July 23, 2014
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Study: Assisted reproduction may increase risk for postpartum depression

Women who conceive using assisted reproductive technologies (ART) such as in vitro fertilization may face a heightened risk for postpartum depression and other early parenting difficulties, research indicates.

In a study published in the journal Fertility and Sterility, a team of Australian researchers analyzed data from more than 700 women who were admitted to a hospital unit for new mothers suffering from mood disorders or exhaustion and for infants with sleeping or feeding difficulties.

Postpartum depression can range from mild to severe, with symptoms such as sadness, irritability and impatience, restlessness, fatigue, and insomnia. In its most severe form, known as postpartum psychosis, a mother may experience hallucinations or delusions as well as thoughts of harming herself or the baby.

Of the files included in the study, 526 specified the mode of conception. Of those, 45 - or 6% of the total study population - had conceived using assisted reproductive technologies. In contrast, just 1.5% of the general population achieved conception through infertility treatments.

Women who conceived through in vitro fertilization techniques were also more likely to be older than their natural-conception counterparts, to have multiple births, and to have a C-section delivery, three additional factors that may contribute to the higher incidence of depression.

"Cesarean surgery carries adverse psychological consequences," the researchers note. "These have been variously conceptualized as depression, disappointment, grief, and dissatisfaction.... Alternative conceptualizations suggest that emergency procedures during childbirth, in particular cesareans, can induce post-traumatic stress reactions and are disruptive to the first encounter between mother and infant."

The researchers add that while cesarean deliveries do not appear to raise the risk of depression among women who have conceived naturally, it's possible that surgery "adds to the psychological burden of infertility and ART and that these interventions act cumulatively to diminish maternal well-being and confidence in parenting."

While the researchers say further investigation is necessary to probe the various factors that may contribute to a higher incidence of postpartum depression among women who conceive through ART, they speculate that women who have a history of fertility problems may be ill-prepared to deal with the realities of parenthood.

"Women with fertility difficulties may idealize parenthood, including the notion of an instant family created through multiple birth, but underestimate the hazards and difficulties. It may also be that women who have conceived through ART have a lowered sense of entitlement to complain or seek help because these are highly desired babies. Together these factors may lead women to be insufficiently prepared for the social isolation, loss of autonomy, and potentially difficult work of infant care," the researchers write.

They go on to suggest that women who conceive through ART receive special care leading up to and following delivery.


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