Infertility's dark moods.

Couples who try but repeatedly fail to conceive a child can end up exploring the far reaches of anguish. A new study suggests, in a reversal of this sequence, that women who experience bouts of depression in the months or years before trying to get pregnant have a substantially greater chance of encountering infertility.

"Our data suggest that depressive symptoms as well as the drugs used to treat these conditions may play an important role in the [causation] of infertility in women," contend Kate L. Lapane, a psychologist at Memorial Hospital of Rhode Island in Pawtucket, and her colleagues. They report their findings in the November-December Psychosomatic Medicine.

The researchers administered questionnaires to 339 women age 22 to 47 who had participated in health surveys conducted in the Pawtucket area during the 1980s.

Of 58 women who cited a history of depressive symptoms-periods of feeling so sad, discouraged, hopeless, or burdened by problems that they "wondered if anything was worthwhile"-14 reported infertility. Lapane's team defined that condition as the inability to get pregnant for at least 1 year with a partner known to be able to conceive a child.

In contrast, only 38 of 281 women noting no prior periods of depression reported infertility. In other words, previously depressed women exhibited about twice the infertility rate of nondepressed women. This difference remained when the investigators controlled statistically for cigarette and alcohol use, antidepressant drug use, weight, amount of physical exercise, and sexually transmitted diseases in the past.

Infertility also showed a strong independent association with imbibing any amount of alcohol at least twice a week and with the prior use of antidepressants.

Although the study is far from conclusive, "depression may be an important factor to consider in future studies of infertility," write David R. Rubinow and Catherine A. Roca, both psychiatrists at the National Institute of Mental Health in Bethesda, Md., in an accompanying editorial.

Other evidence indicates that depressed women who undergo in vitro fertilization or embryo transfers get pregnant far less often than nondepressed women, Rubinow and Roca point out. Depression sparks a variety of hormonal and immune system changes that may contribute to infertility, they suggest.