A prospective study of depression and anxiety among fertility preservation and IVF patients

Abstract

Limited research has examined the emotional experiences of patients undergoing fertility preservation. We prospectively studied anxiety, depression, coping, cognitive appraisal, and treatment expectations of women who underwent fertility preservation (FP) and compared them to a sample of women undergoing IVF. Prospective pre- and post-treatment survey. 40 patients (19-39y; x- = 31.9y) with cancer and 80 age-matched IVF controls (26-36; x- = 31.4y) who underwent fertility preservation or IVF were given a pre and post-treatment survey including demographics, depression (CES-D), anxiety (STAI), Ways of Coping (WOC), infertility–related stress (FPI), appraisal of treatment (ALE), and treatment expectations. FP patients reported greater state (p = .001) and trait (p = .02) anxiety than IVF patients, but IVF patients’ anxiety worsened over time (p < .05). 37% of FP and 11% of IVF patients’ scores exceeded the clinical cut-off for depression on the CES-D at pre-treatment (p < .001). IVF patients were more optimistic about treatment, despite experiencing more loss related to infertility than FP patients (p <. 05). 44% of FP and 18% of IVF women thought they had > 60% chance of pregnancy despite being given lower case specific pregnancy rates. Coping strategies and infertility-related stress did not differ between groups. Insurance covered most treatment expenses for 69% of IVF patients and 38% of FP patients (p <.01). FP patients reported more anxiety and depression than IVF patients with more than one third of FP patients reporting clinically significant depressive symptoms. In contrast to FP patients, IVF patients’ anxiety increased across treatment. A substantial subset of FP patients reported unrealistic treatment expectations. Fertility preservation and IVF patients should be provided psychological consultation prior to treatment to address mood and anxiety symptoms as well as potentially unrealistic treatment expectations.