Individuals undergoing in-vitro fertilization (IVF) treatment, especially those with unsuccessful IVF pregnancies, face increased mental health risks, according to a population-based retrospective study.
In a cohort of 514,808 women, the incidence rate of new-onset mental illness per 100 person-years was 7.70 among those who conceived via IVF but suffered a loss, 4.57 among those who whose IVF treatment failed to result in pregnancy, 4.21 among those who had a livebirth via IVF, and 3.25 among those who had a livebirth following an unassisted conception. [ESHRE 2026, abstract L26-O-100]
Compared with women who had a livebirth following an unassisted conception (reference group), those who conceived via IVF but suffered a loss had a 41-percent higher risk of new-onset mental illness (adjusted hazard ratio [aHR], 1.41, 95 percent confidence interval [CI], 1.33–1.50).
The risk was lower but remained elevated among women whose IVF treatment failed to result in pregnancy (aHR, 1.22, 95 percent CI, 1.19–1.26) and those who had a successful IVF pregnancy (aHR, 1.13, 95 percent CI, 1.10–1.16).
The finding that the group of women with unsuccessful IVF pregnancies had the highest risk of new-onset mental illness “is consistent with the well-documented psychological burden of pregnancy loss compounded here by the additional stress of fertility treatment,” noted lead investigator Dr Dalia Limor Karol from McGill University in Montreal, Canada.
“However, the elevated incidence across all these IVF groups, including those who achieved a live birth, suggests that there are factors beyond pregnancy loss and pregnancy failures that may contribute to the mental health vulnerability of this population,” Karol added.
The investigator highlighted the need for enhanced mental health screening and early referral pathways for IVF patients throughout treatment and the postpartum period, with particular attention to those experiencing pregnancy loss.
Study details
For the study, Karol and colleagues used data from the Canadian Assisted Reproductive Technology Registry (CARTR) and the MOMBABY birth database. They included 41,734 women who underwent ≥1 IVF cycle between 2013 and 2022 and 473,074 women with an unassisted pregnancy resulting in a livebirth within the same time period in the analyses.
Compared with women with an unassisted pregnancy resulting in a livebirth, women who underwent IVF were notably older, with a mean age of 34.9 to 36.2 vs 29.6 years. Women in the IVF groups were more likely to be in the highest income quintile (23.2 percent to 24.3 percent vs 15.6 percent), less likely to be parous (19.2 percent to 274 percent vs 33.7 percent), and more likely to have chronic hypertension (3.4 percent vs 4.1 percent vs 1.7 percent).
The primary outcome of new-onset mental illness was defined as at least two outpatient visits or at least one emergency department/hospital admission for a psychiatric diagnosis. The diagnosis could be mood or anxiety disorder, psychotic disorder, substance use disorder, self-harm event, eating disorder, or obsessive-compulsive disorder. The median duration of follow-up was 1 year.
The study was limited by the possibility of residual confounding due to misclassification of exposure and outcome, as well as the lack of data on infertility cause, number of embryos transferred, IVF protocol used, number of prior failed cycles, baseline psychological distress, and family history of mental illness.
Future research should evaluate targeted mental health interventions in IVF patients, as well as investigate the role of different diagnoses requiring IVF (eg, endometriosis and polyendocrine metabolic ovarian syndrome) in relation to mental illness, according to Karol.