Association between infertility treatment and perinatal depressive symptoms: A meta-analysis of observational studies

Objective: Recent reports have shown a considerable number of couples received infertility treatment, raising new concerns about the association between infertility treatment and perinatal depressive symptoms. However, the conclusions of existing studies were inconsistent. Therefore, we conducted a meta-analysis to determine whether infertility treatment increase the risk of developing perinatal depressive symptoms. Methods: A systematic literature search was performed in several databases up to July 2018 for relevant articles. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup and sensitivity analyses were performed to explore possible sources of heterogeneity. Results: Twenty-two studies with a total of 69,201 individuals were included in this study. The pooled OR of the association between infertility treatment and perinatal depressive symptoms was 1.01(95% CI: 0.83, 1.23), with substantial heterogeneity (I-2 = 63%, P < .001). However, in subgroup analyses, a significantly positive association between infertility treatment and depressive symptoms was observed only in some Asian countries (six studies), and the pooled OR was 1.73 (95% CI:1.07, 2.81). An inverse association was found in 6-12 months after delivery (OR = 0.56, 95% CI:0.33, 0.96). Sensitivity analyses validated evidence of the robustness of the findings. Conclusion: The results show that women who receive infertility treatment do not appear to be at increased risk of significant perinatal depressive symptoms compared with those after spontaneous conception.