Does Fertility Treatment Impact Perinatal Mental Health?
A population-based study offers new insight, read the full research breakdown here
What’s the Research?
If you work with postpartum clients, there’s a good chance you’re already seeing it: the lingering impact of fertility struggles, long after a positive test.
That low mood at 5 months postpartum? The anxiety that seems to come out of nowhere? For some clients, it’s not just about sleepless nights or new parent stress, it’s about the grief and exhaustion that started months or even years before conception.
This new Ontario-based study confirms what many of us have suspected: the experience of infertility, regardless of how someone conceives, raises the risk of postpartum mental illness by 12–14%. And not just right after birth. These mood and anxiety disorders often show up several months later, just when clients are expected to be “adjusted” and “grateful.”
So even if fertility isn’t your specialty, this research matters because it’s changing how we understand what shows up in the postpartum period, and why.
Let’s break it down:
Infertility treatment and postpartum mental illness: a population-based cohort study
Dayan et al. (2022), CMAJ Open
What was the study trying to learn?
The study titled “Infertility Treatment and Postpartum Mental Illness: A Population-Based Cohort Study” aimed to determine whether individuals who experience infertility, whether treated or untreated, are at an increased risk of developing postpartum mental illness.
The researchers specifically sought to compare the incidence of mental health conditions after childbirth among three groups: those who conceived naturally, those who received noninvasive infertility treatments (such as ovulation induction or intrauterine insemination), and those who underwent invasive procedures (such as in vitro fertilization). By examining these groups, the study aimed to identify whether subfertility or the experience of assisted reproductive technologies contributes to a higher likelihood of postpartum mental illness.
This research is intended to inform clinical care and emphasize the importance of mental health screening and support for individuals with a history of infertility.
What did they do to explore this?
To explore the relationship between infertility treatment and postpartum mental illness, the researchers conducted a population-based retrospective cohort study using health administrative data from Ontario, Canada. They included individuals who gave birth to a single live infant between 2006 and 2014 and who had no prior history of mental illness in the two years before conception. The study categorized participants into three groups: those who conceived without reproductive assistance, those who received non-invasive infertility treatment (such as ovulation induction or intrauterine insemination), and those who underwent invasive treatment (like in vitro fertilization).
The team used linked health databases to track mental health diagnoses in the first year postpartum, identifying conditions such as mood disorders, anxiety disorders, and psychosis. They applied multivariable log-binomial regression models to estimate the relative risk of postpartum mental illness across the different conception groups, adjusting for factors such as age, socioeconomic status, rurality, and other relevant maternal characteristics. This approach allowed the researchers to assess whether infertility and its treatment were associated with an increased risk of postpartum mental illness, independent of other confounding factors.
What did they find in the exploration?
The study found that individuals with subfertility or those who used infertility treatments had a slightly increased risk of developing postpartum mental illness compared to those who conceived naturally. Among over 786,000 births, the rate of postpartum mental illness within one year was approximately 61 cases per 1,000 births for women who conceived without assistance.
In contrast, individuals with subfertility or those who received infertility treatments had a relative risk increase of about 12% to 14%. Specifically, individuals with subfertility faced a 14% higher risk, those who underwent noninvasive treatments had a 12% higher risk, and those who used invasive treatments like IVF also experienced a 14% higher risk. Most cases of postpartum mental illness involve mood or anxiety disorders diagnosed in outpatient settings, typically occurring around 4 to 5 months after delivery.
More severe mental illnesses that required emergency care or hospitalization were less common and occurred more frequently in those who conceived without reproductive assistance.
What conclusions can be drawn from this?
The study concludes that individuals experiencing subfertility or undergoing infertility treatments have a slightly increased risk of developing postpartum mental illness compared to those who conceive without medical assistance. While the overall increase in risk is modest, these findings highlight the need for healthcare providers to be more aware of the mental health challenges faced by patients who have had difficulty conceiving. The similar risk levels across both noninvasive and invasive treatment types suggest that it is not the specific medical interventions causing this increased risk, but rather the broader experience of infertility itself, including the emotional and psychological stress associated with it.
These results emphasize the importance of integrating mental health screening and support into fertility care and postpartum follow-up. The study encourages clinicians to consider mental health as a critical aspect of care for individuals who have utilized fertility services or experienced delays in conception. Additionally, public health and clinical policies should ensure that these populations are not overlooked in postpartum mental health initiatives. Early identification and intervention could help reduce the burden of postpartum mental illness in this potentially vulnerable group.
The takeaway? Ask about fertility history. Not just whether someone had IVF or IUI, but what that experience was like for them. The stress of delayed parenthood can shape how someone experiences new parenthood, and we can offer better care when we understand that connection.
This research gives us one more tool to approach postpartum mental health with nuance, compassion, and context.