Depression anxiety and antidepressant treatment in women: association with in vitro fertilization outcome

A diagnosis of depression, anxiety, or treatment with antidepressants before an in vitro fertilization cycle had a slight negative association with pregnancy and live birth but not miscarriage.


Carolyn E. Cesta, M.Sc., Alexander Viktorin, Ph.D., Henrik Olsson, M.Sc., Viktoria Johansson, Ph.D., Arvid Sjölander, Ph.D., Christina Bergh, M.D., Alikistis Skalkidou, Ph.D., Karl-Gösta Nygren, M.D., Sven Cnattingius, Ph.D., Anastasia N. Iliadou, Ph.D.

Volume 105, Issue 6, Pages 1594-1602



To investigate associations between depression, anxiety, and antidepressants before in vitro fertilization (IVF) and IVF cycle outcomes, including pregnancy, live birth, and miscarriage.


Nationwide register-based cohort study.


Not applicable.


Nulliparous women undergoing their first IVF cycle recorded in the Swedish Quality Register of Assisted Reproduction, January 2007 to December 2012 (n = 23,557).


Not applicable.

Main Outcome Measure(s):

Associations between diagnoses of depression/anxiety, antidepressants, and IVF cycle outcome evaluated using logistic regression to produce adjusted odds ratios (AOR) and 95% confidence intervals (CI).


In total, 4.4% of women had been diagnosed with depression/anxiety and/or dispensed antidepressants before their IVF first cycle. The odds for pregnancy and live birth were decreased (n = 1,044; AOR = 0.86; 95% CI, 0.75–0.98; and AOR = 0.83; 95% CI, 0.72–0.96, respectively). For women with a prescription for a selective serotonin reuptake inhibitor (SSRI) only (n = 829), no statistically significant associations were found. Women with non-SSRI antidepressants (n = 52) were at reduced odds of pregnancy (AOR = 0.41; 95% CI, 0.21–0.80) and live birth (AOR = 0.27; 95% CI, 0.11–0.68). Women with a depression/anxiety diagnosis with no antidepressant (n = 164) also had reduced odds of pregnancy (AOR = 0.58; 95% CI, 0.41–0.82) and live birth (AOR = 0.60; 95% CI, 0.41–0.89). Among the women who became pregnant (39.7%), there were no statistically significant associations between exposure and miscarriage except for the women taking non-SSRI antidepressants (AOR = 3.56; 95% CI, 1.06–11.9).


A diagnosis of depression/anxiety and/or treatment with antidepressants before IVF was slightly associated with reduced odds of pregnancy and live birth. Women with the presence of depression/anxiety without antidepressants had a more pronounced reduction in odds, implying that the underlying disorder is important for the observed association.

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