Depression in Men Impedes Pregnancy for Infertile Couples

Emily A. Evans-Hoeker, MD

Couples undergoing infertility treatments were 60% less likely to conceive and produce a live birth when the male partner had major depression than when he did not, research funded by the US National Institutes of Health shows. In contrast, depression in the female partner did not affect the likelihood of becoming pregnant.

“It’s very interesting, and concerning, that male depression was associated with decreased pregnancy rate,” corresponding author Emily A. Evans-Hoeker, MD, Section Chief-Reproductive Medicine and Fertility, Virginia Tech-Carilion Clinic, told MD Magazine. “I would recommend we pay attention to male depressive symptoms.”

For women, the study also looked at antidepressant use. It found that those who were taking nonselective serotonin reuptake inhibitor (non-SSRI) drugs were about 3.5 times more likely to experience pregnancy loss in the first trimester than those not using antidepressants.

SSRIs, another class of antidepressants, were not linked to pregnancy loss, the study found. The results were published in Fertility and Sterility.

“It’s concerning that we found non-SSRI antidepressants to be associated with higher miscarriage rate,” Evans-Hoeker said. “I would likely prefer an SSRI medication in patients pursuing fertility treatments, if an SSRI medication is deemed appropriate treatment for their depression.’’

The study did not address why depression in men seemed to affect the chances of becoming pregnant while the condition in women did not. Theories focus on the man’s decreased sexual function, including lower libido, erectile and ejaculatory dysfunction, less frequent intercourse, or the effects of depression on sperm quality, Evans-Hoeker said.

She suggested that men seeking infertility treatments—as well as their partners–be screened for depression. Clinicians should then help them connect with an appropriate provider for treatment. “It’s difficult to discover you are infertile and even more difficult to have an unsuccessful fertility treatment,” she said.

While depression affects 7.4% of Americans aged 18 to 39, infertile couples have much higher rates of major depression.

Previous studies have shown that 41% of women seeking care for infertility have symptoms of depression. One study of men involved in in-vitro-fertilization (IVF) treatments estimated that almost half of them experienced depression.

Research involving non-IVF therapies, such as treatments to induce ovulation, has been less prevalent than investigations of IVF when it comes to depression, the researchers said.

“The present study sought to fill the gaps in the literature by evaluating the effect of depression and antidepressant use in couples pursuing non-IVF fertility treatments,” they wrote.

The researchers considered data from two previous studies. One compared 2 ovulation-inducing drugs used by women with polycystic ovary syndrome (PCOS). The other looked the effectiveness of 3 ovulation-inducing drugs in couples with unexplained infertility.

The team analyzed data for 1,650 women and 1,608 men. Among the women, 5.96% had active major depression and 5.72% used antidepressants. Approximately 2.28% of the men had active depression.

In an unexpected finding, the presence of active major depression among women who were not using an antidepressant was not associated with poorer fertility outcomes. Instead, depression in this group was associated with a slightly increased likelihood of pregnancy.

“Our study is not able to identify the other treatments that depressed women may be using (psychotherapy, meditation, acupuncture, mind-body programs, etc.),” Evans-Hoeker said. “So it’s possible that those non-medication treatments are improving the pregnancy rate for those women.”

As for why it’s important to consider depression in infertile couples who are trying to conceive, Evans-Hoeker noted depression is more common in this group and studies have shown that it worsens with each negative pregnancy test after fertility treatments. “We should try to identify those suffering from depression and get them the help they need in order to improve their quality of life and possibly improve their treatment outcomes,” she said.