Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-25T23:14:16.100Z Has data issue: false hasContentIssue false

Chapter 7 - “It’s Complicated”: The Intersect Between Psychiatric Disorders and Infertility

from II - Therapeutic Approaches

Published online by Cambridge University Press:  24 November 2022

By
Katherine Williams  and
Lauri Pasch
Edited by
Sharon N. Covington
Sharon N. Covington
Affiliation:
Shady Grove Fertility, Rockville, MD
Get access

Summary

The experience of Infertility is extremely stressful for all people.The goals of this chapter are to provide the mental health practitioner with an understanding of the relationship between infertility in men and women and psychiatric illnesses. Patients with a history of major depression are at an increased risk of recurrence of major depression during infertility evaluation and treatment, and women who have had recurrent miscarriages are especially high risk for depression. Some patients will need to continue their antidepressants during the infertility process and pregnancy, and in this chapter we will discuss the risks and benefits associated with antidepressants in this population. Research on the interaction of the infertility medications and bipolar disorder destabilization is lacking, but it is important for the mental health practitioner to recognize that the dramatic hormonal changes associated with ovarian stimulation may lead to increased lability, especially if the medications have the side effect of insomnia. While some mood stabilizers such as lamotrigine are considered relatively safe to take in pregnancy, others, such as valproic acid are associated with congenital abnormalities and should be discontinued. Personality disorder patients may also react to the stress of infertility treatment with primitive defenses that are difficult for the infertility treatment team to manage, such as acting out and splitting. In this chapter, we will discuss the intersection of personality disorders and psychiatry and we will also provide guidance about when to recommend that patients defer or stop infertility treatment due to psychiatric illnesses.

Keywords

major depressionborderline personality disorderclomiphene citratehuman menopausal gonadotropinsprogesteronegonadotropin releasing agonists and antagonistsbipolar disorderantidepressantsmood stabilizersdiscontinuation of treatment
Type
Chapter
Information
Fertility Counseling: Clinical Guide , pp. 79 - 87
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Holley, SR, Pasch, LA, Blei, ME, Gregorich, S, Katz, PK, Adler, NE. Prevalence and predictors of major depressive disorder for fertility treatment patients and their partners. Fertil Steril 2015;103(5):1332–1339.CrossRefGoogle ScholarPubMed
Klock, SC, Chang, G, Hiley, A, Hill, J. Psychological distress among women with recurrent spontaneous abortion. Psychosomatics 1997;38(5):503–507.CrossRefGoogle ScholarPubMed
Chen, LC, Hsu, JW, Huang, KL, et al. Risk of developing major depression and anxiety disorders among women with endometriosis: a longitudinal follow-up study. J Affect Disord 2016;190:282–285.Google Scholar
Cooney, LG, Lee, I, Sammel, MD, Dokras, A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod 2017;32(5):1075–1091.CrossRefGoogle ScholarPubMed
Skakkebæk, A, Moore, PJ, Pedersen, AD, et al. Anxiety and depression in Klinefelter syndrome: the impact of personality and social engagement. PloS One 2018;13(11):53247532.Google Scholar
Chen, TH, Chang, SP, Tsai, CF, et al. Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Hum Reprod 2004;19(10):2313–2318.CrossRefGoogle Scholar
Pasch, LA, Holley, SR, Bleil, ME, Shehab, D, Katz, P, Adler, NE. Addressing the needs of fertility treatment patients and their partners: are they informed of and do they receive mental health services? Fertil Steril 2016;106(1):209–215 e2.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Crawford, NM, Hoff, HS, Mersereau, JE. Infertile women who screen positive for depression are less likely to initiate fertility treatments. Hum Reprod 2017;32(3):582–587.Google Scholar
Pedro, J, Sobral, MP, Mesquita-Guimarães, J. Couples’ discontinuation of fertility treatments: a longitudinal study on demographic, biomedical, and psychosocial risk factors. J Assist Reprod Genet 2017;34(2):217–224.CrossRefGoogle ScholarPubMed
Williams, K, Reynolds, MF. Sexual dysfunction in major depression. CNS Spectr 2006;11(8 Suppl. 9):19–23.CrossRefGoogle ScholarPubMed
Yland, JJ, Eisenberg, ML, Hatch, EE, et al. North, A American prospective study of depression, psychotropic medication use, and semen quality. Fertil Steril 2021;116(3):833–842.CrossRefGoogle ScholarPubMed
Evans-Hoeker, EA, Eisenberg, E, Diamond, MP, et al. Reproductive Medicine Network. Major depression, antidepressant use, and male and female fertility. Fertil Steril 2018;109(5):879–887.Google Scholar
Payne, JL. Psychopharmacology in pregnancy and breastfeeding. Med Clin North Am 2019;103(4):629–650.Google Scholar
Molitch, ME. Medication-induced hyperprolactinemia. Mayo Clin Proc 2005;80(8):1050–1057.CrossRefGoogle ScholarPubMed
Akioyamen, LE, Holloway, AC, Taylor, V, et al. Effects of depression pharmacotherapy in fertility treatment on conception, birth, and neonatal health: a systematic review. J Psychosom Res 2016;84:69–80.Google Scholar
Broy, P, Bérard, A. Gestational exposure to antidepressants and the risk of spontaneous abortion: a review. Curr Drug Deliv 2010;7(1):76–92.CrossRefGoogle ScholarPubMed
Beeder, LA, Samplaski, MK. Effect of antidepressant medications on semen parameters and male fertility. Int J Urol 2020;27(1):39–46.Google Scholar
Huybrechts, KF, Bateman, BT, Palmsten, K, et al. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA 2015;313:2142–2151.CrossRefGoogle ScholarPubMed
Bandoli, G, Chambers, C, Wells, A, Palmsten, K. Prenatal antidepressant use and risk of adverse neonatal outcomes. Pediatrics 2020;146(1):e20192493;Google Scholar
Levinson-Castiel, R, Merlob, P, Linder, N, et al. Neonatal abstinence syndrome after in utero exposure to selective serotonin reuptake inhibitors in term infants. Arch Pediatr Adolesc Med 2006;160:173–176.CrossRefGoogle ScholarPubMed
Sørensen, MJ, Grønborg, TK, Christensen, J, et al. Antidepressant exposure in pregnancy and risk of autism spectrum disorders. Clin Epidemiol 2013;5:449–459.Google Scholar
Yonkers, KA, Gotman, N, Smith, MV, et al. Does antidepressant use attenuate the risk of a major depressive episode in pregnancy? Epidemiology 2011;22(6):848–854.CrossRefGoogle Scholar
Field, T. Prenatal depression risk factors, developmental effects and interventions: a review. J Pregnancy Child Health 2017;4(1):301.Google Scholar
Szegda, K, Markenson, G, Bertone-Johnson, ER, Chasan-Taber, L. Depression during pregnancy: a risk factor for adverse neonatal outcomes? A critical review of the literature. J Matern Fetal Neonatal Med 2014;27(9):960–967.Google Scholar
Parial, S. Bipolar disorder in women. Indian J Psychiatry 2015;57(Suppl.2):S252–S263.CrossRefGoogle ScholarPubMed
Raffi, ER, Nonacs, R, Cohen, LS. Safety of psychotropic medications during pregnancy. Clin Perinatal 2019;46:215–234.Google Scholar
Khan, SJ, Fersh, ME, Ernst, C, Klipstein, K, Albertini, ES, Lusskin, SI. Bipolar disorder in pregnancy and postpartum: principles of management. Curr Psychiatry Rep 2016;8(2):13.CrossRefGoogle Scholar
Viguera, AC, Nonacs, R, Cohen, LS, Tondo, L, Murray, A, Baldessarini, RJ. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatry 2000;157(2):179–184.CrossRefGoogle ScholarPubMed
Fornaro, M, Maritan, E, Ferranti, R, et al. Lithium exposure during pregnancy and the postpartum period: a systematic review and meta-analysis of safety and efficacy outcomes. Am J Psychiatry 2020;177(1):76–92.CrossRefGoogle ScholarPubMed
Patorno, E, Huybrechts, KF, Bateman, BT, et al. Lithium use in pregnancy and the risk of cardiac malformations. N Engl J Med 2017;376(23):2245–2254.CrossRefGoogle ScholarPubMed
Khan, SJ, Fersh, ME, Ernst, C, Klipstein, K, Albertini, ES, Lusskin, SI. Bipolar disorder in pregnancy and postpartum: principles of management. Curr Psychiatry Rep 2016;18(2):13.CrossRefGoogle ScholarPubMed
Cohen, LS. Reproductive safety of second-generation antipsychotics: updated data from the Massachusetts General Hospital National Pregnancy Registry for Atypical Antipsychotics. J Clin Psychiatry 2021;82(4):20m13745.Google Scholar
Park, Y, Hernandez-Diaz, S, Bateman, BT, et al. Continuation of atypical antipsychotic medication during early pregnancy and the risk of gestational diabetes. Am J Psychiatry 2018;175(6):564–574.Google Scholar
Paris, J. A Concise Guide to Personality Disorders. Washington, DC: American Psychological Association, 2015.CrossRefGoogle Scholar
Koerner, K, Linehan, MM. Research on dialectical behavior therapy for patients with borderline personality disorder. Psychiatr Clin North Am 2000;23(1):151–167.Google Scholar
Dubovsky, AN, Kiefer, M. Borderline personality disorder in the primary care setting. Med Clin North Am 2014;98(5):1049–1064.CrossRefGoogle ScholarPubMed
Robakis, T, Williams, KE, Nutkiewicz, L, Rasgon, NL. Hormonal contraceptives and mood: review of the literature and implications for future research. Curr Psychiatry Rep 2019;21(7):57.Google Scholar
Gonzalez-Rodriguez, A, Cobo, J, Soria, V, et al. Women undergoing hormonal treatments for infertility: a systematic review on psychopathology and newly diagnosed mood and psychotic disorders. Front Psychiatry 2020;11:479.Google Scholar
Warnock, JK, Bundren, JC, Morris, DW. Sertraline in the treatment of depression associated with gonadotropin-releasing hormone agonist therapy. Biol Psychiatry 1998;43(6):464–465.Google Scholar
Choi, SH, Shapiro, H, Robinson, GE et al. Psychological side-effects of clomiphene citrate and human menopausal gonadotrophin. J Psychosom Obstet Gynaecol 2005;26(2):93–100.Google Scholar
Roth, LW, Ryan, AR, Meacham, RB. Clomiphene citrate in the management of male infertility. Semin Reprod Med 2013;31(4):245–250.CrossRefGoogle ScholarPubMed
Sinha, GA. Could clomiphene kindle acute manic episode in a male patient? A case report. Gen Hosp Psychiatry 2014;36(5):549.e5–6.CrossRefGoogle Scholar
Rosenfeld, CS, Shay, DA, Vieira-Potter, VJ. Cognitive effects of aromatase and possible role in memory disorders. Front Endocrinol 2018 (online). https://doi.org/10.3389/fendo.2018.00610Google Scholar
Bloch, M, Azem, F, Aharonov, I, et al. GnRH-agonist induced depressive and anxiety symptoms during in vitro fertilization-embryo transfer cycles. Fertil Steril 2011;95:307–309.CrossRefGoogle ScholarPubMed
Zaig, I, Azem, F, Schreiber, S, Amit, A, Litvin, YG, Bloch, M. Psychological response and cortisol reactivity to in vitro fertilization treatment in women with a lifetime anxiety or unipolar mood disorder diagnosis. J Clin Psychiatry 2013;74(4):386–392.Google Scholar
Skovlund, CW, Morch, LS, Kessing, LV. Association of hormonal contraception with depression. JAMA Psych 2016;73(11):1154–1162.Google Scholar
STOUDEMIRE, A, THOMPSON TL. The borderline personality in the medical setting. Annals of Internal Medicine. 1982 Jan 1;96(1):76–9.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×