Anxiety symptoms following conception through assisted reproductive technology: a systematic review

The use of assisted reproductive technology (ART) to aid conception is increasing worldwide, yet little research has explored psychological outcomes following ART conception.

To systematically review the prevalence and mean anxiety symptom scores among women who conceived following ART, from confirmed pregnancy until 12 months postpartum, compared to women who conceived without ART (spontaneous conception, SC).

We searched MEDLINE, PsycINFO, and EMBASE from their start dates to 3^rd June 2024 using a piloted search combining keywords related to ART, anxiety symptoms, pregnancy or the postnatal period, using Boolean operators. We extracted data on prevalence and mean anxiety symptom scores in the ART and SC groups, along with study characteristics.

Twenty studies met inclusion criteria, comprising cohort (n=15), case-control (n=1), and cross-sectional (n=4) designs. Most studies measuring symptoms during the first (n=3) and second trimester (n=8) reported non-significant differences, apart from one second trimester study which reported elevated pregnancy-specific anxiety symptoms in the ART group. Studies measuring symptoms during the third trimester (T3) (n=16) and postnatal period (n=8) reported mixed findings of higher (T3:n=4; postnatal:n=2), lower (T3:n=1; postnatal:n=2), and no significant differences (T3:n=9; postnatal:n=4) anxiety in the ART group relative to SC. Two third trimester studies reported higher pregnancy-specific anxiety but lower or equivalent generalized anxiety symptoms in the ART group.

While some studies reported elevated anxiety symptoms following ART, particularly in late pregnancy and postpartum, findings remain mixed, with others indicating no differences or lower symptom levels. Further longitudinal research is warranted to better understand the postpartum experiences of women with fertility difficulties.