title: Are repeated assisted reproductive technology treatments and an unsuccessful outcome risk factors for unipolar depression in infertile women?
abstract: BACKGROUND
  Previous studies have shown conflicting results as to whether unsuccessful medically assisted reproduction is a risk factor for depression among women. This study therefore investigated if women with no live birth after assisted reproductive technology (ART) treatment had a higher risk of unipolar depression compared with women with a live birth after ART treatment.
  
  
  METHODS
  The Danish National ART-Couple (DANAC) Cohort is a national register-based cohort study that consists of women who received ART treatment from 1 January 1994 to 30 September 2009, in Denmark (n = 41 050). Information on unipolar depression was obtained from the Danish Psychiatric Central Research Register. The analyses were conducted in Cox regression analysis.
  
  
  RESULTS
  During the 308 494 person-years of follow up, 552 women were diagnosed with unipolar depression. A Cox proportional hazards model showed that women in ART treatment, with no live birth yet, had a lower risk of unipolar depression compared with women with a live birth. Women had the highest risk of unipolar depression 0-42 days after a live birth (adjusted hazard ratio 5.08, 95% CI 3.11-8.29) compared with women with no live birth. A lower, but still increased, risk of unipolar depression, was found in women 43 days to 1 year and >1 year after a live birth compared with women with no live birth yet.
  
  
  CONCLUSIONS
  Motherhood is an important trigger of unipolar depression in women conceiving after ART treatment.
authors.affiliation: Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Camilla S
authors.initials: CS
authors.lastname: Sejbaek
authors.affiliation: Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark.
authors.forename: Anja
authors.initials: A
authors.lastname: Pinborg
authors.affiliation: Psychiatric Center Copenhagen, Copenhagen University Hospital, Rigshopitalet University Hospital, Copenhagen, Denmark.
authors.forename: Ida
authors.initials: I
authors.lastname: Hageman
authors.affiliation: Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Forman
authors.affiliation: Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Charlotte Ø
authors.initials: CØ
authors.lastname: Hougaard
authors.affiliation: Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Lone
authors.initials: L
authors.lastname: Schmidt
mesh_terms: D001714:Bipolar Disorder / Q000453:epidemiology; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000523:psychology* / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D027724:Reproductive Techniques, Assisted; D019233:Retreatment; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology
keywords: Assisted reproductive technology treatment; cohort study; depression; live birth; register-based study; women