7. Correlation between infertility and mental disorders

A number of studies have investigated the correlation between infertility and mental indicators and disorders. A vast majority of studies show that a significant correlation existed between infertility and mental indicators. It was identified that among infertile patients, the hardest psychological challenge was anxiety, and for those couples having had a failed treatment, depression was the greatest psychological burden. In an interview conducted with 112 infertile women, it was reported that psychiatric disorder was vivid across 40% of cases. The most pervasive diagnoses were reportedly anxiety disorder (23%), major depressive disorder (17%), and dysthymic disorder (9.8%) in the infertile group in Japan [36]. These findings point out that in comparison to society at large, frequency of psychiatric disorder was higher among cases with a diagnosed infertility issue. In studies encompassing

different communities, it was detected that correlation existed particularly between generalized anxiety disorder and infertility [29, 38–40]. For example, generalized anxiety disorder was associated with infertility in the 11,000-person study conducted in the American community [37]. In Japanese society, which has various cultural characteristics, the results also supported the generalized anxiety disorder [14]. Similarly, in many studies from different society, the highest prevalence of anxiety and depression as a psychiatric illness were detected in patients with infertile [35, 38–40]. Infertility is also compared with chronic physical diseases. In one study that contrasted infertility-diagnosed cases with patients diagnosed with HIV-positive, cancer, cardiac disease, or similar life-threatening chronic diseases, anxiety effect was reported to be higher among the infertile group [41]. By the same token, it was identified that compared to healthy, pregnant women, infertile women maintained higher depression rates [40, 42]. Undoubtedly, the reason for more frequent depressive indicators among women is that interventional diagnosis and infertility treatment procedures are administered on women's body. In a relevant study, it was seen that compared to control group, mood disorder was reported to be 3.4 times and generalized anxiety disorder 2.7 times more widespread in infertile patient group [40]. Among infertile patients, other common psychiatric problems are sexual function disorder, somatization disorder, dysthymia, panic disorder, obsessive compulsive disorder, and social anxiety disorder. Eating disorders such as anorexia nervosa, bulimia nervosa, and obesity were reported to be linked with infertility. In addition, alcohol and drug addiction were also reportedly widespread among infertile cases. Some studies revealed that among infertile women, there was elevated level of anger and stronger aggression, while other studies showed that anger could be turned to the self or to outside. It was highlighted that among patients undergoing infertility treatment, hormonal imbalance in hypothalamus hypophyseal ovarian axle or administered hormonal medications could also lead to mood disorders [2, 8, 38–42]. In a study that examined mental state and personality profile of infertile patients, one mental disorder at some intensity could be detected among 83.8% of women; 52% of the cases were reported to have mild or severe personality disorder [43]. In the same study, it was also revealed that in infertile patient group, depression and anxiety level were higher and mental composure was less stabile which was related with personality traits. With respect to gender, there are certain variations in mental indicators and disorders. Among infertile women, depression is reported to be more widespread; among men, on the other hand, there are a higher number of psychosomatic indicators due to suppressed anxiety [44, 45]. It was reported that among infertile men with an elevated alexithymia trait, there was higher level of experienced stress and worsened life quality [46]. Infertile women were reported to score significantly higher in the categories of psychiatric traces, hostility, cognitive dysfunction, diminished self-respect, anxiety, and depression. Among infertile men, a significant rise was observed in lower self-confidence but heightened anxiety level and somatization symptoms. Compared to women, men got higher scores in satisfaction from marriage and sexual life [47–50]. The reasons for observing more psychopathology among women can be related to assuming more responsibility and feeling of guilt, exposure to higher social pressure, and stigma [51, 52]. In one study, it was reported that 49% of infertile individuals were exposed to stigma [53]. Motherhood being a social role attributed to all women makes woman to fear infertility as a threat for marriage, which then leads to anxiety [8]. During the infertility experience, a woman having a mature personality, total self-confidence, a fulfilling bond with her spouse, and positive attitude to adoption choice can go through fewer psychological problems; on the other hand, inadequate psychological support, unsuccessful treatment interventions, low socioeconomic status, being of a foreign nationality,

#### The Psychosocial Aspect of Infertility DOI: http://dx.doi.org/10.5772/intechopen.80713

absence of partner support were reported to be related with heightened depression risk [46, 47]. In a noticeably significant number of studies, a critical finding showed that negative reaction of one's spouse and parents-in-law were related with higher anxiety-depression scores and lower self-esteem [20].

Mental indicators were extensively analyzed as other causes of infertility. Unexplained infertility was reported to be correlated with high anxiety level and suppressed anger; on the other hand, innate infertility was more linked with depression [54–56]. In male-related infertility cases, compared to other causes, stress level is higher in effect. In one study, it was reported that in male-caused infertility, couples avoided expressing negative emotions and it was positively linked with increased pregnancy ratios [57]. There is a correlation between mental indicators and findings and infertility itself. Findings revealed that anxiety level is a determinant for the result of infertility treatment and decision to continue the protocol [58–62]. Anxiety is also effective on patient's reaction against the possibility of losing baby after a successful treatment and pregnancy-borne complications. Also, anxiety, depression, and deteriorated marriage life are linked with unsuccessful infertility treatment. Infertility-rooted psychological problems could lead to discontinuing the treatment. It was reported that among couples not taking a second chance after a failed IVF treatment, the most decisive cause was psychological burden and incorrect prognosis [63]. Extended infertility term and unsuccessful but expensive treatment attempts were reportedly correlated with heightened depression-anxiety level. A different study indicated that rather than the length of treatment, the length of infertility was more closely associated with depression. In other studies, it was detected that compared to an average-length infertility protocol, depression levels were lower in short- and long-term infertility. Some of the reasons behind this difference are at the onset of treatment procedure, couples believe to have a baby in just a few months but as infertility period extends longer, couples may develop specific coping mechanisms and accept the situation [48–50].
