Centre for Longitudinal Studies, Social Research Institute, University College London, London, United Kingdom.
Centre for Longitudinal Studies, Social Research Institute, University College London, London, United Kingdom.
Am J Obstet Gynecol. 2023 Mar;228(3):311.e1-311.e24. doi: 10.1016/j.ajog.2022.10.041. Epub 2022 Nov 3.
Medically assisted reproduction can negatively affect women's mental health, particularly when the treatments do not result in a live birth. Although the number of women relying on medically assisted reproduction to conceive has grown rapidly, our knowledge about the mental health effects before, during, and after treatment is limited.
This study aimed to understand the long-term association between medically assisted reproduction and mental health outcomes for women before, during, and after their treatments, and according to whether the treatment resulted in a live birth.
Using Finnish register data for the period from 1995 to 2018, we estimated the probability of psychotropic purchases (antidepressants, anxiolytics, hypnotics, and sedatives) for 3 groups of women who: (1) gave birth after natural conception, (2) gave birth after medically assisted reproduction treatments, or (3) underwent medically assisted reproduction but remained childless. We followed up women for up to 12 years before and 12 years after the reference date, which corresponded to the conception date for women who had a first live birth either after a natural or a medically assisted conception, or the date of the last medically assisted reproduction treatment for women with no live birth by the end of 2017. We estimated linear probability models before and after adjustment for sociodemographic characteristics.
The results show that women who did not have a live birth after undergoing medically assisted reproduction treatments purchased more psychotropics than women who gave birth after conceiving naturally or through medically assisted reproduction, and that these differences did not attenuate over time. Twelve years after the reference date, 17.73% (95% confidence interval, 16.82-18.63) of women who underwent medically assisted reproduction but remained childless purchased psychotropics vs 11.11% of women who gave birth after natural conception (95% confidence interval, 10.98-11.26) and 12.17% (95% confidence interval, 11.65-12.69) of women who gave birth after medically assisted reproduction treatments. In addition, women who conceived naturally and through medically assisted reproduction had very similar psychotropic use patterns from 3 years before conception to 4 years after, and over the long term. Adjustment for women's sociodemographic characteristics did not change the results.
The similarities in psychotropic purchases of women who had a live birth, whether naturally or through medically assisted reproduction, suggest that the higher psychotropic use among women who remained childless after undergoing medically assisted reproduction were likely driven more by involuntary childlessness than by treatment-related stress. The results highlight the importance of counseling for women undergoing medically assisted reproduction treatments, especially if their attempts to conceive are unsuccessful.
辅助生殖技术可能对女性的心理健康产生负面影响，尤其是在治疗未导致活产的情况下。尽管依赖辅助生殖技术受孕的女性人数迅速增加，但我们对治疗前、治疗中和治疗后的心理健康影响的了解有限。
本研究旨在了解辅助生殖技术对女性在治疗前、治疗中和治疗后的心理健康结果的长期影响，并根据治疗是否导致活产进行分析。
使用芬兰 1995 年至 2018 年的登记数据，我们估计了三组女性的精神药物购买概率：（1）自然受孕后分娩，（2）辅助生殖治疗后分娩，或（3）接受辅助生殖治疗但仍未生育。我们对女性进行了长达 12 年的治疗前和 12 年的治疗后随访，参考日期对应于自然受孕或辅助受孕后首次活产的女性的受孕日期，或 2017 年底未活产的女性的最后一次辅助生殖治疗日期。我们在调整社会人口特征后，分别在治疗前和治疗后估计了线性概率模型。
结果表明，与自然受孕或辅助生殖受孕后分娩的女性相比，接受辅助生殖治疗但未生育的女性购买精神药物的比例更高，且这些差异并未随时间减弱。参考日期 12 年后，17.73%（95%置信区间，16.82-18.63）接受辅助生殖治疗但仍未生育的女性购买了精神药物，而自然受孕后分娩的女性为 11.11%（95%置信区间，10.98-11.26），辅助生殖治疗后分娩的女性为 12.17%（95%置信区间，11.65-12.69）。此外，自然受孕和辅助生殖受孕的女性在受孕前 3 年至受孕后 4 年以及长期内的精神药物使用模式非常相似。调整女性的社会人口特征并没有改变结果。
自然受孕和辅助生殖受孕的女性在精神药物购买方面的相似性表明，接受辅助生殖治疗但仍未生育的女性精神药物使用较高，可能更多是由于非自愿性不孕，而不是治疗相关的压力。这些结果强调了对接受辅助生殖治疗的女性进行咨询的重要性，特别是如果她们的受孕尝试不成功。
