In today’s world of endless data and information, it sometimes feels like every bad thing is ‘on the rise’. Are our improved screening and diagnosing techniques alerting us to trends that have always existed? Or is the modern society we live in perpetuating an ill state of mental and physical health?
It’s important to remember that even if two things are increasing at the same time, we can’t assume that one is causing the other. However, it is also important to question how our changing lifestyles might be contributing to our changing health and fertility outcomes.
44 percent of Australians aged 16 to 85 have experienced a mental health disorder at some point in their life, and this number appears to be increasing over time. According to a global burden of disease study, the rate of global infertility is also on the rise, with 15 percent of couples living through it.
Thanks to more visibility on social media and the brave couples willing to share their story, it’s becoming more obvious just how stressful and emotional the journey of treating infertility really is. It is estimated that 40 percent of women experiencing infertility also have a mental health diagnosis. This statistic alone shows us that there is most likely a relationship between the two. But it is difficult to determine whether mental health issues and their treatment can contribute to infertility, or if the experience of infertility leads to mental health issues.
Infertility is defined by the inability to conceive after 12 months of regular, unprotected sexual intercourse and it is influenced by so many factors. 25 percent of the time, the cause of fertility is unknown, and so optimising the physical and mental health of both partners is the first line of management.
As many of us have probably experienced, the way we feel, our moods and our headspace can have a significant impact on our bodies both directly and indirectly. Direct influences can include things like the release of cortisol and adrenaline during periods of stress which can suppress the immune system and render us more susceptible to infections and illness. Indirect ways that our state of mind can impact health include things like having the motivation to go to the gym, or the energy to cook a healthy meal at home instead of ordering out.
In Australia, approximately 17 percent of the population is taking an ‘antidepressant’. The most commonly prescribed antidepressant is the SSRI (Selective Serotonin Re-uptake Inhibitor) which you may recognise as ‘citalopram’, ‘prozac’ or ‘sertraline’. The way they work is by increasing the time that serotonin (AKA the happy hormone) hangs around in the brain after being released by specialised cells. SSRIs are also commonly prescribed to people with anxiety, panic disorders, OCD and PTSD.
One of the most common side effects of SSRIs is sexual dysfunction, which can involve reduced libido, difficulty reaching orgasm and erectile dysfunction. But even if the physical act of sex is possible, there are still more hurdles to pass before a pregnancy can take place.
In humans, two structures within the brain (called the hypothalamus and pituitary gland) are intrinsically connected to fertility, as they control the activity of reproductive organs and their ability to create sperm, or develop and release an egg. It is not a stretch to consider that any medication aiming to alter the chemistry of the brain may also affect the way the brain is communicating with our reproductive organs.
This is the hypothesis that researchers around the world have wanted to test. One group from Harvard analysed the research available to date and came to the conclusion that SSRIs do not negatively impact this communication between the brain and reproductive organs in those who identify as a woman. However, they could negatively impact sperm quality. There is currently insufficient data available to prove or disprove this.
Thankfully, reproductive healthcare and our social and political culture is catching on to the fact that both fertility and pregnancy are very dependent on factors from both partners. In the same way that the contraception discussion requires us to consider the shared responsibility of both partners, infertility needs to be something that considers all genders too. This starts with investment into research. While it is still unclear whether mood disorders directly affect fertility, it is clear that the experience of infertility can precipitate mental health disorders.
The stigma surrounding both does not aid in the healthy processing and management of either. As someone experiencing infertility, is important to remind yourself that you are not alone and that your emotions are a normal response. If you are in a position to seek psychological support from a professional, that may be a helpful step. Otherwise, it is so important to continue dialogue with your partner, trusted family or friends.
If this article has raised any concerns, please consult your GP or a medical professional.
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