RT Journal Article
SR Electronic
T1 Infertility treatment and postpartum mental illness: a population-based cohort study
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E430
OP E438
DO 10.9778/cmajo.20210269
VO 10
IS 2
A1 Natalie Dayan
A1 Maria P. Velez
A1 Simone Vigod
A1 Jessica Pudwell
A1 Maya Djerboua
A1 Deshayne B. Fell
A1 Olga Basso
A1 Tuong Vi Nguyen
A1 K.S. Joseph
A1 Joel G. Ray
YR 2022
UL http://www.cmajopen.ca/content/10/2/E430.abstract
AB Background: Subfertility and infertility treatment can be stressful experiences, but it is unknown whether each predisposes to postpartum mental illness. We sought to evaluate associations between subfertility or infertility treatment and postpartum mental illness.Methods: We conducted a population-based cohort study of individuals without pre-existing mental illness who gave birth in Ontario, Canada, from 2006 to 2014, stratified by fertility exposure: subfertility without infertility treatment; noninvasive infertility treatment (intrauterine insemination); invasive infertility treatment (in vitro fertilization); and no reproductive assistance. The primary outcome was mental illness occurring 365 days or sooner after birth (defined as ≥ 2 outpatient visits, an emergency department visit or a hospital admission with a mood, anxiety, psychotic, or substance use disorder, self-harm event or other mental illness). We used multivariable Poisson regression with robust error variance to assess associations between fertility exposure and postpartum mental illness.Results: The study cohort comprised 786 064 births (mean age 30.42 yr, standard deviation 5.30 yr), including 78 283 with subfertility without treatment, 9178 with noninvasive infertility treatment, 9633 with invasive infertility treatment and 688 970 without reproductive assistance. Postpartum mental illness occurred in 60.8 per 1000 births among individuals without reproductive assistance. Relative to individuals without reproductive assistance, those with subfertility had a higher adjusted relative risk of postpartum mental illness (1.14, 95% confidence interval 1.10–1.17), which was similar in noninvasive and invasive infertility treatment groups.Interpretation: Subfertility or infertility treatment conferred a slightly higher risk of postpartum mental illness compared with no reproductive assistance. Further research should elucidate whether the stress of infertility, its treatment or physician selection contributes to this association.