never go on to have children.

So says Brigitte Baldur-Feskov of the Danish Cancer Society Research Center in Copenhagen, and colleagues, who analysed data from 98,737 Danish women who had seen a doctor about infertility between 1973 and 2003. Her team determined hospital admissions for mental health disorders among these women over an average of 12.6 years, and discovered some concerning trends.

Of all the women analysed, 4677 were hospitalised with mental health problems. Of these, 2507 had not been successful in producing a child, compared with 2107 women who were able to have at least one child.

Baldur-Feskov's analysis, which excluded any women with previous diagnoses for mental health problems, also found a significantly higher risk for subsequent drug and alcohol abuse among women who did not go on to have children after an initial fertility consultation. Of 571 women who were treated for drug and alcohol abuse, 195 had eventually been able to have children compared with 376 who were unsuccessful.

Because the study only looked at mental health problems severe enough to warrant hospitalisation, Baldur-Feskov says these figures point to a larger problem. "I think the tip of the iceberg is the most precise way to put it," she says.

As well as the higher risk for substance abuse, the team noted that women who did not go on to have children were 47 per cent more likely to be hospitalised for schizophrenia than those who gave birth.

Baldur-Faskov suggests that the known higher prevalence of fertility issues among women with schizophrenia may in part explain this trend, as women who would have gone on to develop the psychiatric disorder at some point may have been more likely to seek fertility treatment.

Yet while some of these women may have developed mental health disorders at some point in life regardless of whether they were able to carry children, the higher risk faced by those who did not have babies should be taken into account when determining how best to treat and counsel people with infertility. "I think that clinicians should be aware that this is a possible risk factor and think about ways to follow up with these unsuccessful women," says Baldur-Feskov.

The results were presented this week at the annual meeting of the European Society of Human Reproduction and Embryology in Istanbul.

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