Infertility Summary

Treatment of Depression Caused by Infertility; an Experimental Study Fatemeh Alzahra Infertility and Reproductive Health Research Center of the Babol University of Medical Sciences in Babol, Iran conducted a research study in 2007, to evaluate the “effectiveness of cognitive behavioral therapy along with fluoxetine for improvement infertility stress in infertile women,”(Faramarzi et al, 1). Often private situations, such as infertility and grief, can be overlooked as a psychological concern by general practitioners and fertility specialists. Faramarzi et al’s study, The Effect of the Cognitive Behavioral Therapy and Pharmacotherapy on Infertility Stress: A Randomized Controlled Trial, can be used as an educational tool for many physicians
and patients. It may be widely overlooked that infertility can create a form of stress which may lead to a variety of psychological problems.
(Faramarzi et al, 1). The Psychologists involved in the experiment Used 89 diagnosed infertile women with mild to moderate depression scores on the Beck depression scale. “The participants all had the following characteristics: “less than 45 years of age, more than five years of education, more than two years of infertility, having at least one in vitro fertilization, no fertility treatment for a three-month interval after IVF, no practicing in any relaxation techniques, no participating in any support group no taking any psychotherapy, and no assisted reproductive therapy,” (Faramarzi, et al, 2). They then randomly assigned the participants to one of three groups. The random assignment was done by “a computer randomize list in which participants were labeled randomly to number 1-124 by an investigator with no clinical involvement in the trial,”(Faramarzi et al, 3). 89 participants were then divided into either a cognitive behavioral therapy group, a Fluoxetine group, which is the generic drug name for the popular anti-depressant drug, Prozac, or a control
group. In the study the independent variable was the use of either, cognitive behavioral therapy, Fluoxetine or no treatment for the participant’s mild depression which most likely was caused by their diagnosis of infertility. Prior examination of depression was based on low ratings on a questionnaire related to psychological concerns specific to infertility. The independent variable was the decrease in ratings for social concerns, sexual concerns, marital concerns, rejection of childfree lifestyle and need for parenthood, determined by a follow-up questionnaire given post experiment, and treatment. Members of the Cognitive Behavioral Therapy group, (referred to as CBT in the writings), participated in a two hour group CBT group session once a week, for ten weeks. Members of the fluoxetine group, self-administered the medication daily, (20 mg), for 90 days. The third group, the control group, did not participate in any therapies, or psycho-pharm treatments. In the experimental and control groups, there were no statistically significant differences among participants for age, education level, and the duration of infertility. The means for all groups were within 1.5 years for age differences, .6 variation for years of education, and the means duration of infertility struggles ranged from 5.4-6.3 years, (Faramarz et al, 4). The most overwhelming feeling caused by infertility, that the participants dealt with, and the administrators of the experiment hoped to improve, was the rejection of the childfree lifestyle they were forced to live. The results of the experiment showed that the best treatment, (in this particular study), for depression caused by infertility was cognitive behavioral therapy. Fluoxetine was able to improve the patients mean score for sexual concerns, but Fluoxetine did not affect any of the other four depression concerns examined. There was no significant difference found in the control group at the beginning and end of the study. Each and every mean of the five main fertility problems, decreased after participants in the CBT group underwent their treatment. The CBT treatment was done in a group format. The sessions began with an explanation of the causes of infertility for each woman by an expert gynecologist. Later, the irrational beliefs about an individual’s cause of infertility were challenged. Finally, the participants were taught varying techniques for maintaining their new outlooks. Also, in the second half of the therapy, progressive muscle relaxation of Jacobson was included during the cognitive behavioral sessions, (Faramarzi et al, 3). The Effect of The Cognitive Behavioral Therapy and Pharmachotherapy on Infertility Stress: A Randomized Controlled Trial, is an important study because the findings show that many woman, and subsequently, their partners are suffering from a form of situational depression that may affect many different aspects of each sufferer’s life. It is important that specialists recommend the appropriate treatment for situational depression caused by infertility stresses. The findings show that the most appropriate treatment for this particular form of depression is cognitive behavioral therapy, when comparing it to the medicinal anti-depressant treatment of floxitine. The study may also indirectly show that therapy in general may be a better treatment for depression caused by infertility than anti-depressants alone. In our text, Infertility depression may fall into one of three categories.
Initially it may be considered a form of reactive dysphoria. It “is characterized by relatively low-grad mood changes—sadness, disappointment, despair—that occur in response to minor losses and disappointments,” (Preston O’Neal Talaga, 75). Infertility may also be considered a form of grief, since it is, in fact, the loss of a child one wanted, but was never, as of yet, able to have. Our text explains grief as, “uncomplicated bereavement…. Resulting in significant degrees of emotional distress for a period of six to twelve months, and continued, albeit less intense, grieving often lasts for an additional one to three years, (Preston O’Neal Talaga, 75). As stress takes its toll on an infertility sufferer, they may develop reactive depression which, “can range in intensity from mild or moderate to severe. These disorders occur in response to identifiable psychosocial stressors, (Preston O’Neal Talaga,
77).
Our text mentions a potential biological basis for depressions in some people, which may be triggered by a life event, but in all actuality, the patient may have a predispositioned likelihood of becoming depressed. The authors refer to this as reactive-biological depression. Explaining that, “these disorders begin in much the same way as the more classic reactive depressions described above. Over time we see the emergence of various Physiological symptoms,” (Preston O’Neal Talaga, 80). Our authors would see a benefit for both therapeutic treatments, as well as Psychotropic treatment for these situationally depressed patients. Considering the patients in the Faramarzi study who were administered floxitine treatment were not also given therapeutic treatment, our authors would support the CBT and Pharmacotherapy study’s findings. Our text states that, “even under ideal circumstances when medications work well, most patients must engage in a good deal of soul-searching, mourning, and working through. The combined approaches of pharmacotherapy and psychotherapy offer the best chance of successful recovery from depression,” (Preston O’Neal Talaga, 89). Therefore, without pairing the floxitine group with some form of therapy, the medication would be of little use for the treatment of infertility based depression.
Because of the evidence shown in the Faramarzi et al study, physicians and patients alike, may now be able to recommend and participate in the appropriate treatment for patients infertility based depression. Faramarzi et al’s findings show that patients should participate in a cognitive behavioral based therapy program in order to find more contentment in their infertility diagnosis. Previous studies have shown that stress may be a direct cause, or influence on infertility in general. Faramarzi et al mentions that, “more studies are needed to investigate the effect of CBT on rate of reproduction fertility in infertile women.” Thus seeing a need in studying the success rate in reducing infertility stress to increase the likelihood of patients eventually conceiving.

Works Cited
Faramarzi, Mahbobeh, Ph.D. Pasha, Hajar M.Sc. Esmailzadeh, Seddigheh M.D Kheirkhah, Farzan, M.D.
Heidary, Shima Ph.D. Afshar, Zohreh, M.Sc. "The Effect of The Cognitive Behavioral Therapy and Pharmacotherapy on Infertility Stress: A Randomized Controlled Trial." Royan Institute International Journal of Fertility and Sterility. Vol 7, No 3. Oct-Dec 2013: 199-206. Print.
Preston, John D. PSYD, ABPP O’Neal, John H. MD Talaga, Mary C. RPH, PHD. Handbook of Clinical
Psychopharmacology for Therapists. 7th Edition. Oakland, CA: New Harbinger Publications, Inc., 2013. Print.