Depression and Anxiety Outcomes Associated with Failed Assisted Reproductive Technologies: A Systematic Review and Meta-Analysis

Abstract

ObjectiveOur study examined the psychological outcomes associated with failed ART treatment outcomes in men and women.Search StrategyA systematic search for studies published between January 1980 and August 2015 was performed across seven electronic databases.Inclusion CriteriaStudies were included if they contained data on psychosocial outcomes taken pre and post ART treatment.Data Extraction and SynthesisA standardised form was used to extract data and was verified by two independent reviewers. Studies were meta-analysed to determine the association of depression and anxiety with ART treatment outcomes. Narrative synthesis identified factors to explain variations in the size and directions of effects and relationships explored within and between the studies.Main ResultsBoth depression and anxiety increased after a ART treatment failure with an overall pooled standardised mean difference (SMD) of 0.41 (95% CI: 0.27, 0.55) for depression and 0.21 (95% CI: 0.13, 0.29) for anxiety. In contrast, depression decreased after a successful treatment, SMD of -0.24 (95% CI: -0.37,-0.11). Both depression and anxiety decreased as time passed from ART procedure. Nonetheless, these remained higher than baseline measures in the group with the failed outcome even six months after the procedure. Studies included in the narrative synthesis also confirmed an association with negative psychological outcomes in relation to marital satisfaction and general well-being following treatment failure.ConclusionLinking ART failure and psychosocial outcomes may elucidate the experience of treatment subgroups, influence deliberations around recommendations for resource allocation and health policy and guide patient and clinician decision making.

The prevalence of anxiety symptoms in infertile women: a systematic review and meta-analysis

“…Females who are unable to conceive perceive their social security to be at risk and become anxious because they foresee a future with no child to take care of them in old age or in case of illness [47]. Note, however, that certain studies revealed no significant difference in anxiety levels between women undergoing reproductive health treatments and control groups, but such works inadequately elaborated on infertility-related factors (female and male determinants separately, both factors, unknown factors) [12,48,49]. The anxiety prevalence rate found in the present study (i.e., 36.17%) is also greater than the prevalence rate found among infertile men.…”

Depression and state anxiety scores during assisted reproductive treatment are associated with outcome: a meta-analysis

“…Further, only a small number of studies included first-time ART patients (n = 5), with all the others including a mix of first-time ART patients and patients who have had previous unsuccessful treatment. This is a shortcoming because rates of depression and anxiety are known to increase after ART treatment failure (Milazzo et al, 2016).…”

“…However, it is estimated that only a quarter of women will get pregnant after a single ART cycle in the UK (Kushnir et al, 2017), so most couples will experience negative pregnancy results and repeat treatment. A recent meta-analysis found that rates of depression and anxiety increased after ART treatment failure, but depression decreased after successful treatment (Milazzo et al, 2016). Another recent meta-analysis also found no increased risk of depressive symptoms in women after they conceived using fertility treatment compared with those with spontaneous pregnancies (Gressier et al, 2015).…”

Mental Disorders and Female Infertility

“…A meta-analysis shows that assisted reproductive technology failure is associated with increased depression and anxiety. Correspondingly, depression decreased with successful treatment (Milazzo et al, 2016).…”