Cognitive behavioural therapy for women with infertility: A systematic review and meta-analysis

Women's reproductive mental health: currently available evidence and future directions for research, clinical practice and health policy

Sex and gender differences in the epidemiology of mental disorders are well documented. Less well understood are the drivers of these differences. Reproductive health represents one of the gendered determinants of mental health that may affect women throughout their life course. In this paper, we review common reproductive events that may be associated with mental ill health, including menstruation (with premenstrual dysphoric disorder appearing for the first time in recent classifications of mental disorders), contraception, abortion, sexual dysfunction, hypersexuality, sexual violence, reproductive coercion, infertility and associated gynaecological conditions, and menopause. Such reproductive events may differentially affect women globally via a range of potential biological and psychosocial mechanisms. These include, for example, vulnerability to the physiological changes in hormone levels across the menstrual cycle; side effects of treatment of mental disorders; inflammation underpinning endometriosis and polycystic ovarian syndrome as well as mental disorders such as depression; intersections with gender disadvantage manifesting, for example, as structural barriers in accessing menstrual products and sanitation, contraception and abortion, underscoring the broader social determinants impacting women's mental health. Greater understanding of these mechanisms is guiding the development of effective interventions, which are also reviewed here. However, key evidence gaps remain, partly as a result of the historic gender bias in mental health research, and the neglect of reproductive health in clinical practice. Furthermore, while several women's health strategies have recently been proposed internationally, they do not usually include a focus on mental health across the life course, particularly for women with severe mental illness. Integrating co-designed reproductive health interventions into primary and secondary mental health care settings, providing tailored care, increasing the evidence base on effective interventions, and empowering women to make informed choices about their reproductive health, could improve not only reproductive health but also women's mental health across the life course.

Di-2-ethylhexyl phthalate (DEHP) exposure increase female infertility

This study explores the relationship between Di-2-ethylhexyl phthalate (DEHP) exposure and female infertility. The analysis included 998 female participants aged between 18 and 44 years. We analyzed data from the National Health and Nutrition Examination Survey (2013-2018) using multiple logistic regression and generalized linear models to assess the impact of DEHP on infertility. Additionally, we employed curve fitting and two-piecewise linear regression models to investigate potential nonlinear correlations, conducting subgroup analyses based on age, BMI, alcohol consumption, smoking status, hypertension, and diabetes. Our results, after adjusting for confounders, revealed a positive association between DEHP exposure and infertility. This association was significant whether DEHP was treated as a continuous variable (odds ratio OR = 1.28, 95 % confidence interval CI: 1.08-1.52, P = 0.0072) or as a categorical variable (P for trend = 0.0038). A non-linear relationship was identified, with an inflection point at - 3.35 (∑DEHP = 0.0981 × 10-9 mol/mg creatinine). Effect sizes were 1.55 (1.01-2.36) on the left side of the inflection point and 0.73 (0.43-1.23) on the right side. Subgroup analysis indicated that the correlation was consistent across stratified variables. In conclusion, our findings suggest a non-linear association between DEHP exposure and female infertility, with a positive correlation within a specific dose range, but no further increase in risk beyond a certain threshold.

Effects of physical activity on infertility in reproductive females

OBJECTIVES

To explore the relationship between different types of physical activity and female infertility.

METHODS

This study analyzed data from 2,796 female participants aged 18-44 years in the United States, obtained from the National Health and Nutrition Examination Survey (NHANES) database spanning the years 2013 to 2020. Multiple logistic regression analyses and generalized linear models were used to explore the relationship between different types of physical activity and infertility after adjusting for potential confounding factors.

RESULTS

We found a non-linear relationship between recreational activities and infertility with an inflection point of 5.83 h/week (moderate intensity), while work activities and traffic-related activities did not. On the left side of the inflection point, there was no significant association between recreational activity time and infertility (OR = 0.93, 95% CI: 0.86 to 1.02, P = 0.1146), but on the right side of the inflection point, there was a positive association between recreational activity time and the risk of infertility (OR = 1.04, 95% CI: 1.02 to 1.06, P = 0.0008).

CONCLUSIONS

The relationship between different types of physical activity and female infertility varies. We acknowledge the potential influence of confounding variables on this relationship. However, we have already adjusted for these potential variables in our analysis. Therefore, our findings suggest that appropriate recreational activity programs are essential for promoting reproductive health in women of reproductive age. Nevertheless, it is important to note that the observed association does not imply causality. Given the limitations of cross-sectional studies, further prospective cohort studies are needed to explore the causal relationship while accounting for additional confounding factors.

Integrated Behavioral Health Care in Reproductive Medicine: How and Why to Include Mental Health Professionals in Infertility Care Teams

Despite fertility patients' reports of significant distress, few have access to integrated mental health care services. We elucidate the benefits and challenges of mental health integration in infertility practices from the perspective of both patients and providers. We outline specific models of integration, financial viability, and the first steps fertility clinics could take to improve their patients' access to these critical supports.