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Chapter 7 - “It’s Complicated”: The Intersect Between Psychiatric Disorders and Infertility

from II - Therapeutic Approaches

Published online by Cambridge University Press:  24 November 2022

By
Katherine Williams  and
Lauri Pasch
Edited by
Sharon N. Covington
Sharon N. Covington
Affiliation:
Shady Grove Fertility, Rockville, MD
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Summary

The experience of Infertility is extremely stressful for all people.The goals of this chapter are to provide the mental health practitioner with an understanding of the relationship between infertility in men and women and psychiatric illnesses. Patients with a history of major depression are at an increased risk of recurrence of major depression during infertility evaluation and treatment, and women who have had recurrent miscarriages are especially high risk for depression. Some patients will need to continue their antidepressants during the infertility process and pregnancy, and in this chapter we will discuss the risks and benefits associated with antidepressants in this population. Research on the interaction of the infertility medications and bipolar disorder destabilization is lacking, but it is important for the mental health practitioner to recognize that the dramatic hormonal changes associated with ovarian stimulation may lead to increased lability, especially if the medications have the side effect of insomnia. While some mood stabilizers such as lamotrigine are considered relatively safe to take in pregnancy, others, such as valproic acid are associated with congenital abnormalities and should be discontinued. Personality disorder patients may also react to the stress of infertility treatment with primitive defenses that are difficult for the infertility treatment team to manage, such as acting out and splitting. In this chapter, we will discuss the intersection of personality disorders and psychiatry and we will also provide guidance about when to recommend that patients defer or stop infertility treatment due to psychiatric illnesses.

Keywords

major depressionborderline personality disorderclomiphene citratehuman menopausal gonadotropinsprogesteronegonadotropin releasing agonists and antagonistsbipolar disorderantidepressantsmood stabilizersdiscontinuation of treatment
Type
Chapter
Information
Fertility Counseling: Clinical Guide , pp. 79 - 87
Publisher: Cambridge University Press
Print publication year: 2022

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