Depression and anxiety levels in "in vitro fertilization" patients with endometriosis

Endometriosis is associated with higher levels of depression and anxiety in patients who are planned to receive infertility treatments.

Key Points

Highlights:

• The infertile patients with endometriosis have a higher susceptibility to develop depression and anxiety.

Importance:

• The women with endometriosis who are scheduled for assisted reproductive technology treatments should be counseled about the association between endometriosis and the risk for depression and anxiety.

What’s done here?

• This prospective case-control study was conducted in an infertility center. A total of 93 patients were included [endometriosis group (n=37) and non-endometriosis group (n=56)].
• Endometriosis was diagnosed either using laparoscopy, magnetic resonance imaging, or ultrasonography.
• The clinicodemographic characteristics of the patients such as age, body mass index, the presence of endometriosis, ovarian reserve tests in terms of follicle-stimulating hormone (FSH), antral follicle count (AFC), and estradiol (E2) levels were recorded.
• Beck Depression Inventory-Turkish (BDI-II-TR), Beck Anxiety Inventory (BAI), and The World Health Organization Quality of Life Short Form Turkish version (WHOQOL-BREF-TR) questionnaires were used to evaluate the quality of life, depression, and anxiety levels in these women.

Key results:

• There was no significant difference between the groups regarding age, body mass index, duration of infertility, FSH, E2 levels, and ovulation induction parameters.
• Although total gonadotropin dose during ovulation induction was significantly higher in the endometriosis group, the number of oocytes retrieved, metaphase II oocyte counts, numbers of embryos obtained, the grade of embryos, and clinical pregnancy rates were not different.
• The patients in the endometriosis group had higher moderate-severe depression scores; whereas anxiety scores were found to be comparable between the groups.
• The psychological domain of quality of life, depression, and anxiety scores had no impact on pregnancy outcomes in all patients.

Strengths and Limitations

• Being the first prospective study assessing anxiety, depression, and the psychological domain of quality of life scales in infertile women with endometriosis who are scheduled for in vitro fertilization treatment was the major strength of the study.
• Not having a distinction between primary and secondary infertility, not to record prior obstetric history and pain scoring -previous treatments and duration/stage/symptoms of endometriosis; and the inclusion of patients receiving only fresh antagonist in vitro fertilization/intracytoplasmic sperm injection cycles are limitations.

Lay Summary

Endometriosis is a reproductive-aged and estrogen-dependent disease. The most common symptoms of this disease are dysmenorrhea, dyspareunia, chronic pelvic pain, and infertility affecting the quality of life in several aspects mainly the psychological domain.

In the literature, there are many studies reporting higher levels of depression and anxiety in these women. Medications in the treatment of endometriosis, some familial risk factors, and the underlying mechanisms of endometriosis including neuroinflammation, autoimmunity dysregulation may contribute the mood changes in the patients with endometriosis.

Ceran et al. published a study titled “Psychological domain of quality of life, depression and anxiety levels in "in vitro fertilization/intracytoplasmic sperm injection" cycles of women with endometriosis: a prospective study” in the journal named "Journal of Psychosomatic Obstetrics & Gynecology". The primary aim of this study was to investigate the impact of endometriosis on the psychological domain of quality of life, depressive and anxiety symptoms in women undergoing in vitro fertilization treatments. The secondary objective was to assess the impact of the psychological domain of quality of life scores, depression, and anxiety on in vitro fertilization success and pregnancy rates.

The study population was evaluated in two groups based on the presence of endometriosis. There was no significant difference between the patients with and without endometriosis regarding the demographic and clinical characteristics. The patients in the endometriosis group had significantly higher moderate-severe depression scores, but anxiety scores were comparable between the groups.

In vitro fertilization success, and clinical pregnancy rates were not adversely affected by the psychological domain of quality of life, depression, and anxiety scores.  

“Before initiating in vitro fertilization treatments, open discussion about emotional stress, anxiety, and depressive symptoms will help identify women suffering from these disorders and alleviate their symptoms via different strategies and regain their psychological health.” the authors added.

Research Source: https://pubmed.ncbi.nlm.nih.gov/32635772/