Psychiatric morbidity in couples attending a fertility service

Global prevalence of major depressive disorder, generalized anxiety, stress, and depression among infertile women: a systematic review and meta-analysis

BACKGROUND

In recent years, the global prevalence of infertility has increased among women (Talmor and Dunphy, Best Pract Res Clin Obstet Gynaecol 29(4):498-506, 2015) and is considered as a public health concern. One of the impacts of infertility is mental health problems in the patients, which can lead to complications such as stress, anxiety, and depression. The aim of this study is to investigate the global prevalence of major depressive disorder, general anxiety, stress, and depression in infertile women through a systematic review and meta-analysis.

METHODS

To identify studies that have reported the prevalence of major depressive disorder, generalized anxiety, stress, and depression in infertile women, the PubMed, Scopus, Web of Science, Embase, ScienceDirect, and Google Scholar repositories were systematically searched. Articles published up until February 2023 were included, while no lower time limit was imposed in the search strategy. Heterogeneity of studies was examined using the I2 test and, thus, random-effects model was used to perform the analysis. Data analysis was conducted within the Comprehensive Meta-Analysis (v.2) software.

RESULTS

In the review of 44 studies with a sample size of 53,300 infertile female patients, the overall prevalence of major depressive disorder (clinical depression), generalized anxiety, stress, and depression was found to be 22.9%, 13.3%, 78.8%, and 31.6% respectively. It was also found that mental health complications are more prevalent among infertile women in Asia (continent).

CONCLUSION

Considering the prevalence of mental disorders among infertile women, health policymakers can use the results of the present meta-analysis to pay more attention to the mental health of infertile women and devise suitable interventions and programs to reduce and prevent the spread of psychological disorders among infertile women.

The prevalence of adjustment disorder and predisposing factors in infertile women

BACKGROUND

Infertility is a stressful life event that increases the risk of developing mental disorders, particularly adjustment disorder (AD). Given the paucity of data on the prevalence of AD symptoms in infertility, the purpose of this study was to ascertain the prevalence, clinical presentation, and risk factors for AD symptoms in infertile women.

METHOD

In a cross-sectional study, 386 infertile women completed questionnaires including the Adjustment Disorder New Module-20 (ADNM), the Fertility Problem Inventory (FPI), the Coronavirus Anxiety Scale (CAS), and the Primary Care Posttraumatic Stress Disorder (PC-PTSD-5) at an infertility center between September 2020 and January 2022.

RESULT

The results indicated that 60.1% of infertile women exhibited AD symptoms (based on ADNM > 47.5). In terms of clinical presentation, impulsive behavior was more common. No significant relationship was observed between prevalence and women's age or duration of infertility. Infertility stress (β = 0.27, p < 0.001), coronavirus anxiety (β = 0.59, p = 0.13), and a history of unsuccessful assisted reproductive therapies (β = 2.72, p = 0.008) were several predisposing factors for AD symptoms in infertile women.

CONCLUSIONS

The findings suggest that all infertile women be screened from the start of infertility treatment. Additionally, the study suggests that infertility specialists should focus on combining medical and psychological treatments for individuals predisposed to AD, particularly infertile women who exhibit impulsive behaviors.

The Outcome of Fatherhood in Patients With Philadelphia-Negative Myeloproliferative Neoplasms: A Single-Institution Experience

Background

Fertility is a highly complex subject; it involves more than one individual and has profound psychological and economic implications. Moreover, it is affected by several factors, including age, significant systemic illness in either partner, exposure to environmental toxins, medications, or radiation. In patients with malignancy, fertility is more complicated. Patients with a malignancy might have reduced fertility due to the disease, medication, and radiation. Besides the reduced fertility, there are more concerns regarding the subsequent effect of cancer treatment on their offspring and the possibility of having healthy children. There were many studies regarding fertility in patients with cancer; however, in male patients with Philadelphia-negative myeloproliferative neoplasms (MPNs), there are very limited data.

Objectives

In this study, we aim to see the outcome of fatherhood in male patients with Philadelphia-negative myeloproliferative neoplasms (MPNs), polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) whether on treatment or not.

Methods

A retrospective mixed-design study of male patients with Philadelphia-negative MPN was followed up in our institute (National Center for Cancer Care and Research (NCCCR)), Doha, Qatar, between January 1, 2008, and January 1, 2020. Patients were interviewed regarding fertility-related information. All included patients had a confirmed diagnosis of Philadelphia-negative MPN according to World Health Organization (WHO) 2008 or WHO 2016 criteria for MPN, aged more than 18 years old.

Results

A total of 124 male patients were interviewed, and only 20 patients met the inclusion criteria. The majority of the patients were lost to follow-up or could not be contacted, and 28.8% of the excluded patients had their families completed by the time of diagnosis. The treatment received included hydroxycarbamide (n=8), pegylated interferon 2 alpha (n=10), ruxolitinib (n=1), and phlebotomy (n=1). The mean duration of exposure to treatment before pregnancy was 4.7 years. The mode of delivery was normal vaginal delivery in 71.4% of the pregnancies. The total number of offspring was 30, and the total number of conceptions was 30.

Conclusion

Our data showed that most Philadelphia-negative MPN male patients on treatment had their offspring born normally with no serious complications, congenital anomalies, or reports of MPN-related cancers. Patients’ concerns regarding fertility should be addressed well to ensure a better quality of life.

Worldwide prevalence, risk factors and psychological impact of infertility among women: a systematic review and meta-analysis

OBJECTIVES

To assess the prevalence, risk factors and psychological impact of infertility among females. This review summarises the available evidence, effect estimates and strength of statistical associations between infertility and its risk factors.

STUDY DESIGN

Systematic review and meta-analysis.

DATA SOURCES

MEDLINE, CINAHL and ScienceDirect were searched through 23 January 2022.

ELIGIBILITY CRITERIA

The inclusion criteria involved studies that reported the psychological impact of infertility among women. We included cross-sectional, case-control and cohort designs, published in the English language, conducted in the community, and performed at health institution levels on prevalence, risk factors and psychological impact of infertility in women.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently extracted and assess the quality of data using the Joanna Briggs Institute Meta-Analysis. The outcomes were assessed with random-effects model and reported as the OR with 95% CI using the Review Manager software.

RESULTS

Thirty-two studies with low risk of bias involving 124 556 women were included. The findings indicated the overall pooled prevalence to be 46.25% and 51.5% for infertility and primary infertility, respectively. Smoking was significantly related to infertility, with the OR of 1.85 (95% CI 1.08 to 3.14) times higher than females who do not smoke. There was a statistical significance between infertility and psychological distress among females, with the OR of 1.63 (95% CI 1.24 to 2.13). A statistical significance was noted between depression and infertility among females, with the OR of 1.40 (95% CI 1.11 to 1.75) compared with those fertile.

CONCLUSIONS

The study results highlight an essential and increasing mental disorder among females associated with infertility and may be overlooked. Acknowledging the problem and providing positive, supportive measures to females with infertility ensure more positive outcomes during the therapeutic process. This review is limited by the differences in definitions, diagnostic cut points, study designs and source populations.

PROSPERO REGISTRATION NUMBER

CRD42021226414.

Comparison of anxiety scores between unexplained primary and secondary infertile couples

OBJECTIVE

To investigate the anxiety levels among infertile women and their partners also factors that may affect the anxiety status.

STUDY DESIGN

A total of 403 infertile couples who applied to Infertility Outpatient Clinics of a University-affiliated Teaching and Research Hospital were included in the study. The infertile group was divided into two groups as primary and secondary infertile. One hundred and thirty-two fertile couples who applied to Gynecology Outpatient Clinics composed the control group. Hamilton Anxiety Rating Scale (HAM-A) form was filled by the infertile couples to evaluate the anxiety status before they started their treatment.

RESULTS

Three hundred and twenty infertile and 84 fertile couples completed the study. The mean total scores of HAM-A of women were similar between the groups. So were the scores of their husbands. In all groups, women had significantly higher mean total HAM-A scores than their husbands. There was no association between the mean HAM-A score of women and age, BMI, AFC, duration of marriage, duration of infertility, number of previous treatment cycles. Education status, working status and family structure of women did not correlate with the mean HAM-A score.

CONCLUSION

Unexplained primary and secondary infertile couples had similar anxiety scores before the commencement of fertility treatments. However, the scores were higher in women than their male partners. Since the burden of treatment and the likelihood of treatment failure might increase the level of anxiety the women could be offered proper cognitive coping and relaxation interventions.

Common mental disorders, quality of life and explanatory models in men undergoing infertility treatment in a tertiary care hospital: A cross-sectional study

BACKGROUND

Men with infertility experience significant distress, however research on psychiatric morbidity among this group is limited. Literature on explanatory models of infertility, which influence help seeking behaviour is also scarce.

OBJECTIVES

The aim of this cross-sectional study was to assess the prevalence and factors associated with psychiatric morbidity among men with infertility, their quality of life, and explanatory models regarding infertility.

MATERIALS AND METHODS

One hundred and thirty-five consecutive males who attended the reproductive medicine outpatient clinic in a tertiary care hospital were recruited after obtaining informed consent. Psychiatric morbidity, quality of life and explanatory models were assessed using the Clinical Interview Schedule - Revised, Fertility Quality of Life scale and modified Short Explanatory Model Interview respectively. Socio-demographic and clinical details were recorded using a structured proforma.

RESULTS

Common mental disorder (CMD), observed in one third of the sample, was associated with longer duration of infertility and treatment, family history of psychiatric illness, sexual dysfunction, and past psychiatric illness in spouse. Presence of CMD was associated with lower quality of life scores. Participants held simultaneous and multiple explanatory models for infertility.

CONCLUSION

Men with infertility experience psychological distress that can further impair their quality of life. They should be offered support and psychosocial interventions as they undergo infertility treatment.

Psychiatric Disorders in Women Seeking Fertility Treatments: A Clinical Investigation in India

Fertility treatments began in several countries, including India, in the1970s. Despite various advancements in intra uterine insemination (IUI) and in vitro fertilization (IVF), empirical investigations on the psychological endurance and emotional tolerance of Indian women to such treatments are rather scarce. Thus, the aim of this study is to estimate the prevalence of psychiatric disorders in Indian women seeking fertility treatments. It is a cross-sectional study with three hundred women participants undergoing various treatments at the Manipal Assisted Reproductive Centre, Kasturba Medical College, Karnataka, India. Psychiatric disorders were assessed in women using the "ICD- 10 Classification of Mental and Behavioural Disorders" followed by descriptive data analysis. The results show that 78% of women have psychological issues and 45% of them have a diagnosable psychiatric condition. Adjustment Disorders, Anxiety Disorders and Mixed Anxiety and Depression Disorder are established as the top three categories of diagnoses. The findings of this study suggest that women have a high emotional stake in infertility treatments. The data highlights the need for modification of the existing treatment protocol (in Indian clinics) in ways that ensure the emotional wellbeing of patients.

A Comparison of Postpartum Depression in Mothers Conceived by Assisted Reproductive Technology and Those Naturally Conceived

Background

It is thought that mothers who conceive via assisted reproductive technology (ART) may be at greater risk of postpartum depression (PPD) because of the problems and psychological stresses associated with ART treat- ment. The aim of the present study is to determine the occurrence of PPD among mothers who conceive by ART in comparison with mothers who naturally conceive. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD.

Materials and Methods

This historical cohort study investigated 406 mothers with infants aged 3-9 months. Three hundred and eight women with natural pregnancies were selected as the control group from mothers who referred to Tehran healthcare centres for infant vaccinations. The ART group consisted of 98 women who conceived via ART at Royan Institute. Participants completed a general questionnaire that asked about education, occupation, number of children, delivery method, history of infant hospitalization, breastfeeding, mothers’ and infants’ ages, cause of infertil- ity (ART group), and history of depression. A validated Persian version of the EPDS was used to measure depressive symptoms.

Results

The mean EPDS score in mothers who naturally conceived was 8.38 ± 0.35 in comparison with mothers who conceived via ART (7.59 ± 0.63). The proportions of women who reported PPD were 26.0% for the control group and 20.4% for the ART group. There was no statistically significant difference in PPD between the control and ART groups (P=0.26).

Conclusion

The occurrence of PPD in mothers who conceived via ART was similar to those who conceived naturally.

Illness Cognitions, Anxiety, and Depression in Men and Women Undergoing Fertility Treatments: A Dyadic Approach

Background

Emotional response to infertility is mediated by numerous interrelated psychological variables such as personality, health perceptions, cognitive appraisals, coping, and social support. While men and women respond to infertility differently, illness cognitions are a vital component of their emotional adjustment. The aim of this study is to compare the infertile men and women undergoing fertility treatments on perceived distress, helplessness, acceptance, benefits, anxiety, and depression.

Materials and Methods

Eighty-one infertile couples, undergoing intrauterine insemination participated in the study. They were assessed on the presence of infertility distress using the fertility problem inventory, for psychiatric morbidity using the Mini International Neuropsychiatric Interview, for affective disturbances using the Hamilton Anxiety and Depression scales, and for illness cognitions using the Illness Cognition Questionnaire.

Statistical Analysis

Data are analyzed using SPSS version 15. The paired sample t-test is performed for assessing differences on normally distributed data. The Wilcoxon Signed-Rank test is performed for assessing differences in medians obtained on data that was skewed.

Results and Discussion

Infertile women (wives) were more emotionally distressed, anxious, and depressed than men (husbands). Gender-wise differences were found for perceptions of helplessness and acceptance of infertility. Infertility was perceived to be a nonbeneficial event for both partners investigated.

Conclusion

Negative cognitions and affective disturbances may contribute to higher treatment burden in couples seeking-assisted conception. The present study suggests that psychosocial intervention for couples plays a central role and should be integrated within the conventional treatments for infertility.

Quality of life and general health of infertile women

Background

Measuring the quality of life (QOL) is a benchmark in today’s world of medicine. The aim of the present study was to determine the general health and QOL of infertile women and certain affecting conditions.

Methods

In a cross-sectional study, 161 infertile women referring to Dr. Rostami’s Infertility Center of Shiraz, Southern Iran, in 2013 were enrolled by the convenience sampling method. Data were collected via a socio-demographic, general health (GHQ28), and the QOL Questionnaire of Infertile Couples and analyzed using descriptive and analytical statistics.

Results

According to 146 completely filled-out questionnaires, the mean age of the participants and their spouses were 29.4 ± 5.4 and 33.8 ± 5.8 years, respectively. Moreover, the general health of 57 (39%) patients was normal and that of 89 (61%) patients showed a degree of impairment. The scores for depression and physical symptoms were the highest and lowest, respectively. In addition, quite positive, positive, neutral, and negative specific QOL of infertile women were detected in 4 (2.8%), 72 (49.3%), 70 (47.9%), and 0 (0%) individuals, respectively. The total QOL scores had maximum correlation with GHQ anxiety (r = −0.596, P < 0.001) and general health scores had the highest correlation with physical QOL (r = −0.637, P < 0.001). The QOL was economically (P = 0.027), emotionally (P = 0.004), sexually (P = 0.017), physically (P = 0.037), and psychologically (P = 0.001) less for the women living in rural areas than other infertile women. However, university education (P = 0.015) and higher income per month (P = 0.008) had positive associations with QOL.

Conclusion

General health of more than half of the infertile women indicated a degree of disorder. These women face the risk of anxiety, social dysfunction, and depression. Educational status, monthly income, and rural/urban residency are the major factors influencing the QOL.

Assessing the quality of life of infertile Chinese women: a cross-sectional study

OBJECTIVE

To assess QoL of infertile Chinese women and determine the specific factors adversely affecting QoL for improving the care and treatment compliance of infertile women.

MATERIALS AND METHODS

We conducted a cross-sectional study on a randomized, demographically matched, controlled population of infertile married Chinese women to determine their demographic, menstrual, family stress, and infertility characteristics and then applied the World Health Organization QoL Instrument (WHOQOL-100) to determine which factors would be associated with significant QoL differences between infertile women and their demographically matched fertile controls.

RESULTS

Infertile women showed lower QoL scores in the facets of spirituality/religion/personal beliefs, self-esteem, financial resources, and accessibility to and quality of health and social care, as well as increased pain and discomfort, while also experiencing positive QoL adjustments in terms of mobility, daily living activities, work capacity, sexual activity, freedom, physical safety, security, and transport.

CONCLUSION

Married infertile Chinese women had significantly lower overall and comprehensive QoL scores, as well as higher anxiety scores, compared with fertile controls.

Depression, anxiety and stress among female patients of infertility; A case control study

OBJECTIVES

Infertility, in many ways, is a very distressing condition that can have its impact on social and marital life of a couple. Depression, anxiety and stress associated with infertility may affect treatment and outcomes for such couples. The purpose of this study was to find out prevalence of depression, anxiety and stress among females suffering from infertility.

METHODS

One hundred females suffering from infertility as study subjects and 100 females accompanying them as controls were randomly selected from infertility clinic at Arif Memorial Teaching Hospital, Lahore, Pakistan. Females with diagnosed mental health issues and those from couples having male factor infertility were not included. Validated Urdu version of Depression, anxiety, stress scale (DASS) was used for assessment of depression, anxiety and stress scores. Results from both groups were compared and independent sample t-test was used to analyze the results.

RESULTS

There was high prevalence of depression, anxiety and stress among females suffering from infertility compared to females in control group (p < 0.05). Level of education did not appear to have any positive effect on these scores. Similarly, results did not appear to change when occupations of infertile females were used for stratified analysis.

CONCLUSION

Depression, anxiety and stress are very common among females suffering from infertility. Healthcare professionals should consider psychological counseling, and psychiatric help if required, when they offer fertility treatment for such females.

Mental Health and Its Socio-Demographic Predictors in Male Partner of Iranian Infertile Couples

Infertility is considered a traumatic stressor for infertile couples. This cross-sectional study aimed to determine the mental health status and its relationship with social support in 345 male partners of infertile couples. Scores on the mental health measure (GHQ-28) indicated that 41.2% of the men had mental problem. Social support from the family, cause of infertility, education, and adequacy of family income were predictors of the mental health in infertile men according to multivariate linear regression. Strengthening social support for improving mental health of infertile men seems necessary.

Suicidal risk among infertile women undergoing in-vitro fertilization: Incidence and risk factors

Despite the fact that depression and other emotional distress are well documented in infertile women, little is known about the relationship between infertility and suicidal risk. The aim of this cross sectional study was to examine the rate of suicide risk (suicidal ideation/suicidal attempts) among 106 infertile women visiting Infertility and In-Vitro Fertilization (IVF) Hospital Unit, and to identify the demographic, medical and clinical correlates to suicidal risk. The incidence of suicide risk was 9.4%. Suicidal women were more likely to be childless or had fewer children and experienced higher levels of depressive symptoms. In addition, they reported more frequently on denial, social withdrawal and self-blame coping strategies compared to participants without suicidal risk. A multiple logistic regression model revealed that being childless, using non-positive reappraisal and exhibiting depressive symptoms were significant predictors of suicide risk in the future. These results suggest that routine assessment of suicidal risk and depression should be provided for infertile women in the course of IVF. Furthermore, future interventions should focus on helping them acquire different emotions regulation strategies and provide alternative skills for positive coping.

Prevalence and predictors of infertility-specific stress in women diagnosed with primary infertility: A clinic-based study

BACKGROUND

According to the existing literature on infertility, stress appears to be inevitably associated with infertility diagnosis and treatment in sub-fertile individuals. The epidemiological data on the prevalence and predictors of infertility-specific stress in cultural specific scenario are scarce. The objective of the present study was to estimate the prevalence of infertility-specific stress and identify predictors of infertility-specific stress in women diagnosed with primary infertility.

MATERIALS AND METHODS

This cross-sectional study was conducted on 300 infertile married women, diagnosed with primary infertility. The tools used for the assessment were "semi-structured questionnaire" compiled by the authors, "ICD-10 Classification of Mental and Behavioral Disorders (Clinical Descriptions and Diagnostic Guidelines)," and "Psychological Evaluation Test for infertility."

STATISTICAL ANALYSIS

Data were analyzed using SPSS (version 15). Chi-square test was used for univariate analysis followed by multiple logistic regressions between stress and the predictor variables.

RESULTS AND DISCUSSION

The prevalence of stress among women was 80%. Univariate analysis revealed that predictors of stress were years of marital life, duration of infertility, infertility type, history of gynecological surgery, cycles of ovulation induction with timed intercourse and intra-uterine inseminations, present and past psychiatric morbidity, coping difficulties, gynecological diagnosis, and severity of premenstrual dysphoria. Multivariate analysis showed leading associations of stress with infertility type and coping difficulties.

Psychiatric Morbidity in Infertility Patients in a Tertiary Care Setup

CONTEXT

Infertility is regarded as a trigger for psychological morbidity. Infertile couples often suffer from anxiety, depression and lack of self confidence.

AIMS

To study the demographic factors associated with infertility in a tertiary care setup and to determine the level of anxiety and depression associated with it by using standardized scales. The study protocol also included studying the various coping strategies employed by these patient groups.

SETTINGS AND DESIGN

Case control study.

MATERIALS AND METHODS

A prestructured questionnaire based study conducted for a span of 6 months. The study population included the patients attending the infertility and the family planning outpatient department. We applied the Hospital Anxiety and Depression scale (HADS) and the Becks Depression Inventory (BDI). Brief COPE Inventory was applied to look for the various coping measures that are employed by the anxious and depressed patients.

STATISTICAL ANALYSIS

Data analysis was done using SPSS ver20.

RESULTS

A total of 280 study subjects were included in the study; which included 140 women from the infertility clinic and 140 from the family planning OPD. A total of 56.4% (79/140) of the females were found to be suffering from depression and 68.9% (96/140) of the females were found to be suffering from anxiety and depression both. Seven risk factors were found to be significant for depression based on the Beck Depression Inventory (BDI) scale and 6 risk factors were found to be significant based on the Hospital Anxiety and Depression Scale (HADS). The most common coping method employed by depressed women was venting 72.2% (57/79) followed by behavioural disengagement 70.9% (56/79); whereas the most important coping method employed by the anxious and depressed women was behavioural disengagement 71.9% (69/96).

CONCLUSION

Anxiety and depression is common among patients suffering from infertility and measures should be taken to alleviate it.

Sexual satisfaction of infertile couples assessed using the Golombok-Rust Inventory of Sexual Satisfaction (GRISS)

Recently, infertility treatment-related psychological effects are receiving increased attention. However, whether sexual satisfaction is reduced amongst infertile couples remains to be elucidated. In this study, sexual satisfaction of Japanese infertile couples was assessed using a validated questionnaire designed to assess the male and female partner individually, and the couple as a whole for the first time. This study randomly included 170 infertile couples seen at the outpatient clinic and 170 couples that had recently achieved spontaneous pregnancy. All couples were given the Japanese version of the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). In couples aged 35 years or older, the male partners showed significantly worse sexual satisfaction scores than the female partners. Sexual satisfaction also deteriorated with therapeutic interventions, with mental factors affected more than physical factors. Therapeutic interventions such as timed sexual intercourse and assisted reproductive technology were considered emotionally stressful for infertile couples, with sexual satisfaction accordingly lower in this group than in couples achieving spontaneous pregnancy. GRISS successfully evaluated lower sexual satisfaction associated with infertility, and hence is a useful tool for identifying couples whose sexual satisfaction could be enhanced by counselling or other stress-reduction modalities.

A survey on depression among infertile women in Ghana

BACKGROUND

The desire of many young women to become parents may be influenced by the premium placed on children by society. In Africa, children are highly valued for social, cultural and economic reasons. Infertile and childless women in Africa are therefore confronted with a series of societal discrimination and stigmatization which may lead to psychological disorders such as anxiety and depression. Even though some research has been done on the prevalence of infertility in Ghana, very little is known about the psychological impact of childlessness among infertile women. The present study aimed to examine prevalence and severity of depression in relation to age, type of infertility and duration of infertility in Ghanaian infertile women.

METHODS

A total of 100 infertile women who met the selection criteria and had agreed to participate in the study were interviewed using the Beck Depression Inventory questionnaire from December 2012 to April 2013 at the Tamale Teaching Hospital, Tamale/Ghana. Data concerning socio-demographic characteristics such as age, monthly income, duration of infertility, marital status, educational level, number of previous conception, number of previous children, religion, as well as occupation of the respondents were recorded.

RESULTS

The prevalence of depression among the women was 62.0% with the level of depression showing a significant positive correlation with age of the women and the duration of infertility. The level of depression was significantly higher among subjects with low or no formal education and among the unemployed. Women with primary infertility also presented with high depression scores as measured by BDI.

CONCLUSIONS

In conclusion, the prevalence of depression among the infertile women is high, especially among infertile women age 26 and above, those who are less educated, those with primary infertility, as well as those who have been diagnosed as infertile for more than 3 years. Interventions to decrease and prevent the development of severe depression among these patients should be considered.

A preliminary study of the psychological differences in infertile couples and their relation to the coping styles

BACKGROUND

Studies from Western countries have observed that couples undergoing infertility treatment suffer various physical and psychological difficulties at a higher frequency than the comparable general population. These relate to treatment challenges and other psychosocial stressors, often influenced by coping style, personality factors and available support systems. There is paucity of studies in non-Western populations.

OBJECTIVE

The aim of this pilot investigation was to evaluate characteristics and gender differences in perceived psychological difficulties reported by infertile Malaysian couples. In particular, depression, anxiety and stress, along with correlated coping styles, were examined between spouses.

METHODS

Demographic information, including age, ethnicity and duration and causes of infertility, were collected from participants treated within a fertility clinic. The Depression, Anxiety and Stress Scale (DASS) and Coping Inventory for Stressful Situation (CISS) were completed to measure psychological distress and coping styles.

RESULTS

Depression, anxiety and stress-related difficulties were reported at significantly higher frequency by wives than husbands (p<0.05). There were no significant differences in coping styles between wives and husbands. However, emotional-oriented coping style was associated with significantly higher levels of depression, anxiety and stress (p<0.05) within the overall sample with odds ratios of 2.5, 3.0 and 1.5, respectively.

CONCLUSION

The study confirms that, as with Western subjects, Malaysian infertile couples demonstrate the vulnerability to psychological distress that occurs more frequently among wives than husbands. As anticipated, emotional coping style was associated with greater distress in both genders.

Axis I and Axis II diagnoses in women with PCOS

OBJECTIVE

The objective was to determine the current prevalence of Axis I and Axis II psychiatric diagnoses in patients with polycystic ovary syndrome (PCOS).

METHOD

The study sample included 73 patients with PCOS and 73 control subjects. Psychiatric disorders were determined by structured clinical interviews.

RESULTS

The rate of any Axis I psychiatric disorder (28.8% vs. 15.1%), social phobia (13.7% vs. 2.7%), generalized anxiety disorder (11.0% vs. 1.4%), any Axis II psychiatric disorder (23.3% vs. 9.6%) and avoidant personality disorder (12.3% vs. 1.4%) was significantly more common in the patient group compared to the control group. Of women with PCOS, 21 (28.8%) had at least one Axis I and 17 (23.3%) had at least one Axis II diagnosis. The most common Axis I disorder was social phobia (13.7%) and the most common Axis II disorder was avoidant personality disorder (12.3%) in women with PCOS. Social phobia, generalized anxiety disorder, and avoidant personality disorder were significantly more common in the patient group compared to the control group.

CONCLUSION

Our results suggest that a considerable proportion of women with PCOS also present with anxiety and personality disorders.

Psychological impact of single and multiple courses of assisted reproductive treatments in couples: a comparative study

OBJECTIVE

To analyze the psychological impact on levels of anxiety and depression in couples who, confronted with the diagnosis of infertility, propose to carry out ART; to evaluate and compare state-trait anxiety and depression levels in couples undergoing ART treatments for the first time and repeatedly, and to verify gender differences.

STUDY DESIGN

In this prospective study in the Medically Assisted Reproduction Unit of the Centro Hospitalar de São João, Porto, Portugal, 89 couples diagnosed with infertility were divided into two groups: (1) couples starting ART for the first time (43), and (2) couples pursuing ART repeatedly (46). Participants completed the Beck Depression Inventory-II (BDI-II) and the State-Trait Anxiety Inventory-Form Y (STAI-Y), prior to their first or subsequent treatment cycle.

RESULTS

Couples pursuing ART for the first time show higher levels of state-anxiety compared to couples who repeatedly carry out ART (p < 0.05). Levels of depression are higher in couples who repeatedly carry out ART (p < 0.05). In both study groups, women and men have higher levels of state-anxiety compared to trait-anxiety (p < 0.05). With respect to depression, there are significant differences between genders in both groups, showing higher values in women compared to men (p < 0.01).

CONCLUSIONS

The results show that there is room to tailor psychological interventions for the specific story of each couple, but we emphasize the importance and need for more studies to support these findings.

Psychological disturbances and quality of life in obese and infertile women and men

Anovulatory cycles and endometriosis are the main causes of female infertility. The most frequently anovulatory cycles are related to polycystic ovary syndrome (PCOS) commonly associated with obesity and hormonal disturbances in the course of obesity. Recently published studies revealed that infertility affects about one in six couples during their lifetime and is more frequent in obese. Obesity is also associated with male infertility related to erectile dysfunction, hormonal disturbances and lower semen quality. Any of these above mentioned disorder is the important risk factor of psychological disturbances and poor quality of life among women and men in the reproductive age. On the other hand the mood disorders may exacerbate the hormonal disturbances and worsen the effectiveness of infertility management. Infertility, its therapy with accompanying psychological disturbances may also significantly affect the partners relationships. The review summarize the results described in the current literature on the association between obesity and infertility and psychological disturbances as well as their impact on quality of life and sexual functioning in women and men. Moreover, the impact of infertility and psychological disturbances on partners relationships is discussed.

Human infertility: is medical treatment enough? A cross-sectional study of a sample of Italian couples

OBJECTIVE

To explore infertile couples' well-being, needs and drop-out rates considering their previous gynaecological history, treatments and support received.

METHODS

Self-reported questionnaires and a telephone follow-up were used to gather data from a sample of 57 Italian couples undergoing first-step procedures for infertility treatment. The questions concerned socio-demographic and personality factors, global perspective on generation, childbearing motivation, intra-psychic and relational dimensions.

RESULTS

The study found a strong need for psychological and ethical counselling and showed that drop-out rates were related to psychological discontent. Among couples who had a longer history of infertility, those who had no previous treatments presented higher dyadic adjustment than those who had an history of previous treatments. Moreover, the study provides evidences of the stronger need for personal support for couples who had undergone previous treatments, and for psychological and ethical support for couples with previous generative failures. It also showed that there were beneficial effects to attending to couples' religious and ethical needs.

CONCLUSION

Professional care for those who are undergoing or have undergone fertility treatment should (i) embrace a broader and more comprehensive perspective to understand infertile couples' experience and should (ii) provide appropriate therapy to cope with these experiences.

The experience of infertility: a review of recent literature

About 10 years ago Greil published a review and critique of the literature on the socio-psychological impact of infertility. He found at the time that most scholars treated infertility as a medical condition with psychological consequences rather than as a socially constructed reality. This article examines research published since the last review. More studies now place infertility within larger social contexts and social scientific frameworks although clinical emphases persist. Methodological problems remain but important improvements are also evident. We identify two vigorous research traditions in the social scientific study of infertility. One tradition uses primarily quantitative techniques to study clinic patients in order to improve service delivery and to assess the need for psychological counselling. The other tradition uses primarily qualitative research to capture the experiences of infertile people in a sociocultural context. We conclude that more attention is now being paid to the ways in which the experience of infertility is shaped by social context. We call for continued progress in the development of a distinctly sociological approach to infertility and for the continued integration of the two research traditions identified here.

Sexual, marital, and social impact of a man's perceived infertility diagnosis

INTRODUCTION

Male factor infertility is a relatively common problem. This diagnosis may increase sexual, marital, and relationship strain in male partners of infertile couples.

AIM

To measure the personal, social, sexual, and marital impacts of a male factor infertility diagnosis among men in couples evaluated for infertility.

METHODS

Cross-sectional analysis of 357 men in infertile couples from eight academic and community-based fertility clinics. Participants completed written surveys and face-to-face and telephone interviews at study enrollment. This interview queried each participant's perception of their infertility etiology to determine the primary study exposure (i.e., male factor only, male and female factors, female factor only, unknown).

MAIN OUTCOME MEASURES

Personal Impact, Social Impact, Marital Impact, and Sexual Impact scales.

RESULTS

Among the 357 men, no male factor was reported in 47%, isolated male factor was present in 12%, combined male and female factors were present in 16%, and unexplained infertility was present in 25% of couples. Male factor infertility was independently associated with worse Sexual (mean 39 vs. 30, standard deviation [SD] 2.7, P = 0.004) and Personal (mean 37 vs. 29, SD 3.8, P = 0.04) Impact scores relative to men in couples without male factor infertility. These differences remained statistically significant after controlling for male age, partner age, race, religion, educational level, employment status, prior pregnancy, duration of infertility, and prior paternity.

CONCLUSIONS

Male partners in couples who perceive isolated male factor infertility have a lower sexual and personal quality of life compared with male partners of couples without perceived male factor infertility. Social strain is highest among couples without a clear etiology for infertility. These findings highlight the clinically significant negative sexual, personal, and social strains of a perceived infertility diagnosis for men.

Psychiatric disorders among infertile and fertile women

This study was performed in order to determine the prevalence and predisposing factors of psychiatric disorders among infertile and fertile women attending Vali-e-Asr Hospital. A total of 150 fertile women from Vali-e-Asr Reproduction Health Research Center and fertile women from the Gynecology Clinic of Imam Khomeini Hospital were chosen by consecutive sampling. Data included demographic information, SCL-90-R, and a semi-structured questionnaire about stress factors. Results showed that 44% of infertile and 28.7% of fertile women had a psychiatric disorder (P < 0.001). Using the SCL-90-R test, the highest mean scores in infertile women were found to be on the paranoid ideation, depression and interpersonal sensitivity scales, and lowest scores were found on the psychoticism and phobic anxiety scales. The interpersonal sensitivity, depression, phobic anxiety, paranoid ideas and psychoticism scales were significantly different between infertile and fertile women (P < 0.05). Infertile women were at higher risk of developing psychiatric disorders if they were housewives rather than working women (P = 0.001). Considering the high prevalence of psychiatric disorders among infertile women, it seems that gynecologists, psychiatrists and psychologists should be more attentive to identify and treat these disorders. The use of psychotherapy, especially supportive methods, should be considered as part of the general therapeutic framework of infertility.

Depression and anxiety among Polish infertile couples--an evaluative prevalence study

AIM

The aim of this study was to evaluate the influence of infertility on the severity of anxiety and depression in infertile couples.

MATERIAL AND METHODS

This was a cross-sectional study of differences between infertile couples (206 women and 188 men) and fertile couples (n = 190) with symptoms of depression and anxiety, as measured by the Beck Depression Inventory and Beck Anxiety Inventory.

RESULTS

Infertile women (35.44%) scored above the cut-off for severe symptoms of depression, compared with 19.47% of fertile women. In the case of anxiety evaluation there was significant total prevalence among infertile women (15.53%). In the male groups there was a comparable frequency of negative results for depression and anxiety and their intensity. Among Female Infertile, depression occurred most frequently in combined infertility, whilst among Male Infertile in male infertility, with a time-frame of 3-6 years causing the creation and severity of depressive symptoms.

CONCLUSION

The risk factors of depression and anxiety in infertility include: female sex, age over 30, lower level of education, lack of occupational activity, diagnosed male infertility and infertility duration of 3-6 years.

Changes in affect and state anxiety across an in vitro fertilization/intracytoplasmic sperm injection cycle

OBJECTIVE

To identify pattern of change in average positive affect (PA), negative affect (NA), and state anxiety (St ANX) across three biological end points of an IVF/intracytoplasmic sperm injection (ICSI) procedure and to examine whether the pattern varied across sociodemographic and biomedical subgroups.

DESIGN

Longitudinal follow-up study of PA, NA, and St ANX at three different time points: before start of study, before ovum pick-up (OPU), and before embryo transfer.

SETTING

Three infertility centers in northern India.

PATIENT(S)

Baseline data were obtained from a consecutive sample of 85 women. However, final analysis was done on data obtained from 74 women who reached the embryo transfer stage and completed the questionnaires at both OPU and embryo transfer.

INTERVENTION(S)

The PA, NA, and St ANX scores.

MAIN OUTCOME MEASURE(S)

Change in PA, NA, and St ANX scores at three stages of the treatment: baseline (T(0)), before OPU (T(1)), before embryo transfer (T(2)).

RESULT(S)

The PA scores before OPU and embryo transfer were significantly lower than those at baseline. The mean NA and St ANX scores before OPU and embryo transfer were significantly higher than baseline scores. Furthermore, mean NA before embryo transfer was significantly higher than mean NA before OPU. The PA and St ANX scores showed statistically insignificance within cycle variations. Furthermore, the mean PA and St ANX for a subgroup of women who reported more than moderate level of burden were less variable.

CONCLUSION(S)

The OPU and embryo transfer stages are more stressful than the baseline stage for most women across various sociodemographic and biomedical subgroups. Women with more than a moderate level of financial burden were relatively more stable.

Polycystic ovary syndrome and its impact on women's quality of life: More than just an endocrine disorder

In the past, polycystic ovary syndrome has been looked at primarily as an endocrine disorder. Studies now show that polycystic ovary syndrome is a metabolic, hormonal, and psychosocial disorder that impacts a patient’s quality of life. It is extremely important to holistically treat these patients early on to help them deal with the emotional stress that is often overlooked with polycystic ovary syndrome. Early diagnosis and long term management can help control polycystic ovary syndrome so that women can still live a healthy active life and avoid long-term complications such as metabolic syndrome and cardiovascular diseases.

The dilemma faced by patients who undergo single embryo transfer

Purpose

The aim of this study was to identify the factors that contribute to the decision to choose single embryo transfer (SET).

Methods

Two hundred and nine patients who underwent ART treatment in our clinics between April 2006 and May 2007 were enrolled in this study. All patients had elected to undergo SET before the start of each treatment cycle; a questionnaire was administered to all patients prior to the SET procedure.

Results

The mean age of the patients was 34.6 years old (range: 24-45 years). The mean number of redundant embryos was 3.7 (range: 1-17), and the pregnancy rate per embryo transfer was 25.7%. A total of 121 patients (57.9%) who underwent SET returned their questionnaires. Based on the results of questionnaire, 56.2% of patients who received SET waived their right to choose between single and double embryo transfer. Among patients who selected SET, 67.6% believed that the pregnancy rate resulting from double embryo transfer (DET) is significantly greater than that associated with SET, and 25% of patients wanted to have twins. The majority of patients (80.9%) who underwent SET understood that multi-fetal pregnancy increases the risk of complications during gestation and delivery. Among all patients who completed the questionnaire, 72.8% believed that the number of transferred embryos should not be controlled by law.

Conclusions

The results of the present study show that greater than one-half of patients who underwent SET were faced with a dilemma--the difficult choice between their own desires and their clinician's recommendation.

Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment

BACKGROUND

This study was undertaken to determine the prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization (IVF) treatment.

METHODS

Participants were 1090 consecutive women and men, 545 couples, attending a fertility clinic in Sweden during a two-year period. The Primary Care Evaluation of Mental Disorders (PRIME-MD), based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV), was used as the diagnostic tool for evaluating mood and anxiety disorders.

RESULTS

Overall, 862 (79.1%) subjects filled in the PRIME-MD patient questionnaire. Any psychiatric diagnosis was present in 30.8% of females and in 10.2% of males in the study sample. Any mood disorder was present in 26.2% of females and 9.2% of males. Major depression was the most common mood disorder, prevalent in 10.9% of females and 5.1% of males. Any anxiety disorder was encountered in 14.8% of females and 4.9% males. Only 21% of the subjects with a psychiatric disorder according to DSM-IV received some form of treatment.

CONCLUSIONS

Mood disorders are common in both women and men undergoing IVF treatment. The majority of subjects with a psychiatric disorder were undiagnosed and untreated.

Infertility and psychiatric morbidity

OBJECTIVE

To assess the relationship between psychiatric disorders and infertility.

DESIGN

Case-control study.

SETTING

Fertile and infertile volunteer couples in an academic research setting.

PATIENT(S)

Eighty-one infertile couples recruited from an infertility center before fertility treatment and 70 fertile controls recruited from an obstetrics and gynecology clinic.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The presence of Axis 1 psychiatric disorders.

RESULT(S)

The occurrence of current psychiatric disorders was significantly higher among infertile subjects than among fertile controls, especially for adjustment disorder with mixed anxiety and depressed mood (16% vs. 2%) and for binge eating disorder (8% vs. 0).

CONCLUSION(S)

Our data highlight that a percentage of infertile patients have already developed a psychiatric disorder at the time of their first contact with a specialized fertility service. Possible applications are discussed, including the recommendation that gynecologists screen for clinical or subclinical psychiatric disorders in infertility patients and offer treatment accordingly.

Psychiatric aspects of infertility and infertility treatments

Infertility counseling, whether provided by a psychiatrist or another health care professional, involves the treatment and care of patients, not simply when they are undergoing fertility treatment but also with their long-term emotional well-being, and that of their children and the reproductive helpers who may assist them in achieving biologic or reproductive parenthood. They can educate patients about the side effects of infertility treatment medications and the impact of hormone shifts on psychologic well-being. They are also helpful with differential diagnoses among grief, depressions, and stress; in assessing psychologic preparedness; and in determining the acceptability and suitability of gamete donation, a gestational carrier, or surrogacy as a family-building alternative for individuals, couples, and reproductive collaborators.

Mood disorders and fertility in women: a critical review of the literature and implications for future research

A medline literature review of fertility and mood disorder articles published since 1980 was performed in order to critically review the literature regarding a relationship between mood disorders, fertility and infertility treatment. Previous studies suggests that mood disorders, both in the bipolar and unipolar spectrum, may be associated with decreased fertility rates. Most studies report that women seeking treatment for infertility have an increased rate of depressive symptoms and possibly major depression (none showed evaluated mood elevations). Many, but not all, studies found that depressive symptoms may decrease the success rate of fertility treatment. Treatments for infertility may independently influence mood through their effects on estrogen and progesterone, which have been shown to influence mood through their actions on serotonin. Studies are limited in scope and confounding variables are many, limiting the strength of the results. In conclusion, a range of existing studies suggests that fertility and mood disorders are related in a complex way. Future studies should use clinical interviews and standardized and validated measures to confirm the diagnosis of mood disorders and control for the variables of medication treatment, desire for children, frequency of sexual intercourse, age, FSH levels, menstrual cycle regularity in assessing an interrelationship between mood disorders and fertility.

Differences in female and male perception of information and decision-making in single-embryo transfer in in vitro fertilization in Sweden

PURPOSE

The aim of this study was to evaluate the information and the factors that contribute to the decision to accept and choose single embryo transfer (SET) in females and males.

MATERIALS AND METHODS

Fifty-four females and males undergoing SET were interviewed separately using a structured questionnaire.

RESULTS

The women were significantly more satisfied with the information than the men (odds ratio 3.3), but the decision to accept SET was nevertheless more difficult for women (OR 3.1). Only one-third of both female and males were aware of the increased maternal risks with twin pregnancies. There was a tendency that the women who accepted SET had previous children, shorter duration of infertility, and were younger. Cryopreservation of embryos and a good pregnancy chance were important irrespective of gender.

CONCLUSION

The female needs more support to choose SET. The male needs better information and further involvement in decision-making. The females were more aware of the fetal risks, but the awareness of the increased maternal risks with twin pregnancies was low.

[Exacerbation of a schizoaffective psychosis after in vitro fertilization with leuproreline acetate]

Leuproreline acetate is a gonadotropin-releasing hormone (GnRH) analog which is used for in vitro fertilization (IVF) treatment. This compound suppresses gonadal estrogen secretion prior to hormonal stimulation. We report a 37-year-old woman who suffered from a schizoaffective psychosis for several years. She received IVF treatment with leuproreline acetate (Uno-Enantone) because of primary infertility. Under this treatment she developed acute schizoaffective symptoms. Suppression of gonadal secretion can result in exacerbation of schizophrenic psychosis, which is in line with the hypothesis of protective effects of estrogen in schizophrenia. We recommend that IVF treatment with leuproreline acetate in patients with psychiatric disorders be initiated only with special attention to their mental condition. In addition, patients should be informed about the possible mental effects of the treatment.

Infertility treatment and marital relationships: a 1-year prospective study among successfully treated ART couples and their controls

BACKGROUND

Evidence about the effects of infertility and assisted reproduction technique (ART) on marital relationships is discrepant. Here, we examined the impact of ART on marital relationships. The roles of life stressors, infertility and treatment characteristics in predicting marital relations were also evaluated.

METHODS

SUBJECTS

367 couples with singleton IVF/ICSI pregnancies.

CONTROLS

379 couples with spontaneous singleton pregnancies. Women and men were assessed when the child was 2 months (T2) and 12 months old (T3). They further reported stressful life events at T2 and depression in pregnancy.

RESULTS

No between-group differences were found in marital satisfaction and dyadic cohesion. Dyadic consensus deteriorated from T2 to T3 only among control women. Sexual affection was low among control men at T2 and stressful life events decreased it further. Depression during pregnancy predicted deteriorated marital relations only in control couples. Several unsuccessful treatment attempts were associated with good dyadic consensus and cohesion among ART women. Spontaneous abortions and multiple parity predicted poor marital satisfaction in ART women, whereas long duration of infertility and multiple parity predicted poor marital relations in ART men.

CONCLUSIONS

Successful ART does not constitute a risk for marital adjustment. The shared stress of infertility may even stabilize marital relationships.

Long-term psychological adjustment to IVF/ICSI treatment in women

BACKGROUND

The aim of this study was to gain more insight into long-term psychological adjustment to IVF in women.

METHODS

In a prospective cohort study, 298 women entering their first IVF treatment cycle (including ICSI) completed standardized psychological questionnaires before the start of the treatment, just after the last treatment cycle, and 6 months and 3-5 years after the last treatment cycle. The main outcome measures were state anxiety, depression and mode of adaptation to unsuccessful IVF.

RESULTS

Anxiety and depression were found at follow-up to return to baseline levels following treatment not resulting in a live birth, after an initial increase during treatment. On the contrary, treatment resulting in a live birth was found to lead to a more positive long-term emotional status. Women who focused on new life goals as a mode of adaptation 3-5 years after IVF without a live birth showed lower levels of anxiety and depression compared with those who persisted in their attempts to get pregnant.

CONCLUSIONS

Treatment that resulted in a live birth led to more positive emotional adjustment. In addition, most women who did not give birth to a child after treatment adjusted well psychologically. Positive adjustment was related to developing new life goals rather than persisting in attempts to get pregnant. Helping women to change life goals after abandoning treatment might have beneficial effects on the adaptation process.

Alterations of sexual desire and satisfaction in male partners of infertile couples

OBJECTIVE

To clarify the state of sexual desire and satisfaction, with relevant parameters in men, of couples with infertility.

DESIGN

Cross-sectional study.

SETTING

University outpatient clinic.

PATIENT(S)

Two hundred infertile couples referred to a reproductive health research clinic.

INTERVENTION(S)

Patients were investigated by a self-administered structured questionnaire about demographic data, infertility history, and several relevant psychological variables. In addition, clinical and andrological examinations were completed to find predictors for sexual state.

MAIN OUTCOME MEASUREMENT(S)

Sexual desire and satisfaction status were scaled, and the relative factors were analyzed statistically.

RESULT(S)

Subjects reported a reduction in sexual desire in 41.5% of cases and reduction of satisfaction in 52.5% compared with recalled sexual satisfaction before diagnosis of infertility. No relationship was found between andrological findings and the present status of sexual desire (P>.05). Education level, mutual understanding between couples, and recalled state of sexual satisfaction had a direct influence, but the duration of infertility and duration of desire for a child showed a significant inverse impact on sexual satisfaction (P<.05).

CONCLUSION(S)

Less than 50.0% of patients mentioned a reduction in sexual desire and satisfaction after infertility diagnosis, and the frequency of coitus could be regarded as an acceptable indicator of sexual satisfaction in male partners of infertile couples.

Determinants of emotional distress in women with polycystic ovary syndrome

BACKGROUND

The goals were to analyse the incidence of mental distress in women with untreated polycystic ovary syndrome (PCOS) using self-report measures, to characterize PCOS patients at risk for psychiatric disease with regard to sociodemographic and clinical characteristics, and to assess the impact of emotional distress on quality of life.

METHODS AND RESULTS

Complete metabolic, hormonal, clinical and self-report psychological data [emotional distress, Symptom Check List 90 (SCL-90-R); quality of life, Short-Form Health Survey 36 (SF-36); sexual satisfaction, visual analogue scales; sociodemographic data] were obtained from n = 143 untreated women with PCOS. Prior psychiatric diagnoses were exclusionary. Twenty-two patients (15.4%) had a possible psychological disorder, based on SCL-90-R global severity index (GSI) scores > or =63 (SCL cases). SCL cases had significantly elevated body mass index (BMI), but did not differ from SCL non-cases in other clinical, endocrine, metabolic or sociodemographic variables. Stepwise multiple regression analyses identified GSI as a significant predictor of SF-36 Psychological Sum score, along with age and current wish to conceive (R2 = 0.47); the SF-36 Physical Sum score was predicted by BMI and education (R2 = 0.27), but not GSI.

CONCLUSIONS

Psychiatric illness may go undetected in a proportion of PCOS patients. Although the majority of patients exhibit subclinical levels of psychological disturbances, emotional distress together with obesity lead to large decrements in quality of life in PCOS.