Women Undergoing Hormonal Treatments for Infertility: A Systematic Review on Psychopathology and Newly Diagnosed Mood and Psychotic Disorders

Abstract

Background: The association between infertility treatments and mental disorders has been poorly addressed. This work aims to review current evidence on the psychopathological effects of hormonal treatments used for infertility on women and the occurrence of newly diagnosed mood and psychotic disorders.Methods: A systematic review was performed by searching PubMed and clinicaltrials.gov databases from inception until September 2019. Clinical trials on hormone treatments for infertility in patients with mood or psychotic disorders, as well as those evaluating the onset of symptoms, were included. Selected studies were published in English, Spanish, and Dutch language peer-reviewed journals. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Observational studies and case reports were excluded. Effect sizes for changes in depressive symptoms were calculated with Hedges'g and Cohen's d confidence intervals. A meta-analysis was not performed due to the heterogeneity of hormonal compounds in protocols.Results: From 1,281 retrieved records, nine trials were included; all of them were conducted in non-clinical populations. Four trials compared Gonadotropin-releasing hormone (GnRH) agonists and GnRH antagonists, showing a better mood profile for hormonal protocols including antagonists in one trial. Two trials compared protocols using GnRH agonists/antagonists versus natural cycle protocols (without gonadotropin stimulation), with a better mood profile (less depressive symptoms) in those protocols

Psychological Components of Infertility

“…These treatments can significantly interfere with work and travel schedules and are particularly inconvenient for those with a rigid work schedule or who live far away from a fertility clinic. The hormones involved with fertility treatment have emotional side effects including irritability, mood lability, tearfulness, anxiety and depression (Choi et al, 2005; González‐Rodríguez et al, 2020).…”

First manic episode during COVID‐19 infection after IVF treatment: A case report

“… 5 There have not been any studies reported in the literature about the psychiatric effects of hormone treatments to treat infertility on patients with bipolar disorder, schizophrenia, or other psychotic disorders. 5 Nevertheless, there were no other cases reported about psychiatric complications after an IVF treatment both in post‐COVID and non‐COVID patients.…”

“… 6 For this reason, fertility treatments that trigger hypoestrogenism may have an aggravating effect on depressive or psychotic symptoms. 5 On the other hand, current data on the association between progesterone and schizophrenia are inconsistent. Some studies reveal neuroprotective properties for progesterone, while other studies reveal the destructive effects of the hormone.…”

Schizophrenia Psychosis in Women

“…Important for health providers is the fact that psychotic episodes can be triggered or exacerbated by drugs used to treat commonly occurring comorbidities. Examples are corticosteroids for autoimmune disease [106] and agents used to treat infertility [107,108].…”