Prevalence of depression in infertile men: a systematic review and meta-analysis

Using network analysis to identify central symptoms of depression and anxiety in different profiles of infertility patients

BACKGROUND

Depression and anxiety were not only common but also with serious consequence in infertility patients. The current study endeavors to define distinct depression and anxiety profiles of infertility patients and identify central symptoms within different profiles to facilitate targeted interventions.

METHOD

The research employed K-means Clustering to delineate the depression and anxiety profiles, followed by a repetition of the analysis using Latent Class Analysis (LCA). Furthermore, network analysis was utilized to identify central symptoms within the various profiles.

RESULT

K‑means Clustering identified Cluster 1 (16.15%), Cluster 2 (37.08%) and Cluster 3 (46.77%), while LCA yielded the low-risk group (47.23%), the mild-risk group (34.46%) and the high-risk group (18.31%). A majority of patients in the three clusters were predominantly in a single LCA-derived patient class (88.38-100%). Network analysis revealed that connections within each symptom in PHQ-9 and GAD-7 were stronger than those between symptoms. Furthermore, PHQ 2 ("sad mood"), GAD 1 ("nervousness") and GAD 2 ("uncontrollable worry") were identified as the central symptoms in Cluster 1 GAD 3 ("excessive worry"), GAD 2 ("uncontrollable worry") and GAD 5 ("restlessness") emerged as the central symptoms in Cluster 2) Additionally, PHQ 4 ("fatigue"), GAD 6 ("irritability") and GAD 3 ("excessive worry") were identified as the central symptoms in Cluster 3.

CONCLUSIONS

We defined three distinct depression and anxiety profiles among infertility patients and pinpointed central symptoms within each profile. These findings underscore the importance of directing research towards those central symptoms within each profile in order to develop targeted intervention strategies.

Prevalence and contributing factors of depression among women with infertility in low-resource settings: a systematic review and meta-analysis

Background

Depressive symptoms are the most common manifestations of psychiatric disorders among women with infertility. In low-resource settings, the overall prevalence and contributing factors of depressive symptoms among women with infertility remain unknown.

Objectives

To estimate the prevalence and contributing factors of depression among women with infertility in low-resource settings.

Methods

A review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PubMed, MEDLINE, Google Scholar, and Cochrane databases were used to identify eligible studies published up to 30 November 2024. Three authors independently extracted the data. Studies that reported depression among women with infertility were included in this review. The data were analyzed with STATA version 14, and a meta-analysis was conducted using a random-effects model. Publication bias and heterogeneity were assessed via Eager's tests and I2. Subgroup and sensitivity analyses were performed to identify the potential source/s of heterogeneity. A p-value of 0.05 was declared as statistically significant. The findings were synthesized and presented using texts, tables, and forest plots with measures of effect and 95% confidence interval (CI).

Results

Seventeen published cross-sectional studies that met the inclusion criteria with a total of 3,528 women with infertility were selected for this study. The pooled prevalence of depression among women with infertility was 48.77% (95% CI (35.86, 61.67). Good functioning family {OR 0.71 [95% CI (0.51, 0.97), I2: 0.00%]}, good husband support {OR 0.52 [95% CI (0.34, 0.79), I2: 0.00%]}, primary infertility {OR 2.55 [95% CI (1.36, 4.79), I2: 68.53%]}, history of divorce {OR 4.41 [95% CI (2.11, 9.24), I2: 0.00%]}, and duration of infertility lasting more than 10 years {OR 6.27 [95% CI (2.74, 14.34), I2: 15.26%]} were statistically significant.

Conclusion

Depression was high among women with infertility in low-resource settings such as Africa compared to those in high-income countries, men, and pregnant mothers. Good functioning family, good husband support, primary infertility, history of divorce, and duration of infertility lasting more than 10 years were statistically associated. Therefore, African countries and the stakeholders in collaboration with mental health experts and gynecological care providers should address these problems in order to reduce or prevent depression among women with infertility.

Systematic Review Registration

PROSPERO (ID: CRD42024516458).

Infertility stigma and openness with others are related to depressive symptoms and meaning in life in men and women diagnosed with infertility

BACKGROUND

Stigma is the experience of feeling different from socially accepted norms which can lead to personal devaluation or fear of disapproval from others. For men and women experiencing infertility, stigma has been associated with psychological distress, feelings of otherness in relation to people with children, and selective disclosure with others about their infertility challenges. However, there are few studies which examine how infertility stigma and being open with others are related to depressive symptoms and meaning in life for men and women diagnosed with infertility.

METHODS

Participants experiencing infertility were recruited for this cross-sectional study during November 2023-January 2024 via announcements on infertility discussion listservs and social media accounts. Four-hundred fifty-eight women and 89 men completed an online survey. Participants were primarily from the United States (81%), followed by Europe, Canada, and Australia/New Zealand. Participants completed validated and reliable measures of infertility stigma, openness with others, depressive symptoms and meaning in life.

RESULTS

Hierarchical regression models explained substantial variance (adjusted R-squared) for depressive symptoms (41% men; 27% women), search for meaning in life (12% men; 14% women), and presence of meaning in life (19% men; 25% women). For both men and women, higher personal infertility stigma was significantly related with higher depressive symptoms and search for meaning. For both men and women, higher openness with others about infertility was significantly associated with lower levels of depressive symptoms and greater presence of meaning.

CONCLUSIONS

The current findings support prior research indicating a significant association between infertility stigma and depressive symptoms and adds to the infertility literature by offering new insights into the relationships between stigma, openness with others, and meaning in life. Health care providers can use these findings to assist individuals and couples in reducing infertility stigma through collaborative conversations that reduce feelings of personal failure. Providers can also help those with infertility challenges to reduce psychological distress and increase meaning in life through accessing existing social networks and expanding social connections with others in ways that facilitate support.

Vascular health of fathers with history of intracytoplasmic sperm injection

OBJECTIVE

Studies suggest that men who undergo assisted reproductive technologies (ART) may have a higher risk of cardiovascular disease; however, limited data on this matter is available. This observational pilot study aimed to investigate the overall vascular health of fathers with history of intracytoplasmic sperm injection (ICSI) compared to fathers whose partners conceived spontaneously.

METHODS

Diet quality, physical activity, sedentary behavior as well as overall vascular function including the assessment of pulse wave analysis, intima-media thickness (cIMT), arterial stiffness of the common carotid artery (CCA) and blood lipids, were evaluated.

RESULTS

A total of 34 fathers with history of ICSI and 29 controls (48.49 [46.32 - 57.09] years vs. 47.19 [40.62 - 55.18] years, p = 0.061) were included. After adjusting for age, no significantly increased cardiovascular risk was detected regarding vascular function.

CONCLUSIONS

The results suggest an unaltered cardiovascular risk profile in fathers with history of ICSI. In the future, prospective multicenter studies are required to validate these preliminary results.

Rapid Lifestyle Recommendations to Improve Urologic, Heart and Overall Health

PURPOSE OF REVIEW

This literature review is intended to highlight recent correlations between urologic, heart and overall health by emphasizing healthy eating patterns, physical activity, alcohol minimization and tobacco elimination, healthy sleep, weight, cholesterol, blood sugar, blood pressure management, and mental health awareness.

RECENT FINDINGS

Meta-analyses, systematic reviews, and clinical studies espouse a unified message for prevention, reducing the risk of disease recurrence, progression, complementing conventional medical intervention efficacy, and mitigating treatment side effects. Limiting or eliminating alcohol consumption could be considered an independent recommendation and adding a mental health and miscellaneous (genetic risk and lifestyle, planetary health, HPV or other vaccination awareness, spirituality, etc.) category could allow for individualized educational opportunities, synergism appreciation, and self-improvement. Urologic healthcare professionals have the potential to strengthen the collective public health goal of improving the quality and quantity of the lives of patients able to adhere to these heart healthy recommendations.

Assessment of Construct Validity and Reliability of the Hospital Anxiety and Depression Scale in Greek Couples With Infertility Undergoing In Vitro Fertilization Cycles

INTRODUCTION

The Hospital Anxiety and Depression Scale (HADS) is a widely used screening instrument created to assess anxiety and depression symptoms during the experience of various health problems. It has also been increasingly applied to populations facing infertility. The current cross-sectional study aimed to assess the construct validity and reliability of the HADS in a sample of Greek participants undergoing in vitro fertilization (IVF) cycles.

MATERIALS AND METHODS

This study included 90 couples with infertility referred to an assisted reproduction unit in Heraklion, Greece, and an infertility center in Athens, Greece. To validate the scale, confirmatory factor analyses (CFA) were performed. Several goodness-of-fit indices were utilized including the comparative fit index (CFI), the root mean squared error of approximation (RMSEA), the standardized root mean square residual (SRMR), and normed chi-square index with the degree of freedom (c2/df). The reliability analysis was conducted by calculating Cronbach's alpha.

RESULTS

The confirmatory factor analysis revealed that all of the four fitness indexes were good (x2/df=1.489, CFI=0.943, RMSEA=0.052, SRMR=0.055). Based on the item-scale correlation coefficients, reliability was very good for the anxiety factor (alpha = 0.808), good for the depression factor (alpha = 0.707), and very good for the total questionnaire (alpha = 0.858).

CONCLUSION

The results of confirmatory factor analyses and reliability analyses proved that HADS met the criteria of construct validity and reliability, making it suitable for use with couples undergoing an IVF cycle. Examining negative emotions, such as anxiety and depression, during the period of fertility problems and its treatment is important to evaluate the psychological maladjustment of couples with infertility and to create psychological interventions by health professionals that help individuals with infertility manage distress during IVF.

The quality of life of men experiencing infertility: a systematic review

BACKGROUND

Men experiencing infertility encounter numerous problems at the individual, family, and social levels as well as quality of life (QOL). This study was designed to investigate the QOL of men experiencing infertility through a systematic review.

MATERIALS AND METHODS

This systematic review was conducted without any time limitation (Retrieval date: July 1, 2023) in international databases such as Scopus, Web of Science, PubMed, and Google Scholar. The search was performed by two reviewers separately using keywords such as QOL, infertility, and men. Studies were selected based on inclusion and exclusion criteria. The quality of the articles were evaluated based on the Newcastle-Ottawa Scale. In the initial search, 308 studies were reviewed, and after removing duplicates and checking the title and abstract, the full text of 87 studies were evaluated.

RESULTS

Finally, 24 studies were included in the final review based on the research objectives. Based on the results, men's QOL scores in different studies varied from 55.15 ± 13.52 to 91.45 ± 13.66%. Of the total reviewed articles, the lowest and highest scores were related to mental health problems and physical dimensions, respectively.

CONCLUSION

The reported findings vary across various studies conducted in different countries. Analysis of the factors affecting these differences is necessary, and it is recommended to design a standard tool for assessing the quality of life of infertile men. Given the importance of the QOL in men experiencing infertility, it is crucial to consider it in the health system. Moreover, a plan should be designed, implemented and evaluated according to each country's contex to improve the quality of life of infertile men.

Treatment suspension due to the coronavirus pandemic and mental health of infertile patients: a systematic review and meta-analysis of observational studies

BACKGROUND

Access to fertility treatments is considered a reproductive right, but because of the quarantine due to the coronavirus pandemic most infertility treatments were suspended, which might affect the psychological and emotional health of infertile patients. Therefore, this study was conducted to review the mental health of infertile patients facing treatment suspension due to the coronavirus pandemic.

METHODS

This study was conducted based on the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guideline. The Web of Science, PubMed, Embase, Scopus, and Cochrane library databases were searched by two independent researchers, without time limitation until 31 December 2022. All observational studies regarding the mental health of infertile patients facing treatment suspension including anxiety, depression, and stress were included in the study. Qualitative studies, editorials, brief communications, commentaries, conference papers, guidelines, and studies with no full text were excluded. Quality assessment was carried out using Newcastle-Ottawa Scale by two researchers, independently. The random effects model was used to estimate the pooled prevalence of mental health problems. Meta-regression and subgroup analysis were used to confirm the sources of heterogeneity.

RESULTS

Out of 681 studies, 21 studies with 5901 infertile patients were systematically reviewed, from which 16 studies were included in the meta-analysis. The results of all pooled studies showed that the prevalence of anxiety, depression, and stress in female patients was 48.4% (95% CI 34.8-62.3), 42% (95% CI 26.7-59.4), and 55% (95% CI 45.4-65), respectively. Additionally, 64.4% (95% CI 50.7-76.1) of patients wished to resume their treatments despite the coronavirus pandemic.

CONCLUSION

Treatment suspension due to the coronavirus pandemic negatively affected the mental health of infertile patients. It is important to maintain the continuity of fertility care, with special attention paid to mental health of infertile patients, through all the possible measures even during a public health crisis.