Medically assisted reproduction and mental health: a 24-year longitudinal analysis using Finnish register data

Is having children associated with higher partnership stability? A novel perspective on childbearing and involuntary childlessness after medically assisted reproduction

“…We also had access to data on children conceived through MAR from 2004 onwards from the Birth Register. For a detailed description of the algorithm used to identify MAR treatments based on Finnish register data, see Goisis et al (2023). We excluded a small group of women who separated from their partner within three months after discontinuing unsuccessful MAR treatments to be able to assess how the couples adjusted to childlessness, and to exclude cases in which the treatments may have been discontinued due to partnership breakdown (n=318; <2% of all women who started MAR treatments).…”

“…Infertility and the medical procedures associated with MAR can also negatively affect a couple's sexual relationship (Luk and Loke 2015;Starc et al 2019;Wischmann 2010). Over the longer term, infertility and repeated MAR treatments can lead to fatigue and a decrease in partnership satisfaction (Berg and Wilson 1991;Goisis et al 2023;Guerra et al 1998;Repokari et al 2007;); although in some cases infertility can bring the partners closer and strengthen their relationship (Leiblum et al 1998;Peterson et al 2011;Schmidt et al 2005;Sydsjö et al 2002;. MAR treatments could also have an indirect effect on partnership stability by impacting other areas of the partners' lives in ways that are known to increase separation risk.…”

“…Finally, we controlled for mental health, as previous studies have found that underlying mental health difficulties in a couple are negatively associated with partnership stability (e.g., Metsä-Simola et al 2018). From previous research, we also know that compared to women who conceived naturally, the use of psychotropic medication is higher among women who underwent MAR up to 10 years before conception or the last treatment (Goisis et al 2023). To account for selection into MAR by mental health characteristics that could confound the association with partnership stability, we included measures of a couple's mental health up to 10 years prior to conception or the start of MAR treatments.…”

“…At the same time, while the couples with strong fertility intentions might have been more likely to continue treatments for a longer period of time, they may have found it harder to adjust to involuntary childlessness, which could have increased their risk of separation over the longer term. Indeed, previous studies have found that undergoing infertility treatments that were not successful can have long-lasting negative consequences for couples' mental health, sexual life, and relationship satisfaction (Bagade et al 2022;Goisis et al 2023;Klemetti et al 2010;Lechner et al 2007;Verhaak et al 2007;Wirtberg et al 2007), which could increase their risk of separation over the longer term.…”

“…While this could reflect higher commitment levels among couples who conceived through MAR rather than naturally, it is also possible that the increase in life satisfaction and happiness associated with the transition to parenthood had a strong protective effect against the stress related to infertility treatments. Indeed, previous research has shown that couples who conceived through MAR were likely to overcome the mental health and wellbeing consequences of infertility-and MAR-related stress after the transition to parenthood (Goisis et al, 2023;Tosi and Goisis 2021;Verhaak et al 2007). Overall, this finding represents an important contribution to the discussion about the differences between couples who conceived through MAR and couples who conceived naturally.…”