LONDON – Long-standing depression may influence women’s ability to conceive, data from a large, population-based, Swedish cohort study suggest.
A significantly longer time to pregnancy was seen in women with a first diagnosis of depression occurring 6 years or more previously, with a crude odds ratio (OR) of 2.03 and an adjusted OR of 1.25.
Sara Freeman/IMNG Medical Media
Dr. Carolyn Cesta
"This study suggests that long-term psychological distress may lead to longer time to first pregnancy," said Carolyn Cesta, a doctoral student at the Karolinska Institute in Stockholm, where the study was performed.
The study also found that difficulty conceiving was higher in these women with long-term depression who were not treated with selective serotonin reuptake inhibitors (SSRIs), with an adjusted OR of 1.44 versus 1.37 for SSRI use.
"The effects of antidepressant treatment on fertility should be further investigated," Ms. Cesta suggested when presenting the findings at the annual meeting of the European Society of Human Reproduction and Embryology.
There are data to suggest that women with a history of depression are almost twice as likely as are those without it to report decreased fertility, but the data are conflicting. The main objective of the study presented was to investigate the controversial issue further: specifically, to look at whether psychological distress – measured as a diagnosis of depression, anxiety, or both – could predict women’s difficulties to conceive.
"Women during their childbearing years are at their greatest lifetime risk for being diagnosed with depression and anxiety," Ms. Cesta observed, "so it becomes important to know the impact of these conditions on fertility.
All together, data on 1,147,655 women who had delivered live-born infants between 1983 and 2009 were analyzed. These women were identified from several national Swedish registers: the medical birth register (1983-2009), the National Patient Register (1964-2009), the Total Population Register, and the Prescription Drug Register (2005-2009).
Women were then divided by the presence or absence of depression or anxiety reported at their first prenatal visit. There were 1,130,285 women with no such diagnoses, 7,322 with a diagnosis of depression, 7,551 with anxiety, and 2,497 with both disorders.
Involuntary childlessness, defined as the desire to conceive a child but difficulty doing so for 1 year or more, was reported by 6.7% of the overall population, with higher rates observed in women with depression (7.7%), anxiety (7.7%), or both (7.5%) than in women with no depression or anxiety (6.7%).
"We saw that there was no association between having a diagnosis of depression and/or anxiety and involuntary childlessness for more than 1 year when we compared them to women with no diagnosis," Ms. Cesta said.
Adjusted OR for a diagnosis of depression less than1.5 years, 1.5-3 years, and 3-6 years before pregnancy were 0.81, 0.92, and 1.06, respectively.
"The only significant association was seen where women diagnosed with depression had been diagnosed 6 years prior to pregnancy," Ms. Cesta said. They "had a significantly higher risk of involuntary childlessness." She noted that depression had been diagnosed before becoming pregnant in 91% of women.
Data on SSRI use in the women with depression for 6 or more years was available from 2005 onward, so this might have limited the analysis because of small patient numbers for inclusion in the analysis.
"This was a large, register-based cohort study of over 1 million women for which we have data for a large number of known confounders and the association between fertility and depression," Ms Cesta reported.
One of the main limitations, however, was that the study population includes women who have had at least one child already and not those who are perhaps infertile and remain childless.
The study was funded by the Swedish Research Council, the European Union Seventh Framework Program, and the Karolinska Institute. Ms. Cesta had no conflicts of interest to disclose.