Effects of Male, Female Major Depression on Fertility Treatment Outcomes

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Among men, those with active major depression were less likely to have a partner achieve conception.
Among men, those with active major depression were less likely to have a partner achieve conception.

Research published in Fertility and Sterility suggests that currently active major depression in women does not negatively affect the outcome of non-in vitro fertilization fertility treatment. However, researchers did observe a relationship between maternal antidepressant use and first-trimester pregnancy loss, and that active major depression in men may lower the likelihood of conception.

Researchers extracted data from female and male partners currently participating in 1 of 2 randomized trials: PPCOS II (clomiphene citrate vs letrozole for polycystic ovary syndrome) and AMIGOS (gonadotropins vs clomiphene citrate vs letrozole for unexplained infertility). At enrollment in either trial, participants completed the Patient Health Questionnaire, which captured incidence of major depression in both partners and medication use in women. The primary trial outcome was live birth, with pregnancy or first trimester miscarriage classified as secondary outcomes.

Of all women participants (n=1650), 5.72% indicated current antidepressant medication use. Among women who were not using an antidepressant, the presence of active major depression was not associated with poorer fertility outcomes but, rather, with a slightly increased likelihood of pregnancy (relative risk [RR], 1.38; 95% CI, 1.07-1.78). As such, major depression was not associated with poorer outcomes in those undergoing fertility treatments. However, among women without active major depression, antidepressant use was associated with an increased likelihood for first trimester loss (RR, 1.87; 95% CI, 1.18-2.99). Among male study participants (n=1608), those with active major depression were less likely to have a partner achieve conception (RR, 0.44; 95% CI, 0.20-0.98).

As a secondary analysis of 2 existing trials, this study has its limitations, although the inclusion of 2 distinct study populations may make the results highly generalizable. These findings may be useful in identifying potential obstacles for couples undergoing non-in vitro fertilization fertility treatments and in titrating treatment options for couples with depression who are trying to conceive.

Reference

Evans-Hoeker EA, Eisenberg E, Diamond MP, et al. Major depression, antidepressant use, and male and female fertility. Fertil Steril. 2018;109(5):879-887.

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