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Study Highlights Importance of Infertility Support

by Leigh Ann Woodruff, July 5, 2012

There is no doubt that infertility poses a mental health risk for women, and many small studies have demonstrated a link between infertility and psychological distress such as anxiety, mood disorders and depressive symptoms. Now, a new large Danish study has found that women who never had children after infertility treatment are at an increased risk for hospitalization for psychological disorders such as depression or alcohol abuse. The study also raises questions and may encourage more sensitivity for couples who choose not to continue to pursue parenthood.

The Danish Study

The new study, which was presented at the European Society for Human Reproduction and Embryology (ESHRE) conference this week, was a nationwide follow-up of 98,737 Danish women who were evaluated for infertility between 1973 and 2008. In Denmark, all citizens have a personal identification number that can be used to track them through every medical database in the country. The women were cross-linked via Denmark's population-based registries to the Danish PsychiatricCentral, which provided information on hospitalization for psychiatric disorders, including an inclusive group of "all mental disorders," and sub groups:

  • alcohol and intoxicant abuse
  • schizophrenia and psychoses
  • affective disorders including depression
  • anxiety, adjustment and obsessive compulsive disorder
  • eating disorders
  • other mental disorders

The researchers found that over an average follow-up time of 12.6 years, 54 percent of the women did have a baby, and approximately 5,000 of the 98,737 women were hospitalized for a psychiatric disorder. The most common discharge diagnosis was "anxiety, adjustment and obsessive compulsive disorders" followed by "affective disorders including depression." However, the women who remained childless after their initial fertility investigation had an 18 percent higher risk of hospitalization for all mental disorders than the women who went on to have a baby. In particular, the risk was great for:

  • alcohol abuse (103 percent greater risk)
  • schizophrenia (47 percent greater risk)
  • other mental disorders (43 percent)
  • eating disorders (47 percent)

The most commonly seen discharge diagnosis in the entire group — anxiety, adjustment and obsessive compulsive disorders — was not affected by fertility status.

Phyllis Martin, M.Ed., LPC, an infertility counselor in Fairfax, Virginia, says the eating, drinking, anxiety and depressive disorders make sense for women who may not have moved on from their initial dream of creating a family. However, the same cannot be said for the greater risk of schizophrenia. "I don't understand those findings and would very much wonder two things," she says. "One, are people with schizophrenia more apt to suffer from infertility compared to the greater population, and, two, was this undiagnosed at the time of infertility treatment or not? Schizophrenia tends to show itself in full force in late teens/early adulthood. Schizophrenia tends ot have precursors, and those that end up with it have parents and family saying they knew 'all along' that something was 'off' with their loved one — often from childhood. Social oddities, flatness of affect, distortion of reality. Usually a full-blown episode will first be seen when a person goes off to college of the military, not in their 30s or 40s, so the last question is, three, the age of these women that ended up with the diagnosis?"

Positive Mental Health with Infertility

There are ways to maintain good mental health and come to a positive resolution about childree living or taking another step, according to Martin.

"I think there is a big difference in passively making this choice vs. consciously making this decision [to remain childfree]," Martin explains. "Passively means you never really own the decision. You may [assign] blame — 'nothing worked, we ran out of money, my spouse didn't want to do anything else, I'm a failure, I can't do it'— [or have a] healthy perception, such as 'we dedicated all we felt we could, financially, emotionally, etc., and have decided to stop our treatment, our choices, our pursuit of parenthood.'"

Even if an external factor is the reason you do not end of up with a child, Martin says there is a need to own the choice to stop your pursuit of family-building. "If a couple just sort of gets to the end of their treatments, doesn't consider anything else such as adoption or third-party pregnancy, they very well may be making a passive choice that later they will regret," Martin says.

To maintain a positive mental outlook during infertility treatment and afterward, Martin suggests:

  • Have clarity about what you will and will not do, what you can and cannot do and how you and your partner see these crossroads. If you see them as a personal failure, you are more likely to have regret and a diminished sense of self, continued envy at parents and stay stuck in your grief, which can lead to both mental and physical illness. If you understand that you did all you are able and/or willing to do, that you worked very hard for a goal and that you are able to say you tried your best, but it is time to move on, you are less likely to blame yourself and more likely to begin the grieving process for the life you assumed you would have when you began pursuing parenthood.
  • Understand that this decision is one that requires grieving. You will be surprised that after all of your work you are not where you wanted to be, as well as angry, sad and shocked. Eventually, however, you will gain an understanding that you worked very hard, that you did your best and that your life can be shaped into something that brings you joy and satisfaction, even if it isn't they way you anticipated.
  • Re-think your life. It is time to think out of the box. If you chose a house in a neighborhood for a back yard to play in for kids, perhaps you need to consider how you want to live if you do not have kids. "Perhaps a small place in the city is more your speed," Martin says. "Perhaps a career change will be in order. Perhaps getting involved with a cause and sharing of yourself will bring healing and your next step. Any time we reach out and help others, we lessen our focus on self — in doing this, we give our minds a break from a mental barrage of negative thoughts and depression."

The Danish study may add an important component to the counseling aspect for experiencing and being treated for infertility. "I think it can assist mental health practitioners by creating awareness that as people come to the end of their parenthood choices, they must celebrate their effort and strength," Martin says. "Remind them that everything we want we do not get, but that trying for it is critical in moving to another step in life."

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