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How can Depression and anxiety disorders affect fertility

Male fertility

The mood disorders in man may also lead to decreased fertility through the induction of some sexual disorders (e.g. erectile dysfunction or ejaculatory disorders) and through the negative impact on semen quality caused by hormonal imbalance. Additionally, stress can actually lead to a lower sperm count.

Anxiety may appear as a result of worries about sexual performance, sexual technique, sexual frequency and so on. Anxiety with it centre in amygdala (center for emotions, emotional behavior, and motivation) may be the cause of serotonin disturbances (chemical substance inducing reaction between neurones). These changes in serotonin production and function may lead through a hormonal cascade to induction of mentioned sexual disorders. There has been also observed a relation between serotonin receptors and sexual disorders (premature ejaculation, delayed ejaculation, erectile dysfunction) which may be genetically predisposed. Hyposensitivity of serotonin receptors may be related to premature ejaculation, on the other hand hypersensitivity may be related to delayed ejaculation or even absent ejaculation despite full erection.

Female fertility

In case of stressful condition, such as low support received from partner, social discrimination or low self-esteem, anxiety may develop inducing unhealthy stress reaction of the body which may break gonadotropin-releasing hormone pulsation (GnRH; utmost importance in controlling the menstruation cycle) and lead to anovulation when the ovaries do not release the egg during a menstrual cycle. The egg cannot meet the sperm, and hence not fertilized.

Polycystic ovary syndrome (PCOS) is quite often connected with hyperandrogenimia (excessive levels of androgens in the body), increased body weight and menstrual irregularities. All these factors are associated with mood dysfunction which may lead to anxiety feelings. In some cases of PCOS also appear closely related disorders, such as hirsutism (an excessive hairiness) and obesity. Those have negative impact on the appearance of a woman and may induce or worsen the anxiety and social avoidance. Quite similarly, anxiety can be a symptom of anovulation or it can be even the cause of it.

Pic. 1: Mixed anxiety and depressive disorder—diagnostic guidelines for ICD-10 in primary care.
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