Systematic Review: Risk Factors of Anxiety, Depressiveness, and (Lack of) Social Support in Women and Men Prior to Assisted Reproduction

Abstract

This review provides a systematic overview of the state of knowledge to date of psychosocial risk factors with a focus on anxiety, depressiveness, and (lack of) social support among involuntarily childless women and men prior to assisted reproduction. The databases PubMed, PubPsych, PsycINFO-Ebsco, and Web of Science were searched for relevant publications in English or German, and finally a total of 20 publications were included in the systematic review. Of these, 18 studies focused on depressiveness, 15 studies focused on anxiety, and 9 studies focused on social support. Half of the studies included both men and women, while the other half included only women. Due to the large heterogeneity of the study results as well as limitations, no clear conclusions can be drawn regarding a difference between the risk profiles of men and women with an unfulfilled desire to have children. However, it has been shown that infertile couples or women experience higher levels of stress in the form of depressiveness and anxiety compared to fertile participants. Furthermore, it was found that social support, regardless of gender difference, within the couple and from family and friends may be associated with a lower risk for depressiveness and anxiety.

Keywords

infertility - anxiety - depressiveness - social support - assisted reproductive technology (ART)

Publication History

Received: 31 May 2023

Accepted after revision: 19 August 2023

Article published online:
03 November 2023

• References/Literatur

• 1 Mascarenhas MN, Flaxman SR, Boerma T. et al. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med 2012; 9: e1001356 DOI: 10.1371/journal.pmed.1001356.
• 2 Boivin J, Bunting L, Collins JA. et al. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod 2007; 22: 1506-1512 DOI: 10.1093/humrep/dem046. (PMID: 17376819)
• 3 Xie Y, Ren Y, Niu C. et al. The impact of stigma on mental health and quality of life of infertile women: A systematic review. Front Psychol 2023; 13: 1093459 DOI: 10.3389/fpsyg.2022.1093459. (PMID: 36698573)
• 4 Luk BH, Loke AY. The Impact of Infertility on the Psychological Well-Being, Marital Relationships, Sexual Relationships, and Quality of Life of Couples: A Systematic Review. J Sex Marital Ther 2015; 41: 610-625 DOI: 10.1080/0092623X.2014.958789. (PMID: 25211377)
• 5 Chachamovich JR, Chachamovich E, Ezer H. et al. Investigating quality of life and health-related quality of life in infertility: a systematic review. J Psychosom Obstet Gynaecol 2010; 31: 101-110 DOI: 10.3109/0167482x.2010.481337. (PMID: 20443659)
• 6 Greil AL. Infertility and psychological distress: a critical review of the literature. Soc Sci Med 1997; 45: 1679-1704 DOI: 10.1016/s0277-9536(97)00102-0. (PMID: 9428088)
• 7 Greil AL, Slauson-Blevins K, McQuillan J. The experience of infertility: a review of recent literature. Sociol Health Illn 2010; 32: 140-162 DOI: 10.1111/j.1467-9566.2009.01213.x. (PMID: 20003036)
• 8 Wischmann T, Borkenhagen A, David M. et al. Psychosomatically Oriented Diagnostics and Therapy for Fertility Disorders. Guideline of the DGPFG (S2k-Level, AWMF Registry Number 016/003, December 2019). Geburtshilfe Frauenheilkd 2021; 81: 749-768 DOI: 10.1055/a-1341-9664. (PMID: 34276062)
• 9 Peterson BD, Sejbaek CS, Pirritano M. et al. Are severe depressive symptoms associated with infertility-related distress in individuals and their partners?. Hum Reprod 2014; 29: 76-82 DOI: 10.1093/humrep/det412. (PMID: 24256990)
• 10 Donarelli Z, Lo Coco G, Gullo S. et al. Are attachment dimensions associated with infertility-related stress in couples undergoing their first IVF treatment? A study on the individual and cross-partner effect. Hum Reprod 2012; 27: 3215-3225 DOI: 10.1093/humrep/des307. (PMID: 22926837)
• 11 Edelmann RJ, Connolly KJ. Gender differences in response to infertility and infertility investigations: Real or illusory. Br J Health Psychol 2000; 5: 365-375
• 12 Quinlivan J, Rowe H, Wischmann T. et al. Setting the global research agenda in psychosocial aspects of women’s health – outcomes from ISPOG world conference at The Hague. J Psychosom Obstet Gynaecol 2020; 41: 1-4 DOI: 10.1080/0167482X.2020.1695872. (PMID: 31805800)
• 13 Gameiro S, Boivin J, Dancet E. et al. ESHRE guideline: routine psychosocial care in infertility and medically assisted reproduction-a guide for fertility staff. Hum Reprod 2015; 30: 2476-2485 DOI: 10.1093/humrep/dev177. (PMID: 26345684)
• 14 Eskew AM, Jungheim ES. A History of Developments to Improve in vitro Fertilization. Mo Med 2017; 114: 156-159 (PMID: 30228571)
• 15 Quant HS, Zapantis A, Nihsen M. et al. Reproductive implications of psychological distress for couples undergoing IVF. J Assist Reprod Genet 2013; 30: 1451-1458 DOI: 10.1007/s10815-013-0098-7. (PMID: 24043383)
• 16 Agostini F, Monti F, Paterlini M. et al. Effect of the previous reproductive outcomes in subfertile women after in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) treatments on perinatal anxious and depressive symptomatology. J Psychosom Obstet Gynaecol 2018; 39: 29-37 DOI: 10.1080/0167482x.2017.1286474. (PMID: 28635535)
• 17 Moura-Ramos M, Gameiro S, Canavarro MC. et al. Does infertility history affect the emotional adjustment of couples undergoing assisted reproduction? The mediating role of the importance of parenthood. Br J Health Psychol 2016; 21: 302-317 DOI: 10.1111/bjhp.12169.
• 18 von Elm E, Altman DG, Egger M. et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573-577 DOI: 10.7326/0003-4819-147-8-200710160-00010. (PMID: 25046131)
• 19 Aldemir S, Eser A, Ozturk Turhan N. et al. Relation of anxiety and depressive symptoms with perceived social support according to gender within infertile couples. Dusunen Adam 2015; 28: 328-336 DOI: 10.5350/DAJPN2015280404.
• 20 Al-Homaidan HT. Depression among Women with Primary Infertility attending an Infertility Clinic in Riyadh, Kingdom of Saudi Arabia: Rate, Severity, and Contributing Factors. Int J Health Sci (Qassim) 2011; 5: 108-115 (PMID: 23267288)
• 21 Alhassan A, Ziblim AR, Muntaka S. A survey on depression among infertile women in Ghana. BMC Womens Health 2014; 14: 42 DOI: 10.1186/1472-6874-14-42. (PMID: 24612693)
• 22 Baghiani Moghadam MH, Aminian AH, Abdoli AM. et al. Evaluation of the general health of the infertile couples. Iran J Reprod Med 2011; 9: 309-314 (PMID: 26396581)
• 23 Batool SS, de Visser RO. Psychosocial and contextual determinants of health among infertile women: a cross-cultural study. Psychol Health Med 2014; 19: 673-679 DOI: 10.1080/13548506.2014.880492. (PMID: 24479424)
• 24 Berg BJ, Wilson JF. Psychiatric morbidity in the infertile population: a reconceptualization. Fertil Steril 1990; 53: 654-661 (PMID: 2318324)
• 25 Connolly KJ, Edelmann RJ, Cooke ID. et al. The impact of infertility on psychological functioning. J Psychosom Res 1992; 36: 459-468 DOI: 10.1016/0022-3999(92)90006-n. (PMID: 1619585)
• 26 Dadhwal V, Choudhary V, Perumal V. et al. Depression, anxiety, quality of life and coping in women with infertility: A cross-sectional study from India. Int J Gynaecol Obstet 2022; 158: 671-678 DOI: 10.1002/ijgo.14084. (PMID: 34957556)
• 27 Giannouli V, Stoyanova S. Exploring emotional aspects of infertility in women from two countries. Psychiatriki 2018; 29: 34-41 DOI: 10.22365/jpsych.2018.291.34. (PMID: 29754118)
• 28 Karlidere T, Bozkurt A, Yetkin S. et al. [Is there gender difference in infertile couples with no axis one psychiatric disorder in context of emotional symptoms, social support and sexual function?]. Turk Psikiyatri Derg 2007; 18: 311-322 (PMID: 18066722)
• 29 Kiesswetter M, Marsoner H, Luehwink A. et al. Impairments in life satisfaction in infertility: Associations with perceived stress, affectivity, partnership quality, social support and the desire to have a child. Behav Med 2020; 46: 130-141 DOI: 10.1080/08964289.2018.1564897. (PMID: 30726170)
• 30 Mao J, Guo HP, Wang J. et al. Analysis of Related Factors of Coping Styles in Infertile Patients in Central China. Patient Prefer Adherence 2022; 16: 1605-1612 DOI: 10.2147/ppa.S364345. (PMID: 35812764)
• 31 Matsubayashi H, Hosaka T, Izumi S. et al. Emotional distress of infertile women in Japan. Hum Reprod 2001; 16: 966-969 DOI: 10.1093/humrep/16.5.966. (PMID: 11331646)
• 32 Matsubayashi H, Hosaka T, Izumi S. et al. Increased depression and anxiety in infertile Japanese women resulting from lack of husband’s support and feelings of stress. Gen Hosp Psychiatry 2004; 26: 398-404 DOI: 10.1016/j.genhosppsych.2004.05.002. (PMID: 15474640)
• 33 Noorbala AA, Ramezanzadeh F, Abedinia N. et al. Psychiatric disorders among infertile and fertile women. Soc Psychiatry Psychiatr Epidemiol 2009; 44: 587-591 DOI: 10.1007/s00127-008-0467-1. (PMID: 19023508)
• 34 Pinar G, Zeyneloglu HB. Quality of life, anxiety and depression in Turkish women prior to receiving assisted reproductive techniques. Int J Fertil Steril 2012; 6: 1-12 (PMID: 25505505)
• 35 Sadiq U, Rana F, Munir M. Marital Quality, Self-compassion and Psychological Distress in Women with Primary Infertility. Sex Disabil 2022; 40: 167-177 DOI: 10.1007/s11195-021-09708-w.
• 36 Shafierizi S, Faramarzi M, Esmaelzadeh S. et al. Does infertility develop posttraumatic growth or anxiety/depressive symptoms? Roles of personality traits, resilience, and social support. Perspect Psychiatr Care 2022; 58: 2017-2028 DOI: 10.1111/ppc.13023. (PMID: 34997934)
• 37 Vo TM, Tran QTT, Le CV. et al. Depression and associated factors among infertile women at Tu Du hospital, Vietnam: a cross-sectional study. Int J Womens Health 2019; 11: 343-351 DOI: 10.2147/ijwh.S205231. (PMID: 31239787)
• 38 Wischmann T, Stammer H, Scherg H. et al. Psychosocial characteristics of infertile couples: a study by the ‘Heidelberg Fertility Consultation Service’. Hum Reprod 2001; 16: 1753-1761 DOI: 10.1093/humrep/16.8.1753. (PMID: 11473978)
• 39 Karlidere T, Bozkurt A, Ozmenler KN. et al. The influence of emotional distress on the outcome of in-vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) treatment among infertile Turkish women. Isr J Psychiatry Relat Sci 2008; 45: 55-64 (PMID: 18587170)
• 40 Kiani Z, Simbar M, Hajian S. et al. The prevalence of depression symptoms among infertile women: a systematic review and meta-analysis. Fertil Res Pract 2021; 7: 6 DOI: 10.1186/s40738-021-00098-3. (PMID: 33663615)
• 41 UNDP. Human Development Report 2021/2022. New York: UNDP (United Nations Development Programme); 2022
• 42 Fisher JR, Hammarberg K. Psychological and social aspects of infertility in men: an overview of the evidence and implications for psychologically informed clinical care and future research. Asian J Androl 2012; 14: 121-129 DOI: 10.1038/aja.2011.72. (PMID: 22179515)
• 43 Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol 2007; 21: 293-308 DOI: 10.1016/j.bpobgyn.2006.12.003. (PMID: 17241818)
• 44 Thanscheidt CL, Pätsch P, Rösner S. et al. Psychological Aspects of Infertility – Results from an Actor–Partner Interdependence Analysis. Geburtshilfe Frauenheilkd 2023; 83: 843-849 DOI: 10.1055/a-2041-2831.