The Effect of Psychiatric Interventions on Depression and Fertility in Infertile Patients with Polycystic Ovarian Disease
Author(s): Fatemeh Ramazanzadeh, Ahmad Ali Nourbala, Fatemeh Davari Tanha and Fatemeh Mostaan*
Background: Nowadays, about 12% of couples face infertility problems that overwhelm their personal and social life. Psychosocial problems reported in infertile patients include depression, aggression, anxiety, sexual dysfunction, incompatibility, lack of individual control and decreased self-esteem. Polycystic Ovary Syndrome (PCO) is the most common endocrine disorder leading to infertility in women.
Objective: This clinical trial study aimed to investigate the effect of psychiatric interventions on depression and fertility in infertile patients with polycystic ovarian in comparison with non-polycystic ovarian disease.
Methods and Materials: This clinical trial study was carried out on 62 infertile women (41 cases with PCO and 31 cases without PCO) who had depression and referred to Valiasr hospital in Tehran during 2011-2012. All patients fulfilled the General Health Questionnaire-28 (GHQ-28). Those who scored at least 21, fulfilled Beck Depression Inventory (BDI-II) to check depression and patients who scored at least 17, referred to a psychiatrist to be treated with Fluoxetine 20-60 mg/day or psychotherapy. Three months after the start of treatment, beck questionnaire was examined again and after four weeks after the start of the intervention, the fertility success rate was examined by β-hCG test. Unjustifiable infertile patients, infertility with mannish causes including oligospermia or azoospermia, having with moderate to severe endometriosis, infertile patients previously treated with Invitro- fertilization (IVF) or Intra-cytoplasmic sperm injection (ICSI), and patients with infertility longer than five years were excluded. Data were analyzed using SPSS version 16 statistical software. The relationship between variables was investigated using chi-square; t-test and ANOVA repeated measure. The significance level was considered <0.05.
Results: Mean age of the patients in the intervention and control groups was 26.55 year and 26.08 years old, respectively. Both groups were homogeneous regarding age, education, occupation, type of infertility (primary or secondary), history of psychology disorder and duration of infertility (p>0.05). The fertility rate was significantly different in the two groups after the intervention (20 patients in the intervention group and only 3 in the control group) (p=0.0001). Among those who were pregnant after the intervention, 9 patients (64.2%) had PCO and 11 patients (64.7%) had no PCO (p=0.999). Mean score of Beck questionnaire in the intervention group changed from 25.48 to 13.12 (p=0.0001), but in the control group remained unchanged.
Conclusion: Psychiatric interventions in infertile patients with depression, in addition to their positive effect on the improvement of their depression, increase their fertility success rate.