It's not selective serotonin reuptake inhibitors (SSRIs) but depression and anxiety disorders that are associated with a lower pregnancy and live birth rate after in vitro fertilization (IVF), according to a large Swedish study.

Treatment with antidepressants has increased significantly in recent years, both in the general public and in women of reproductive age. The substance group of SSRIs in particular has been more frequently used. However, little is known about how antidepressants affect fertility and the probability of pregnancy.

A recent study of more than 23,000 women was the largest ever to examine the association between depression, anxiety, and antidepressants on the chances of success of in vitro fertilization.The researchers analyzed all IVF procedures that were performed in Sweden from 2007 and established through multiple registers correlations with information on depression diagnoses, anxiety disorders and prescribed medications. 

The results of the study have been published in the journal Fertility and Sterility, and are of great interest to physicians treating infertility as well as women who wish to conceive and undergo IVF.

SSRI unproblematic for IVF

Of all the women in the study, 4.4% had depression or anxiety disorder in the two years prior to the start of their IVF cycle and/or had antidepressant medication in the six months prior to the start of the cycle. The scientists compared the pregnancy rate, the number of live births and the miscarriages of these women with those women who had no psychopathological diagnosis or no antidepressant medication.

It was found that women diagnosed with depression or anxiety had lower rates of pregnancy in their first IVF treatment than those women who did not have such a diagnosis. However, the use of antidepressants was rather beneficial, because depressive or anxious women showed less probabilities of conceiving without medication. However, this effect could only be shown for SSRI, which was the largest group of antidepressants taken, and not for other antidepressant groups.

Depression and anxiety as te main culprits

In summary, the study authors say that it is the depression and anxiety that were the underlying factors leading to lower pregnancy and live birth rates. However, it should be noted that lifestyle factors and genetic influences may also play a role that could not be measured because it was a non-randomized work.