LAUSR

BACKGROUND Medically assisted reproduction (MAR) can negatively impact women's mental health, particularly when the treatments do not result in a live birth. While the number of women relying on MAR to conceive has grown rapidly, our knowledge about the mental health effects before, during, and after treatment is limited. OBJECTIVE To understand the long-term association between medically assisted reproduction and mental health outcomes for women before, during and after their treatments, and according to whether the treatment resulted in a live birth or not. STUDY DESIGN Using Finnish register data for the period 1995-2018 we estimated the probability of psychotropic purchases (antidepressants, anxiolytics, hypnotics and sedatives) for three groups of women who: 1) gave birth after natural conception (NC), 2) gave birth after MAR treatments (MAR+), or 3) underwent MAR but remained childless (MAR-). We followed women for up to 12 years before and 12 years after the reference date which corresponded to the conception date for women who had a first live birth either after a natural or a MAR conception, or the date of the last MAR treatment for women with no live birth by the end of 2017. We estimated linear probability models before and after the adjustment for socio-demographic characteristics. RESULTS The results show that women who did not have a live birth after undergoing MAR treatments purchased more psychotropics than women who gave birth after conceiving naturally or through MAR, and that these differences did not attenuate over time. 12 years after the reference date 17.73% (95% CI: 16.82-18.63) of MAR- women purchased psychotropics, versus 11.11% of NC (95% CI: 10.98-11.26) and 12.17% (95% CI: 11.65-12.69) of MAR+ women. In addition, women who conceived naturally and through MAR had very similar psychotropic use patterns from three years before conception to four years after, and over the long term. Adjustment for women's socio-demographic characteristics did not change the results. CONCLUSIONS The similarities in psychotropic purchases of women who had a live birth, whether naturally or through MAR, suggest that the higher psychotropic use among women who remained childless after undergoing MAR were likely driven more by involuntary childlessness than by treatment-related stress. The results highlight the importance of counselling for women undergoing MAR treatments, especially if their attempts to conceive are unsuccessful.