Studies have shown that male anxiety reduces sperm motility, worsens sperm morphology, and increases DNA fragmentation, all factors that influence fertilization rates and embryo quality during in vitro fertilization (IVF). However, very few studies have focused on a possible association between male anxiety and/or depression and IVF outcomes.
A paper published in Human Reproduction and authored by six Brigham and Women’s Hospital physicians looks at how stress affects not only sperm quality but also IVF success. The investigators found that while men with anxiety had lower final total motile sperm counts during IVF than men without anxiety, there were no differences in live birth rates—regardless of antidepressant use.
Due to concerns about the impact of antidepressants on sperm quality, physicians may be apprehensive about prescribing these medications to men who are attempting to conceive. Corresponding author Zachary Walker, MD, an OB/GYN and reproductive endocrinology and infertility (REI) fellow at the Brigham, hopes this study will encourage physicians to assess patients for mental health disorders and consider the use of antidepressants when appropriate.
“IVF is a stressful process,” Dr. Walker says. “Men of reproductive age who desire to conceive but suffer from anxiety or depression should still be offered medical management such as SSRIs [selective serotonin reuptake inhibitors] or SNRIs [serotonin and norepinephrine reuptake inhibitors] for management of their symptoms. I want physicians to feel more comfortable offering treatment and not fear that they’re going to do harm or ruin a couple’s chances at success.”
Advocating for Clinicians to Assess Mental Health
Four specialists from the Department of Obstetrics and Gynecology and two from the Department of Urology conducted this survey-based, retrospective cohort study. The investigators collected 222 responses from men who underwent IVF at a Brigham-affiliated fertility center 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, live birth rates, and various semen parameters, while also examining the prevalence of erectile dysfunction and low libido among the cohort.
According to HADS scores, 22.5% of respondents experienced anxiety and 6.5% had depression. “We were surprised that men were so much more likely to suffer from anxiety than depression,” Dr. Walker says. “Regardless, these results underscore the importance of the clinician—whether it’s an REI specialist, urologist, or primary care physician—assessing mental health in patients who are starting IVF, especially if they have a history of mental health issues.”
At what point in the IVF process should patients be screened for anxiety and depression? In this study, it was at the time of oocyte retrieval. Dr. Walker recommends that providers screen at the initiation of IVF so that patients can begin mental health treatment earlier, if necessary.
Another noteworthy finding, according to Dr. Walker: Investigators discerned no difference in erectile dysfunction (ED) or low libido between groups of patients with and without anxiety, including those who were or were not on treatment.
“ED and low libido are among the reported side effects of SSRIs,” he says. “But given their somewhat equal distribution amongst the two groups, physicians should be a little more comfortable prescribing these medications in that regard as well.”
A Fruitful Collaboration Between OB/GYN and Urology
This study was the result of a productive collaboration among OB/GYNs and urologists at the Brigham, Dr. Walker says. He worked closely with senior author Martin N. Kathrins, MD, an associate surgeon in the Department of Urology, and would like to see more such dialogue between reproductive specialists in IVF and urologists moving forward.
“It has to be a team effort when it comes to IVF,” he says. “I want to foster that collaborative environment, at the Brigham and elsewhere, to make sure we’re taking the best care of patients.”
Dr. Walker notes that the small proportion of participants with high depression scores made it impossible to evaluate the full impact of depression scores on fertility. An inability to fully assess the hormonal evaluations of all the patients was also a limitation. He hopes future studies will address both of these gaps.
Another limitation: The cohort was roughly 80% Caucasian, which may be indicative of access barriers such as cost and insurance coverage that affect medically underserved racial and ethnic groups seeking fertility care.
“We need to advocate for equal access to care for all patients and make sure we’re more diverse in our patient population,” Dr. Walker says. “Getting more underrepresented people will take time but is something we need to pursue in further studies.”