“About one in five clinically recognized pregnancies end in a miscarriage,” Dr. Cheung Sze Yan Charleen of Queen May Hospital, Hong Kong, and colleagues, told Psych Central. “Our results identified significantly higher stress, anxiety, and depression levels in women who conceived after assisted reproduction, leading us to conclude that miscarriage resulted in greater psychological trauma to these women.”
A total of 150 women were analyzed during the course of the study. Half of them had conceived naturally; half had undergone assisted reproductive technology to conceive. The average ages varied slightly (37 for those in the assisted reproductive group and 31 in the natural conception group), and the average time of miscarriage was about six days earlier for the assisted reproduction group. However, all of the women had miscarried within their first trimester of pregnancy (during the first 12 weeks of pregnancy).
All women that were included in the study were interviewed and asked to fill out questionnaires at weeks one, four and 12 after their miscarriage. The goal was to measure their mental well-being, distress and psychological responses to the loss of pregnancy. Two different questionnaires were used – the 12 item General Health Questionnaire and the 22 item Revised Impact of Events Scale.
Overall, both groups of women suffered the highest amount of stress, anxiety, and depression within the first week of their miscarriage. However, researchers found that those in the assisted reproductive group had significantly higher distress scores at weeks four and 12 than those that had conceived naturally. The ART group was also twice as likely to develop “significant psychological morbidity” (i.e. severe depression) when compared to the natural conception group (9.3 percent versus 5.3 percent).
“Elevated emotional stress after miscarriage could therefore be associated with the duration of the subfertility and the need for assisted reproduction,” Charleen said, adding that those who have miscarried after ART could benefit from timely support and intervention, as well as more research into the long-term psychological impact of miscarriage among those using assisted reproduction technologies.
But the pain and loss that affects all women who suffer miscarriage cannot be ignored. In fact, Dr. Annosofie Adolfsson of the University of Skovde, Sweden, who investigated the traumatic aspects of miscarriage, says that many women suffer from so much pain and loss because they often hold themselves responsible. She even found that some women held themselves responsible and were worried they’d done something to trigger the miscarriage, such as eating something they shouldn’t have.
“Women also held themselves responsible for the event psychologically if they felt they were under undue stress, if they did not want the baby enough, or perhaps their own negative thoughts triggered the miscarriage,” Adolfsson told Psych Central.
For that reason, Peirre Martin Hirsch, editor of BJOG: An International Journal of Obstetrics and Gynecology, the medical journal in which the study was published, says that all women – no matter how they conceive, could benefit from better interventions after miscarriage.
“Though miscarriage is common, women are often unprepared for the loss and suffer a great range of psychological reactions from grief, to anxiety,” Hirsch told Psych Central. “The findings of this study emphasize the importance of early identification and appropriate management process to help improve the psychological well-being of women who miscarry. Women should seek guidance from their obstetrician for their best treatment and support options after an early pregnancy loss.”
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