Depression Treatment During Infertility

It's common for women with infertility to also experience depression, even if for many the relationship is like “the chicken and the egg” – was the patient going through undiagnosed depression prior to running up against conception obstacles, or has the infertility journey, itself, triggered clinical depression? Which struggle started first is not the biggest question, though.

As a recent review of studies bears out, there are legitimate concerns about the use of certain types of antidepressants by pregnant women. The review, published last October in the journal Human Reproduction, concluded that there is no evidence of improved pregnancy outcomes with antidepressant usage and, in fact, the opposite is true. This related article on ScienceBlog describes “mounting evidence that SSRIs may decrease pregnancy rates” in women who used fertility treatment, and there's a link between antidepressant use and increased miscarriage rates.

Depression must be taken seriously, and not dismissed as “merely” infertility-related sadness. But the choice of depression treatment by women who are also going through fertility treatment should be handled with caution, on a very individualized basis. Just because a particular drug benefits one woman, that doesn't necessarily mean it will benefit all.

If you have ever been diagnosed with depression, or if you have a strong family history of depression, be sure to let your fertility care providers – as well as your primary care physician – know. An informed team approach is the best way to handle a dual diagnosis of infertility and depression.

~ Dr. Sonja Kristiansen M.D.

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Depression, Even Among Infertile, Should Never Be Shrugged Off

Speaking as a physician who has specialized for years in helping infertile men and women get pregnant, the high rate of depression among fertility patients is understandable. And for some patients, it's a little bit of a chicken-and-egg situation: Which came first, the struggles of infertility or the clinical depression? Whichever the case, something we do know is that treating your depression is crucial.

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A common question in my office: "Dr. Kristiansen, should I continue taking my depression medication while we're going through fertility treatment?"

My general answer: If it works, keep it up, but there are a few exceptions.

This is a really tough decision for most patients, because they've often done enough of their own research to be confused by the data, even from well-done scientific studies. You can find large-scale, carefully conducted research that says depression, itself, seems to decrease fertility, even with fertility treatment. You'll also see studies that say women who are using depression medication have higher rates of fertility treatment cycles canceled.

Men, too, may have something to worry about if they're trying to become a dad and need to treat their depression. A small 2009 study demonstrated that men using paroxetine (Paxil) had significantly higher rates of sperm DNA fragmentation, which can lower their fertile potential.

Until we know more about links between fertility and depression and depression medication, physicians and patients are instituting choices based on the more established data about impact during pregnancy. Here, fertility treatment provides an advantage over conceiving without fertility assistance. The benefit has to do with timing.

Women using fertility treatment virtually know the moment conception takes place. There are far fewer mysteries when you're inseminated or you've had embryos transferred. And since we know some depression medications when taken during pregnancy are closely linked to congenital defects, essentially scheduling conception allows the woman to make choices in advance. She may choose to stick with her current medication, or she may talk to her prescribing practitioner about using an alternative treatment.

I and my staff at Houston Fertility Center encourage our patients to speak frankly with the health care professional who prescribes their depression treatment. Tell them you are trying to get pregnant, even before you make the choice to use fertility treatment. In no case do I ever recommend that you simply avoid making a choice.

The hormonal fluctuations that every woman undergoes through both fertility treatment and pregnancy can have a tremendous impact on  your emotional well-being. If you already know you experience depression, or if you start to experience mood swings or emotional dullness that are worrisome, keep all of your health care providers in the loop. That way we can work together as a team for the benefit of you and your hoped-for baby.

~ Dr. Sonja Kristiansen M.D.