Hospital mental health admissions in women after unsuccessful infertility treatment and in vitro fertilization: an Australian population-based cohort study.

Louise M Stewart,C D’Arcy J Holman,David Preen,Roger Hart,James B Semmens,Qun Mai

doi:10.1371/journal.pone.0120076

Louise M Stewart, C D’Arcy J Holman + Show 4 more

Open Access

https://doi.org/10.1371/journal.pone.0120076

Copy DOI

Abstract

ObjectiveTo examine the association between in vitro fertilization (IVF) and later admission to hospital with a mental health diagnosis in women who remained childless after infertility treatment.MethodsThis was a population-based cohort study using linked administrative hospital and registry data. The study population included all women commencing hospital treatment for infertility in Western Australia between the years 1982 and 2002 aged 20–44 years at treatment commencement who did not have a recorded birth by the end of follow-up (15 August 2010) and did not have a hospital mental health admission prior to the first infertility admission (n=6,567). Of these, 2,623 women had IVF and 3,944 did not. We used multivariate Cox regression modeling of mental health admissions and compared women undergoing IVF treatment with women having infertility treatment but not IVF.ResultsOver an average of 17 years of follow-up, 411 women in the cohort were admitted to hospital with a mental health diagnosis; 93 who had IVF and 318 who did not. The unadjusted hazard ratio (HR) for a hospital mental health admission comparing women who had IVF with those receiving other infertility treatment was 0.50 (95% confidence interval [CI] 0.40–0.63). After adjustment for age, calendar year and socio-economic status the HR was 0.56 (95% CI 0.44–0.71).ConclusionsIVF treatment is associated with a reduced risk of hospital mental health admissions in women after unsuccessful infertility treatment. This may be explained by the healthy cohort effect.

Highlights

A diagnosis of infertility in the absence of successful treatment, and the ultimate realisation for a woman that she will not be a mother to her own biological children is a potential cause of unresolved grief and psychiatric morbidity. [1,2,3,4,5,6,7]Feelings of depression and anxiety after unsuccessful in vitro fertilization (IVF) can result from a combination of the effects of IVF treatment: its invasive nature, altered levels of circulating hormones experienced and the attending uncertainty, as well as the state of involuntary infertility in which women find themselves
After adjustment for age, calendar year and socio-economic status the hazard ratio (HR) was 0.56
IVF treatment is associated with a reduced risk of hospital mental health admissions in women after unsuccessful infertility treatment

Summary

Introduction

A diagnosis of infertility in the absence of successful treatment, and the ultimate realisation for a woman that she will not be a mother to her own biological children is a potential cause of unresolved grief and psychiatric morbidity. [1,2,3,4,5,6,7]Feelings of depression and anxiety after unsuccessful in vitro fertilization (IVF) can result from a combination of the effects of IVF treatment: its invasive nature, altered levels of circulating hormones experienced and the attending uncertainty, as well as the state of involuntary infertility in which women find themselves. A number of studies [5,6,7,8] have compared levels of anxiety and depression in women after successful and unsuccessful IVF treatment. In this study we were interested in the association between IVF treatment and a mental health diagnosis separately from its association with IVF treatment outcome (successful or unsuccessful). Rather than comparing women who had unsuccessful IVF with women who had IVF and gave birth, we compared nulliparous women who had IVF with nulliparous women who had non-IVF infertility treatment In this way we were able to focus on the effects of IVF treatment, separately from the outcome of the treatment. The alternative possibility was that a woman who has endured the stress of IVF treatment and undertaken this as a last resort may feel she has done all she can to achieve her objective of having a child and this final resolution may allow her to move on and find satisfaction in other areas of her life

Methods

Results

Conclusion