title: Psychiatric disorders leading to hospitalization before and after infertility treatments.
abstract: BACKGROUND
  This study aimed at determining the psychiatric morbidity of women undergoing infertility treatments, before and after treatment as compared with control women.
  
  
  METHODS
  The number of women hospitalized because of psychiatric disorders was obtained from the Hospital Discharge Register (1969-2006) in a cohort of women who purchased drugs for in vitro fertilization, intra-cytoplasmic sperm injection or frozen embryo transfer treatments (n = 9175) in 1996-1998 in Finland and their controls (n = 9175). The age- and residence-matched controls were further adjusted in the analysis for socio-economic position and marital status.
  
  
  RESULTS
  Women with infertility treatments had fewer hospitalizations due to depression, psychotic disorders, personality disorders, anxiety disorders, bipolar disorder or mania, eating disorders, adjustment disorders and alcohol or other intoxicant abuse before their treatments than did controls. However, the difference was statistically significant only for psychotic disorders [Odds ratios (OR) 0.38, 95% confidence intervals (CI) 0.20-0.72]. Differences in hospitalization remained similar also during the 10-year post-treatment follow-up. The exceptions were increased risk of hospitalizations due to adjustment disorders (OR 3.43, 95% CI 1.03-11.4) and decreased risk of alcohol or other intoxicant abuse (OR 0.44, 95% CI 0.25-0.75) among the women with infertility treatments. The infertile women who gave birth had fewer hospitalizations for all psychiatric diagnoses than did infertile women who did not have a baby. The difference was statistically significant for anxiety disorders (OR 0.38, 95% CI 0.18-0.81), depression (OR 0.63, 95% CI 0.41-0.96) and alcohol or other intoxicant abuse (OR 0.38, 95% CI 0.18-0.80). Hospitalizations among infertile women who did not have a baby and controls were similar, with the exception of significantly more hospitalizations for psychotic disorders among controls (OR 0.38, 95% CI 0.19-0.77).
  
  
  CONCLUSIONS
  Women treated for infertility had less serious psychiatric morbidity leading to hospitalization than did the controls, both before and after treatments, suggesting a healthy patient effect. After treatments, the risk of hospitalization due to adjustment disorders was increased among the infertile women. Having a baby after infertility treatments was associated with fewer hospitalizations following psychiatric diagnosis.
authors.affiliation: School of Public Health Medisiinarinkatu 3, University of Tampere, 33520 Tampere, Finland. anna-niina.terava@uta.fi
authors.forename: A-N
authors.initials: AN
authors.lastname: Yli-Kuha
authors.forename: M
authors.initials: M
authors.lastname: Gissler
authors.forename: R
authors.initials: R
authors.lastname: Klemetti
authors.forename: R
authors.initials: R
authors.lastname: Luoto
authors.forename: E
authors.initials: E
authors.lastname: Koivisto
authors.forename: E
authors.initials: E
authors.lastname: Hemminki
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007246:Infertility / Q000150:complications / Q000523:psychology* / Q000628:therapy; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology*; D009017:Morbidity; D027724:Reproductive Techniques, Assisted / Q000523:psychology*; D018570:Risk Assessment