Mental Health in Fertile and Infertile Women During the COVID-19 Pandemic: A Comparative Cohort Study

To assess the impact of the COVID-19 pandemic on symptoms of anxiety, depression, and stress among infertile and fertile women.

This prospective cohort study evaluated psychological distress using the 42-item Depression, Anxiety and Stress Scale (DASS-42) at two time points: during the early pandemic (Phase 1) and after six months (Phase 2). The study included infertile women whose embryo transfers were postponed (n=71) and fertile women who had given birth over six months earlier without fertility issues (n=117). Ethical approval was obtained (CAAE: 32964620.3.1001.5334).

The mean age was higher in the infertile group (37.8 vs. 35.5 years; p=0.001). In Phase 1, infertile women reported significantly higher levels of stress (7.7 vs. 5.6; p=0.018) and depression (4.0 vs. 2.3; p=0.002), with no significant difference in anxiety (3.4 vs. 2.7; p=0.389). In Phase 2, stress (3.7 vs. 3.1; p=0.201), depression (4.0 vs. 3.5; p=0.446), and anxiety (5.8 vs. 5.4; p=0.666) scores were similar between groups. Longitudinal analysis in both infertile and fertile groups showed a significant reduction in stress and an increase in anxiety. Depressive symptoms worsened in the fertile group (p=0.018).

Infertile women initially showed higher stress and depression than fertile controls. Over six months, stress declined and anxiety increased in both groups; depressive symptoms remained stable in infertile women but slightly worsened among fertile women. These findings support the inclusion of targeted and ongoing mental health support as part of fertility care.