Is infertility really associated with higher levels of mental distress in the female population? Results from the North-Trøndelag Health Study and the Medical Birth Registry of Norway

Abstract

Objective: To explore the effect of ever having tried to conceive for more than 12 months on levels of anxiety and depressive symptoms and to investigate if symptom levels of anxiety and depression in infertile women who remain childless, or go on to have children, respectively, differ from symptom levels in mothers without reports of infertility.

Methods: Analyses were based on information from 12 584 Norwegian women aged 19–45 years who participated in the North-Trøndelag Health Study from 1995 to 1997 and data from the Medical Birth Registry of Norway. Anxiety and depressive symptoms were measured by the Hospital Anxiety and Depression Scale.

Results: Having tried to conceive for more than 12 months (ever) was weakly associated with higher levels of depressive symptoms. In the categorical analyses, women with resolved infertility had higher levels of anxiety symptoms (B = 0.25 (95% confidence interval (CI) = 0.04–0.47)) and voluntarily childfree had lower levels of depressive symptoms (B = –0.05 (95% CI = –0.50 to –0.21)) than mothers without infertility. However, women with current primary or current secondary infertility had levels of anxiety and depression not significantly different from mothers without infertility.

Conclusion: At the population level, and from a longitudinal perspective, unresolved infertility is less burdensome than findings from studies on women seeking help for infertility would suggest.

• Anxiety
• depression
• epidemiology
• HUNT study
• infertility
• MBRN
• mental health
• population

Current knowledge on the subject

• Many studies have shown that women seeking help for infertility have higher levels of anxiety and depression than women without infertility.

• However, such clinical studies are subject to a wide range of biases that may affect the association between infertility and levels of mental distress.

• The very few population-based studies that have assessed the association between infertility and mental health have yielded inconclusive results.

What this study adds

• Women with current primary or current secondary infertility have levels of anxiety and depression not significantly different from mothers without infertility.

• At the population level, and from a longitudinal perspective, the mental burden of unresolved infertility is smaller than findings from studies on women seeking help for infertility would suggest.

Acknowledgements

The authors wish to thank the Nord-Trøndelag Health Study, which is a collaboration between the HUNT Research Centre (Faculty of Medicine, Norwegian University of Science and Technology, NTNU), Nord-Trøndelag County Council, Central Norway Health Authority and the Norwegian Institute of Public Health. The authors also acknowledge the services of the Medical Birth Registry of Norway (MBRN), and they thank Jörg Aβmus at the Centre for Clinical Research, Helse Bergen Local Health Authority for the categorization of variables from the MBRN.

Declaration of interest

The authors report no conflicts of interest.

R. S. is partly funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London.