Australian researchers claim women who conceive using in vitro fertilization (IVF) or other types of assisted reproductive technologies (ART) face mood disorders after giving birth, and eventually encounter parenting difficulties more so than mothers who don't seek assisted reproduction.1
Emotional Challenges of ART Moms
The study was conducted as part of a broader objective to assess the health needs of mothers who use assisted reproductive technologies to conceive, wrote Jane Fisher, PhD, with the School of Population Health at the University of Melbourne in Australia, and her colleagues.
"Australia has some internationally unique health services, including residential early parenting centers, which offer brief admissions to mothers who are having emotional difficulties adjusting to parenthood or caring for infants," Fisher told Priority Healthcare. In a recent survey of one such facility, it was learned that a wider majority of women using the service had conceived using ART. Thus, this study was an attempt to confirm the survey finding that women who use early parenting centers for counseling are ART moms more often than not, she explained.
Mothers who seek counseling from these services take part in structured psycho-educational programs that include advice on how to care for infants, and participation in daily support groups that include infant care and parental adjustment advice, said Fisher. "Mothers who require psychiatric treatment can be admitted to specialist joint mother-baby psychiatric services," she explained.
Patient Information Analyzed
For their analysis, the researchers pulled records of mothers who had given birth using ART, and were subsequently referred to a unit of an area hospital that specializes in treating women with postpartum depression, anxiety disorders and exhaustion. The study focused on women referred to the unit during a two-year period. Information on each patient included the age of both mother and baby, method of conception and delivery, infant birthweight, and whether each mother had given birth to single or multiple infants.
Results from a self-reported questionnaire distributed in the hospital unit, asking each mother about her level of depression, were also collected for the study.
Who Sought Stress Counseling More Often?
The investigators found a significant difference in the numbers of women admitted to the hospital unit for psychological evaluation who had conceived spontaneously versus those who had conceived using assisted reproduction. While about 6 percent of the infants admitted to the unit had been conceived using ART, that compared to just 1.5 percent from the general population. Based on statistical analysis, the Australian investigators determined that women who had given birth using ART were four times more likely to be admitted to the hospital unit than those who had conceived spontaneously.
They also found that levels of depression reported by women in the unit were substantially higher than what was reported in a previous study of mothers from the general population.2
Given the apparent fact that women in the hospital unit were more likely than not to have conceived using ART, and noting that each of the women in the unit had reported high levels of postpartum depression, the research team concludes that these psychological issues may be common to women who seek assisted reproductive technologies to conceive. "The excess of IVF conception in women admitted with their infants to this service … suggests that assisted conception may act as a risk factor for early parenting difficulties," wrote the research team.
To date, this was the largest study of women who sought treatment from a hospital unit specializing in postpartum health problems, they wrote.
"Qualitative investigations have found that after the use of ART to conceive, women may be more anxious during pregnancy, have lower self-esteem and self-confidence in relation to parenting, feel less able to show negative emotions and ambivalence, and be ill prepared for the difficulties associated with the care of a newborn," the researchers wrote.
An 'Under-Recognized' Phenomenon
Since it's been suggested that women who use ART seek out perinatal health services more often than women who don't use assisted conception, it would have been more likely that the severity of depression found in these women in this study would have been reduced, but it wasn't, the investigators pointed out.
In ruling out other possible causes for the depression among the ART women in this study, the investigators note that women who seek assisted reproductive treatment are anxious and depressed more often than not due to the experience of infertility, as well as the grief that develops over a woman's inability to conceive, allowing them to reach their deeply desired objective of parenthood. However, it would seem these negative feelings would normally subside after a successful conception, they point out, but that wasn't the case among the patients studied.
"We think that the experience of infertility and fertility treatment may alter the development of a confident maternal identity and that anxiety about ability to provide effective infant care may persist," Fisher explained. "However, it is currently under-recognized because it is presumed that conception of these very highly desired babies removes the distress associated with infertility."
Other Challenges of ART Moms
Further, women who use ART and then give birth to twins, triplets, or higher face a higher likelihood of experiencing postpartum depression, they wrote. "Women with fertility difficulties may idealize parenthood, including the notion of an instant family created through multiple birth, but underestimate the hazards and difficulties."
In addition to parenting multiples, undergoing a C-section can also exacerbate negative psychological feelings that ART moms experience, the Australian doctors wrote. Both of these events are more likely after ART, as well, they stated.
Women who seek treatment to conceive may also feel less entitled to complain or seek help because, after all, they've achieved their goal in any event. But this may cause them to be "insufficiently prepared for the social isolation, loss of autonomy, and potentially difficult work of infant care," they wrote.
While this study didn't individually assess the impact of either giving birth to multiples or having a C-section on postpartum depression and other mood disorders in women who undergo ART, future studies should be initiated to do so, the researchers stressed.
"In practice, however, these data would suggest that obstetricians, pediatricians, and other clinicians caring for pregnant women and mothers, and infants after childbirth, should be conscious that a previous history of fertility difficulties, advanced maternal age, assisted conception, operative delivery, and multiple birth may heighten risk for postpartum mood disturbance and early parenting difficulties," the study team concluded.
In the meantime, Fisher and her fellow researchers are currently conducting a long-term prospective study of women who conceived using ART, beginning with early pregnancy and concluding when their babies reach 18 months of age. "The results are currently being prepared for publication," she said.
1. Fisher JR, Hammarberg K, Baker HW. Assisted conception is a risk factor for postnatal mood disturbance and early parenting difficulties. Fertil Steril 2005 Aug;84(2):426-30.
2. Evans J, Heron J, Francomb H, Oke S, Golding J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ 2001 Aug 4;323(7307):257-60.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
