Anxiety and depression in women with endometriosis: a comparative study across fertility contexts

To assess the prevalence of anxiety and depression in women with endometriosis undergoing ovarian stimulation and oocyte retrieval for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) or fertility preservation (FP) compared with women without endometriosis.

Observational cohort study conducted in a university hospital-based research center.

Women who underwent ovarian stimulation and oocyte retrieval between November 2023 and May 2024 for IVF/ICSI or nononcological FP. Two populations were analyzed: (i) infertile women undergoing IVF/ICSI as part of a current family-building project, and (ii) women undergoing oocyte vitrification for FP.

Participants were classified as endometriosis (exposed) or disease-free (unexposed) based on imaging (transvaginal ultrasound and/or magnetic resonance imaging). All patients completed a 55-item questionnaire, including the validated Hospital Anxiety and Depression Scale (HADS), on the day of oocyte retrieval.

Prevalence of anxiety and depression, defined as a HADS-A or HADS-D score ≥11.

The study included 324 women: 196 IVF/ICSI patients (73 with endometriosis and 123 controls) and 128 FP patients (38 with endometriosis and 90 controls). Overall, 111/324 (34.3%) had endometriosis. Anxiety prevalence was higher in women with endometriosis in both populations, but did not reach significance. In patients undergoing IVF/ICSI, depression was significantly more frequent in those with endometriosis vs. controls (5.5% vs. 0.8%). In the FP population, women with endometriosis more often reported prior psychological support (21.1% vs. 4.4%) and psychotropic use (13.2% vs. 2.2%). Multivariate analysis identified severe deep dyspareunia as a factor independently associated with anxiety and/or depression (adjusted odds ratio 2.7; 95% confidence interval, 1.1-7.2).

Among patients undergoing IVF/ICSI, depression was significantly more prevalent in women with endometriosis, whereas no significant difference was observed in the FP population. These findings underscore the importance of integrating psychological support into assisted reproductive technology management for women with endometriosis, particularly those experiencing severe pain and/or infertility.