Distress and reduced fertility: a follow-up study of first-pregnancy planners.

OBJECTIVE

To assess the effect of psychological distress on time to first pregnancy.

DESIGN

A follow-up study of time to pregnancy with prospective data on distress, with controlling for potential confounding variables.

SETTING

Two university hospitals.

PATIENT(S): Danish couples (n = 430) who were planning their first pregnancy and had no previous reproductive experience were followed for six menstrual cycles. Psychological distress was measured in each menstrual cycle by the General Health Questionnaire.

INTERVENTION(S): None.

MAIN OUTCOME MEASURE(S): A clinically recognized pregnancy or a biochemical pregnancy detected in urine samples from each period of vaginal bleeding.

RESULT(S): For cycles with the highest distress score (General Health Questionnaire score >80th percentile), the probability of conception per cycle was 12.8%, compared with 16.5% in other cycles (adjusted odds ratio [OR] 0.6; 95% confidence interval [CI] 0.4-1.0). The effect of distress was found almost exclusively among women with long menstrual cycles (OR 0.1; 95% CI 0.01-0.4 and OR 0.9; 95% CI 0.5-1.4 for women with cycles of > or =35 and <35 days, respectively). An increased incidence of early embryonal loss was also found among highly distressed women with long cycles, but was based on a small number of observations.

CONCLUSION(S): Psychological distress may be a risk factor for reduced fertility in women with long menstrual cycles.