In vitro fertilization (IVF) is a time-intensive and sometimes stress-inducing fertility procedure. Yet how does that stress impact its success? Investigators at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, assessed the results of hysteria and depression in men on fertility and IVF outcomes. Their findings reveal no correlation between anxiety, no matter antidepressant use, on IVF outcomes or live birth rate. Results are published in Human Reproduction.

Our findings indicate that despite past concerns over antidepressant medication’s impact on fertility, treatment mustn’t be withheld from men experiencing anxiety or depression.”

Zachary Walker, MD, reproductive endocrinology and infertility fellow within the Center for Infertility and Reproductive Surgery on the Brigham

Investigators conducted a voluntary, survey-based study, collecting responses from 222 men undergoing IVF at a hospital-affiliated fertility center between September 2018 and December 2022, using the Hospital Anxiety and Depression Scale (HADS) questionnaire. Participants scoring eight or higher on the survey’s sub-sections were considered to have anxiety or depression, respectively. The study evaluated the correlation between these mental health conditions and IVF outcomes and live birth rates, in addition to various semen parameters, while also examining the prevalence of erectile dysfunction and low libido among the many cohort.

Results indicated that 22.5% of respondents experienced anxiety and 6.5% experienced depression, in keeping with HADS scores. There was no notable difference in live birth rates between those with and without anxiety, though men with anxiety had, on average, lower total motile sperm counts during egg retrieval. Walker and the team found that IVF outcomes and live birth rates were unaffected by antidepressant use. Moreover, there have been no statistically significant findings regarding erectile dysfunction or low libido between groups.

“There’s debate amongst fertility specialists about prescribing antidepressants during IVF as a consequence of potential fertility impacts. Nonetheless, stress itself can alter hormones, sometimes resulting in a condition called hypogonadotropic hypogonadism, where the brain tells our reproductive organs to shut down because we’re too stressed to conceive,” explained Walker. “So, while anxiety medication can hinder fertility, so can stress. Provided that IVF is notoriously stressful, our findings underscore the importance of prioritizing patient mental health during fertility treatment.”

The study’s limitations included an inability to evaluate sperm morphology at time of egg retrieval and to judge the complete impact of depression scores on fertility as a consequence of the small portion of participants with high depression scores. Researchers also couldn’t fully assess all patients’ hormone levels – something they aim to research with future studies. Roughly 80 percent of the cohort was Caucasian, which Walker explains could also be indicative of access barriers, resembling cost and insurance coverage, that many medically underserved racial and ethnic groups face when looking for fertility care.

Going forward, Walker and his team aim to judge patient hormone levels throughout the duration of fertility treatment to higher understand how stress affects IVF and birth outcomes. He emphasizes the importance of screening patients for mental health issues prior to starting IVF.

“These findings add to the growing body of literature examining general medical health and male fertility outcomes. Based on this study, I might encourage my patients to pursue and proceed appropriate therapies for anxiety and depression without concern that they may adversely impact their IVF outcomes,” said senior creator Martin Kathrins, MD, a urologist within the Department of Urology on the Brigham.