Women who have healthy babies as a result of infertility treatments may be unlikely candidates for postpartum depression. But new research suggests they might be uniquely vulnerable.
Gina (not her real name) is a case in point. The birth of her daughter four years ago should have been the happiest time of Gina's life. After years of infertility, two failed in vitro fertilization attempts, and countless other treatments, she and her husband finally had the healthy child they so desperately wanted.
But soon after bringing the baby home, Gina realized something was very wrong. Instead of joy, the Alabama mom felt crushing anxiety that left her almost unable to function.
"I remember calling my friends and just sobbing," she tells WebMD. "I had this beautiful baby and I felt like I couldn't take care of her. I was completely irrational, but it didn't occur to me that it was postpartum depression."
Increased Risk of Emotional Problems
In the latest issue of the journal Fertility and Sterility, researchers in Australia report that treatment for infertility appears to be associated with an increased risk for developing emotional problems related to parenting.
Conceiving a child after undergoing infertility treatment was four times more likely to result in emotional issues related to parenting than having a child without such treatments.
Brooke Shields' Battle
Postpartum depression affects as many as one in 10 new mothers, according to the American College of Obstetricians and Gynecologists.
In her new book, Down Came the Rain, actress Brooke Shields writes about her battle with depression following the birth of her now 2-year-old daughter, Rowan Francis. Shields underwent a well-publicized struggle with infertility, including several failed IVF attempts, before her daughter's birth.
In a March interview with WebMD the Magazine, Shields said she experienced escalating depression with intrusive thoughts of self-harm and even suicide after delivering her baby.
"I really didn't want to live anymore," she said.
With the help of psychotherapy, antidepressant medication, and support from family and friends, Shields got the help she needed. She said she wrote her book to try and help remove the stigma associated with postpartum depression.
The Australian study included just over 700 new moms with mild to moderate depression, anxiety, or other emotional problems that led them to seek treatment at a special clinic.
The researchers determined that 6 percent of the mothers seeking emotional treatment conceived through infertility treatments. This is four times greater than the 1.5 percent of infants conceived through infertility treatments in the general population.
Mothers who conceived through IVF and other forms of assisted reproduction were more likely than other moms to be older, have multiple births, and have difficult deliveries that ended in cesarean sections -- three other suspected risk factors for postpartum depression.
The researchers suggest that women who achieve successful pregnancies after undergoing infertility treatment may benefit from additional emotional support before and after their babies are born.
"Obstetricians, pediatricians and other clinicians caring for pregnant women and mothers and infants after childbirth should be conscious that a previous history of fertility difficulties ... [and] assisted conception ... may heighten risk for postpartum mood disturbance and early parenting difficulties," write researcher Jane Fisher, PhD, and colleagues of the University of Melbourne.
American Society of Reproductive Medicine President Robert Schenken, MD, says there is a growing awareness among infertility specialists of a link between assisted reproduction and postpartum depression.
"I think specialists are aware of it, but there is a need to disseminate this information to the general obstetrician/gynecologists who actually deliver these women," he tells WebMD.
Schenken is professor and chairman of the department of obstetrics and gynecology at the University of Texas Health Science Center in San Antonio.
Taking Action Early
Shields said she wants more children and anticipates having IVF again to make that happen. But this time she said she will be ready if depression strikes again. She knows a history of postpartum depression is a red flag for problems with future births.
"I may not feel (any depression) after this second baby, or I may plummet even further, but I am prepared," she told WebMD.
Gina and her ob-gyn also recognized the signs of depression well before the birth of her second child, a healthy boy born six weeks ago.
She began taking an antidepressant before his birth and continues to take it.
"The first time around it took me at least three months to figure out what was wrong and get on treatment," she says. "I was really fighting it. With this pregnancy I had a doctor who knew what was going on and took it very seriously."
SOURCES: Fisher, J. Fertility and Sterility, August 2005; vol 84: pp 426-430. WebMD the Magazine: "Brooke Shields' Struggle with Postpartum Depression," April/May 2005. Robert Schenken, MD, president, American Society for Reproductive Medicine; professor and chairman, department of obstetrics and gynecology, University of Texas Health Science Center, San Antonio.