Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Hum Reprod. 2023 Nov 2;38(11):2119-2127. doi: 10.1093/humrep/dead179.
What are the effects of male anxiety and depression on IVF outcomes?
Men with anxiety had lower final total motile sperm counts (fTMSC) during IVF compared to men without anxiety; however, there were no differences in live birth rates (LBRs).
Studies have shown that male anxiety causes low sperm motility, worse sperm morphology, and increased DNA fragmentation, which are known to be influential factors on fertilization rates and embryo quality during IVF. However, data are lacking on whether there is a direct association between male anxiety and/or depression and IVF outcomes.
STUDY DESIGN, SIZE, DURATION: This was a survey-based, retrospective cohort study completed at a single, large hospital-affiliated fertility center with 222 respondents who underwent IVF with or without ICSI. The study was conducted between 6 September 2018 and 27 December 2022.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Male partners of couples who underwent IVF or IVF/ICSI completed a Hospital Anxiety and Depression Scale (HADS) questionnaire. They were separated into two groups for both anxiety (HADS-A ≥ 8 or HADS-A < 8) and depression (HADS-D ≥ 8 or HADS-D < 8). Men with an elevated HADS-A or HADS-D score ≥8 were considered to have anxiety or depression, respectively. The primary outcome was LBR. Secondary outcomes included semen parameters at the time of IVF, cycle outcomes, pregnancy outcomes, and prevalence of erectile dysfunction and low libido.
There were a total of 222 respondents, of whom 22.5% had a HADS-A ≥ 8 and 6.5% had a HADS-D ≥ 8. The average age of respondents was 37.38 ± 4.90 years old. Antidepressant use was higher in the respondents with a HADS-A or HADS-D ≥ 8 (P < 0.05). Smoking use was similar between groups for both HADS-A and HADS-D (P > 0.05). When adjusted for male BMI, antidepressant use and smoking, men with a HADS-A or HADS-D ≥ 8 had similar rates of erectile dysfunction (adjusted relative risk (aRR) = 1.12 (95% CI 0.60, 2.06)) and low libido (aRR = 1.70 (95% CI 0.91, 3.15)) compared to those with a HADS-A or HADS-D ≤ 8. Men with a HADS-A ≥ 8 were more likely to have a lower fTMSC on the day of oocyte retrieval (11.8 ≥ 8 vs 20.1 < 8, adjusted ß = -0.66 (95% CI -1.22, -0.10)). However, the LBR per embryo transfer (ET) was similar between the HADS-A groups (43.2% ≥8 vs 45.1% <8, adjusted relative risk = 0.90 (95% CI 0.65, 1.06)). Although depression was uncommon in the entire cohort, the HADS-D groups were clinically similar for fTMSC (18.7 ≥ 8 vs 16.0 < 8) and LBR per ET (46.7% ≥8 vs 45.4% <8).
LIMITATIONS, REASONS FOR CAUTION: Limitations of our study are the survey-based design, the lack of sperm morphology assessment at the time of IVF, our inability to fully assess the HADS-D ≥ 8 cohort due to the small sample size and the large Caucasian demographic.
Couples undergoing IVF have an increased likelihood of suffering from anxiety and/or depression. There is currently a debate on whether or not men should be treated with antidepressants while attempting to conceive due to potential detrimental effects on sperm quality. Our study shows that, regardless of antidepressant use, couples with men who did or did not report anxiety and/or depression have similar LBRs when undergoing IVF. Therefore, it is important to assess both partners for mental health and to not withhold treatment due to a concern about a potential impact of antidepressants or anxiety/depression on sperm quality.
STUDY FUNDING/COMPETING INTEREST(S): There was no funding to report for this study. Z.W. is a contributing author for UptoDate. S.S.S. is on the advisory board for Ferring Pharmaceuticals. E.G. was a medical consultant for Hall-Matson Esq, Teladoc, and CRICO and is a contributing author for UptoDate. The remaining authors have nothing to report.
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男性焦虑和抑郁对试管婴儿结局有何影响？
与无焦虑的男性相比，患有焦虑症的男性在接受试管婴儿治疗期间的最终总活动精子计数（fTMSC）较低；但活产率（LBR）无差异。
研究表明，男性焦虑会导致精子活动力降低、精子形态更差和 DNA 碎片化增加，这些已知是试管婴儿受精率和胚胎质量的影响因素。然而，关于男性焦虑和/或抑郁与试管婴儿结局之间是否存在直接关联的数据尚缺乏。
研究设计、规模、持续时间：这是一项基于调查的回顾性队列研究，在一家大型附属生殖中心进行，共有 222 名接受试管婴儿或试管婴儿/卵胞浆内单精子注射（ICSI）的夫妇的男性伴侣完成了医院焦虑和抑郁量表（HADS）问卷。他们根据焦虑（HADS-A≥8 或 HADS-A<8）和抑郁（HADS-D≥8 或 HADS-D<8）分为两组。HADS-A 或 HADS-D 评分≥8 的男性被认为患有焦虑或抑郁，分别。主要结局是活产率。次要结局包括试管婴儿时的精液参数、周期结局、妊娠结局以及勃起功能障碍和性欲低下的患病率。
共有 222 名受访者，其中 22.5%的人 HADS-A≥8，6.5%的人 HADS-D≥8。受访者的平均年龄为 37.38±4.90 岁。有 HADS-A 或 HADS-D≥8 的受访者中使用抗抑郁药的比例较高（P<0.05）。两组的吸烟使用情况相似（P>0.05）。在调整了男性 BMI、抗抑郁药使用和吸烟因素后，HADS-A 或 HADS-D≥8 的男性勃起功能障碍（调整后的相对风险（aRR）=1.12（95%CI 0.60，2.06））和性欲低下（aRR=1.70（95%CI 0.91，3.15））的发生率与 HADS-A 或 HADS-D≤8 的男性相似。HADS-A≥8 的男性在取卵日的 fTMSC 更有可能较低（11.8≥8 与 20.1<8，调整β=-0.66（95%CI-1.22，-0.10））。然而，每个胚胎移植（ET）的活产率（LBR）在 HADS-A 组之间相似（43.2%≥8 与 45.1%<8，调整后的相对风险=0.90（95%CI 0.65，1.06））。尽管整个队列中抑郁较为少见，但 HADS-D 组的 fTMSC（18.7≥8 与 16.0<8）和每个 ET 的 LBR（46.7%≥8 与 45.4%<8）在临床上相似。
局限性、谨慎的原因：我们研究的局限性是基于调查的设计、缺乏在试管婴儿时的精子形态评估、由于样本量小且白种人占比大，我们无法充分评估 HADS-D≥8 组，以及由于潜在的生育能力受损。
接受试管婴儿的夫妇更有可能患有焦虑和/或抑郁。目前，关于男性在尝试受孕时是否应该使用抗抑郁药存在争议，因为这可能会对精子质量产生潜在的不利影响。我们的研究表明，无论是否使用抗抑郁药，报告有或没有焦虑和/或抑郁的男性的夫妇在接受试管婴儿时的活产率相似。因此，评估双方的心理健康非常重要，不应因担心抗抑郁药或焦虑/抑郁对精子质量的潜在影响而拒绝治疗。
研究资助/利益冲突：本研究无资金支持。Z.W.是 UpToDate 的撰稿人。S.S.S.是 Ferring 制药公司、Teladoc 和 CRICO 的顾问，也是 UpToDate 的撰稿人。其他作者没有要报告的。
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