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ANAHEIM, Calif. -- Women with a history of infertility, especially those who never had children, were more likely to develop depression and anxiety in midlife than women without infertility, a study found.

Women with infertility, including those who did not get pregnant after trying for at least 1 year, had an increased risk of depressive symptoms before menopause (adjusted risk ratio [aRR] 1.28, 95% CI 1.09-1.50), reported Victoria Fitz, MD, a third-year fellow at Massachusetts General Hospital in Boston.

Women unable to have a child at all -- who were involuntarily childless -- faced an even higher risk of depression leading up menopause (aRR 1.45, 95% CI 1.06-1.98), Fitz said in a presentation at the American Society for Reproductive Medicine annual meeting.

Women with a history of infertility also had an increased risk of anxiety throughout the menopausal transition (aRR 1.19, 95% CI 1.07-1.33), as did those who were involuntarily childless (aRR 1.28, 95% CI 1.02-1.60).

A history of infertility or involuntary childlessness was not associated with increased vasomotor or vaginal symptoms during the menopausal transition.

Primary care and ob/gyn providers should be aware of a potential increased risk of anxiety and depression among patients with infertility so they can receive appropriate screening, Fitz told 乌鸦传媒

"I don't think I've thought of infertility as signaling a reason to give someone a full depression screening," Fitz said. "It could be viewed as a risk factor if it is confirmed in more studies."

She added it was "reassuring" that patients with infertility did not see increased risks of vasomotor or vaginal symptoms during menopause.

In this study, researchers analyzed data from the Study of Women's Health Across the Nation , a multisite longitudinal cohort study, to assess the relationship between infertility or involuntary childlessness with menopausal symptoms.

Women included in the analysis were between 42 and 52 years old, were not receiving hormone therapy, were not pregnant, and had at least one menstrual period in the last 3 months.

Study participants underwent a baseline visit and 16 follow-up visits up until 2017. At each visit, investigators assessed physical measures and conducted a detailed assessment of patients' menopausal stage and transition. The investigators evaluated vasomotor and vaginal symptoms, sleep, and depression and anxiety.

Women who reported a history of infertility and who had not previously given birth to a child were considered involuntarily childless. Those with missing data on pregnancy were excluded from the analysis. Fitz's group adjusted their findings for covariates including oral contraceptive use, marital status, insurance, education, and race or ethnicity.

The researchers included 3,061 women in their analysis. Of the total study population, 600 participants had infertility and 127 were involuntarily childless.

All women in the study had an average age of around 46, regardless of their fertility status. Around 63% of the women without infertility were married or partnered, compared to 79% in the group with infertility or involuntary childlessness.

Women with infertility had an increased risk of sleep disturbances during the premenopausal period (aRR 1.22, 95% CI 1.06-1.40). While there was a small increased risk in vaginal dryness among women with infertility, the differences between most vasomotor or vaginal symptoms were not significant.

The study relied on self-reported data to classify patients as infertile or involuntarily childless, which may have limited the findings, Fitz acknowledged. Additionally, the researchers did not have access to information about the cause of infertility.

Future research should investigate symptoms of anxiety and depression among women who attempted to use assisted reproductive technologies to get pregnant, and look more closely at how causes of infertility may influence these symptoms, Fitz said.

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