Female Infertility Diagnosis and Adult-Onset Psychiatric Conditions: A Matched Cohort Study

Study questionIs there an association between infertility diagnosis and long-term adult-onset psychiatric conditions in women? Summary answerInfertility diagnosis in women is linked to higher risks of mood disorders, anxiety- and stress-related disorders, and behavioral syndromes with physical components, but not schizophrenia or other psychotic disorders, particularly notable from 9 years after the first infertility diagnosis. What is known alreadyInfertility, especially in women, is associated with major mental health challenges around the time of diagnosis. However, the long-term connection with a wide range of psychiatric disorders is largely unknown. Study design, size, durationThis study employed a matched-pair design within the UK Biobank (UKB) cohort, including 3,893 females with a diagnosis of infertility and 15,603 matched female controls, totaling 19,496 participants. Participants/materials, setting, methodsFemale UKB participants with a diagnosis of infertility were matched to females without the diagnosis in a 1:4 ratio based on year of birth, index of deprivation of their residency area, and primary care data linkage status. The diagnosis of female infertility was identified by the first occurrence of a primary or secondary diagnosis in either primary care or hospital records. Additional analyses explored interactions between infertility diagnosis and both miscarriage and childbearing status on psychiatric conditions. Main results and the role of chanceDiagnosis of infertility was associated with higher risks of mood disorders, anxiety- and stress-related disorders, and behavioral syndromes with physical components, but not with schizophrenia or other psychotic disorders. The most notable increases in the risk of psychiatric diagnoses were observed 9 years after the first infertility diagnosis. No significant interactions were found between infertility diagnosis and either miscarriage or childbearing status on psychiatric conditions. Sensitivity analysis confirmed the robustness of these associations across different data sources for infertility diagnosis and psychiatric condition ascertainment. Limitations, reasons for cautionThe studys limitations include the racial homogeneity and the overall healthier status of the UKB cohort compared to the general UK population, and potential underestimation of associations due to misclassification of subfecund women. Wider implications of the findingsThese results emphasize the need for integrated mental health support in infertility care and long-term monitoring of infertility patients for psychiatric risks. Study funding/competing interest(s)The study was conducted using data from the UK Biobank, a prospective cohort study based in the UK. No competing interests were declared.