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Depression and anxiety, but not necessarily the use of antidepressant medication, are associated with a lower rate of pregnancy and successful births after in vitro fertilization. This discovery is the result of a large-scale registry study conducted by the Karolinska Institute in Sweden. The results published in the scientific journal Fertility & Sterility may be of great interest for doctors treating infertility and as well as for women with depression or anxiety who are planning to undergo a fertility treatment.

During the last decades, treatments with antidepressants have increased both in the population in general and among women of reproductive age. In particular, the use of selective serotonin reuptake inhibitors, SSRIs, has increased. However, little has been known about the effect of antidepressants on fertility and the ability to conceive.

This new study, which included more than 23,000 women, is the largest so far in evaluating the association between depression, anxiety and antidepressants with the result of in vitro fertilization. The researchers used anonymous data on all in vitro fertilization procedures performed in Sweden since 2007, extracted from the Swedish Quality Register of Assisted Reproduction. These data were added to information on depression, anxiety and on antidepressant prescriptions provided by the Swedish Patient and Prescribed Drug Registers.

Of all the women in the study, 4.4 percent presented a diagnosis of depression or anxiety in the two years before the beginning of their cycle of in vitro fertilization, or of taking antidepressants in the six months before the start of the cycle. Researchers compared the rates of pregnancy, of births and of miscarriages of these women to the rates of women without diagnosis or use of antidepressants.

“We found out that women undergoing their first in vitro fertilization treatment, who had either been diagnosed with depression or anxiety or had taken an antidepressant, had lower pregnancy rates and successful births compared to women who did not suffer of these conditions or did not take antidepressants before starting their fertility treatment, “said the study’s lead author, Carolyn Cesta, a doctoral student in the Department of Medical Epidemiology and Biostatistics. “It is important to note that we found that women with a diagnosis of depression or anxiety without a prescription of antidepressants had an even lower probability of becoming pregnant or giving birth.”

SSRIs are the most common type of antidepressant prescribed in Sweden. In the large group of women in the current study who take SSRIs, there was no difference in the rate of successful pregnancies or births after in vitro fertilization treatment. However, a small group of women taking different SSRI antidepressants, who present more complex cases of depression and anxiety, had reduced chances of successful pregnancies and births, as well as being at increased risk of miscarriage after their IVF treatment.

“Overall, these results indicate that diagnoses of depression and anxiety may be the underlying factor that leads to lower rates of pregnancy and successful births for these women,” concludes the study’s principal investigator Anastasia Nyman Iliadou, an associate professor at the Department of Medical Epidemiology and Biostatistics.

However, it needs to be noted that since the study was not randomized, the results could also be explained by unmeasured factors of lifestyle, as well as by genetic factors associated with depression and anxiety.