Can Infertility Lead to Mental Illness?
Infertility comes in two basic forms, known as primary infertility and secondary infertility. Doctors typically issue a primary infertility diagnosis when a couple unsuccessfully attempts to conceive a child during a minimum of one full year of unprotected intercourse. They issue a secondary infertility diagnosis when a couple conceives a child once but is unsuccessful during further attempts at conception.
The US National Library of Medicine lists known reasons for female infertility that include a fertilized egg’s inability to survive inside the uterus, inability of an unfertilized egg to reach the uterus, lack of normal egg production in the ovaries, and the effects of health problems such as diabetes, excessive substance use, advancing age, ovarian cysts, pelvic inflammation, after effects of sexually transmitted infection, thyroid disease, and cancer or cancer treatment. Known reasons for male infertility include a low sperm count, lack of proper sperm release from the testes, improperly functioning sperm, and health problems such as impotence, excessive substance use, hormonal imbalances, advancing age, pollutant exposure, prolonged heat exposure, smoking, cancer or cancer treatment, and an ejaculation disorder called retrograde ejaculation.
Generally speaking, women develop stronger negative psychological reactions to infertility than men, the Massachusetts General Hospital Center for Women’s Mental Health reports. However, when men perceive themselves as the source of infertility, their emotional reactions commonly reach the same intensity as the reactions found in women. Specific psychological states associated with infertility include anxiety, depression, anger, loss of self-identity, lowered self-esteem, and feelings of incompetence or inadequacy. When compared to couples without fertility problems, infertile couples exhibit symptoms associated with major depression significantly more frequently. Infertile couples also exhibit symptoms of medically serious anxiety significantly more frequently than their fertile counterparts. In many cases, infertility issues lead to additional concerns such as a breakdown in sexual communication within a relationship, larger-scale marital difficulties or isolation from the larger community.
As indicated previously, some researchers believe that preexisting psychological problems can reduce levels of male or female fertility. For example, the presence of clinical depression and stress may trigger such things as lowered output of a hormone required for normal ovulation or immune system changes that alter normal function in the male or female reproductive system. However, the overall evidence for psychological problems as a cause of infertility is fairly limited and/or inconclusive.
Risks for Diagnosable Mental Illness
In a 2012 presentation before the European Society of Human Reproduction and Embryology, a team of Danish researchers released the results of a long-term study that examined the ongoing mental status of more than 98,000 women who sought help or guidance from their doctors after receiving an infertility diagnosis. A study of this size was made possible by nationwide efforts in Denmark to track the data of people hospitalized for various reasons. Nearly 5,000 women who initially reported infertility problems remained childless throughout the course of the study, while roughly 50,000 eventually gave birth.
Compared to the women who conceived a child, the women with ongoing fertility problems were hospitalized with some form of mental illness roughly 20 percent more frequently. The specific diagnoses most commonly found among infertile women were obsessive-compulsive disorder, various anxiety disorders, a group of conditions known collectively as adjustment disorders, and some form of depressive disorder. Women with ongoing fertility problems also had significantly increased chances of developing schizophrenia or getting involved in some form of alcohol or drug abuse. Diagnosable eating disorders appeared with more or less equal frequency in childless women and women who conceived during the study. The authors of the study concluded that infertility can act as an important factor in the onset of mental illness when it continues after consultation with a doctor. They also concluded that doctors working with infertile women should stay alert for any potential signs of the onset of serious mental illness.