Psychological Factors in Obstetrics and Infertility

Psychological Factors in Obstetrics

While much more attention has been paid to postpartum de-pression, antepartum depression also adversely affects preg-nancy outcome. Both antepartum anxiety and depression have been associated with growth retardation and premature birth, resulting in lower birth weights, but potential confounding fac-tors have often not been adequately controlled for. Whether depression and other psychological dysfunction cause poorer obstetric outcomes through poor nutrition, substance abuse (including tobacco), poor adherence or no prenatal care, and/ or physiological (hormonal, vascular) effects require further investigation.

Psychological Factors in Infertility

Psychological factors are likely to affect fertility because fre-quency and timing of sexual intercourse are important determi-nants of fertility. Nonconsummation, avoidance of intercourse, vaginismus and psychogenic amenorrhea are attributable to psychological origins. Psychogenic causes do not account for most male impotence but may play a secondary role in many cases.

Whereas some prospective data support psychological fac-tors influencing fertility in the general population, psychological factors appear less potent in predicting pregnancy outcome in couples receiving treatment for infertility. In general, measures of stress, but not of psychopathology, have been associated with infertility. This is a particularly complex subject for study be-cause it involves potential psychological factors in both mem-bers of the couple and interactions between them as well as their effects on sexual behavior and fertility. Most psychological dis-tress seen in infertile couples is a result of, rather than a cause of, infertility.