2. be associated with improvement in specific treatment
outcomes (11–15). For example, studies have shown that
the emotional toll of fertility treatment is one of the
primary reasons that patients discontinue treatment
prematurely when their chances of pregnancy are still
good (14, 16). MHS could decrease premature treatment
discontinuation, thereby increasing the chance that
patients remain in treatment long enough to reach their
goal of pregnancy.
Despite these strong arguments in favor of MHS
during fertility treatment, it is not clear that all patients
need them. It has been argued that encouraging all
patients to use MHS is misguided because many patients
can cope with stress of infertility without professional
help (17). Researchers have called for fertility treatment
programs to screen and target high-risk patients (e.g.,
patients who exhibit clinically significant psychological
distress) for MHS referral, but there are no data regarding
whether clinics actually do this (18–20).
Current data on MHS service use and referral for
fertility patients are extremely limited. The few studies
that do exist were conducted in the United Kingdom and
suggest that few patients receive referrals or use MHS.
Specifically, in a multicenter study of fertility patients in
Scotland, Souter et al. reported that only 14% of patients
said they had been offered MHS, though 57% thought
they would use MHS if offered to them (21). Regarding
actual MHS use, Hernon et al. surveyed fertility clinics in
the U.K. and reported that fewer than 25% of patients
used MHS (7). In a study focusing on one U.K. fertility
clinic, Boivin et al. showed that only 8.5% of women
and 6.1% of men currently in treatment reported having
used MHS (17).
The purpose of the present study was to determine the
extent to which female fertility treatment patients and
their male partners experienced clinical levels of distress
(depression or anxiety), how many received MHS, and
how many were provided with information about MHS
by their fertility clinics in the United States. We were
particularly interested in whether the use of MHS, or
the provision of information about MHS by fertility
clinics, was targeted to the most high-risk individuals,
that is, those patients who reported clinically significant
levels of distress. Additionally, we examined whether
the answers to these questions differed based on having
had a successful child-related outcome versus failure
(i.e., those who remained childless at the end of the
study). We reasoned that those who were not successful
might experience higher rates of distress as time passed
and thus might be more likely to seek MHS; furthermore,
owing to their ongoing childlessness, they may have had
more contact over time with fertility clinics, which may
in turn have afforded the clinics more opportunity to pro-
vide these patients with information about MHS.
Conversely, those patients who had a successful child-
related outcome might report lower rates of depression
and anxiety as time passed; furthermore, they would
have transferred their care to their obstetrician and there-
fore perhaps their fertility clinics would have had fewer
opportunities to provide those patients with information
about MHS.
MATERIALS AND METHODS
Study Population and Protocol
Men and women were participants in the Fertility Experiences
Project, an investigation of the experiences of heterosexual
couples seeking treatment for infertility. Information
regarding the cohort has been published previously (22–25).
Couples were recruited from five reproductive
endocrinology practices over eight locations in the San
Francisco Bay area in 2000–2004. Eligibility criteria
included: 1) first visit to the fertility clinic; 2) no previous
cycles of in vitro fertilization (IVF); 3) no hysterectomy or
sterilization; 4) no recurrent miscarriage; 5) currently trying
to get pregnant with a male partner; and 6) English
speaking. Potential participants received initial information
about the research at the clinic or via mail and were
telephoned by research staff to receive additional
information, assess eligibility, and schedule the baseline
interview. Participants were told that the purpose of the
research was to learn more about patients' experiences and
decisions surrounding infertility, their perspectives
regarding possible fertility treatments, and the impact of
infertility on their lives. Both partners were encouraged to
participate, but women were allowed to participate alone.
Baseline in-person interviews were scheduled within 3 months
of the first clinic visit and before the start of fertility treat-
ment. Participants were sent a questionnaire packet in the
mail which they completed independently at home; the ques-
tionnaire was collected at the baseline interview. From a total
of 1,040 eligible women, 416 (41.2%) women completed the
baseline interview, 372 (35.1%) refused, 194 (18.3%) were un-
able to be contacted, and 58 (5.5%) undertook a fertility treat-
ment procedure before the interview could be conducted. In
addition, 378 of their male partners also completed the base-
line interview. Demographic data recorded at the baseline
assessment included age, ethnicity, income, educational level,
and the number of months the couple had been attempting
conception. Source of the fertility problem was obtained
through complete medical record abstraction and was catego-
rized into female only, male only, mixed factors, and no
known factors.
Follow-up assessments were conducted 4, 10, and
18 months after the baseline interview and involved the
completion of questionnaires and telephone interviews. At
each follow-up interview, participants were asked to report
on fertility treatments and outcomes since the last interview.
Participants remained in the study regardless of their treat-
ment use and outcomes or where they received their fertility
care. Retention rates were high, with 96% of the original sam-
ple completing the 4-month follow-up, 93% completing the
10-month follow-up, and 89% completing the 18-month
follow-up. Of the original sample at baseline, 352 women
and 274 men had complete data and were included in the
present study.
The study protocol was approved by our Institutional Re-
view Board, and informed written consent was obtained from
210 VOL. 106 NO. 1 / JULY 2016
ORIGINAL ARTICLE: MENTAL HEALTH, SEXUALITY, AND ETHICS
3. every participant in person before the start of the interview.
Each participant was compensated by up to $170 USD for
completion of the entire 18-month study.
Study Measures
Depression. Depressive symptoms were measured at each of
the four time points with the use of the Center for Epidemio-
logic Study of Depression Scale (CES-D) (26), which measures
depressive symptoms and was developed for use in the gen-
eral population. The CES-D consists of 20 items which are
rated with the use of a 4-point ordered response set to indicate
how frequently symptoms were experienced during the previ-
ous week (from 0 ¼ rarely or none of the time; to 3 ¼ most or
all of the time). Total scores were created for each respondent
by summing their item responses, resulting in a measure with
a possible range of 0–60, with higher scores indicating more
depressive symptoms. Participants with CES-D scores R16
have been considered to be at risk for clinical depression
(27). The test has excellent concurrent validity (levels up to
r ¼ 0.72) and internal consistency (a ¼ 0.85 for general pop-
ulation; a ¼ 0.90 for clinical populations). The present study
yielded an internal consistency score of a ¼ 0.90.
Anxiety. Anxiety symptoms were measured at each of the
four time points with the use of the State Anxiety subscale
of the State-Trait Anxiety Inventory (STAI) (28). The STAI is
a 20-item measure of the intensity of the emotional state
characterized by subjective feelings of tension, anxiety, and
apprehension during the past week. Responses are made
with the use of a 4-point ordered response set (from 1 ¼ not
at all; to 4 ¼ very much so). Total scores were created for
each respondent by summing their item responses, resulting
in a measure with a possible range of 20–80, with higher
scores indicating more anxiety symptoms. The test has excel-
lent concurrent validity (levels up to r ¼ 0.80) and internal
consistency (0.91 for general populations). A cut-point of
39 is often used as indicative of clinically significant symp-
toms of state anxiety (29). The present study yielded an inter-
nal consistency of a ¼ 0.92.
Mental health service information provision and use. At the
18-month follow-up, participants were asked, ‘‘Did any
clinic where you were receiving fertility treatment make in-
formation available to you about professional MHS?’’
(note: this could have included the original clinic from
which participants were recruited for the research or any
other clinic where they sought care later). Participants
were also asked, ‘‘Did you see a mental health professional
for help with personal or relationship issues related to your
difficulty having a baby?’’ If they had seen a mental health
professional, they were asked to report the number of ses-
sions they attended.
Analysis
All analyses were conducted separately for women and men
owing to the nonindependence of couples' data. The percent-
age of participants who met clinical cutoff criteria for risk for
depression or anxiety at each assessment point was calculated
and used as the primary data for analysis. Specifically, to
examine whether the use of MHS, or the provision of informa-
tion about MHS by fertility clinics, was targeted to the most
distressed individuals, two groups of at-risk individuals
were identified: those who met criteria for clinically
significant depression at at least one assessment point (termed
‘‘at risk’’) and those who met the criteria for clinically signif-
icant depression at at least three of the four assessment points
(termed ‘‘high risk’’). We used chi-square analyses to compare
use of MHS and provision of MHS information in: a) at-risk
patients versus all others; and b) high-risk patients versus
all others.
The full sample was then divided into two subgroups:
those participants who had a successful child-related outcome
by the end of the study (i.e., they were pregnant, delivered, or
had adopted a child) versus those who were remained infertile
by the end of the study (i.e., they had not achieved a successful
child-related outcome). Chi-square analyses compared
depression, anxiety, MHS use, and receipt of information in
the two groups. We also conducted chi-square analyses
comparing at-risk/high-risk patients with all others for each
of these two subgroups to assess whether there were system-
atic differences in their experiences with MHS use and receipt
of referrals.
RESULTS
The demographic and reproductive characteristics of the
study sample are summarized in Table 1. The average age
for men and women was in the mid-thirties. The majority
were white, highly educated, and with relatively high
TABLE 1
Participant characteristics.
Baseline characteristic Women (n [ 352) Men (n [ 274)
Age (y), mean Æ SD
(range)
35.6 Æ 4.6 (22–46) 36.9 Æ 5.2 (22–59)
Ethnicity, %
White 73.0 79.4
Asian/Pacific Islander 12.9 11.0
Hispanic/Latino 4.4 4.4
Black 3.5 1.1
Other 4.1 4.0
Education, %
Less than college
graduate
23.9 25.3
College graduate
or above
76.1 74.7
Duration of infertility (y),
mean Æ SD (range)
2.1 Æ 1.9 (0–11) 2.1 Æ 1.8 (0–11)
No. of treatment cycles,
mean Æ SD (range)
2.4 Æ 2.2 (0–11) 2.3 Æ 2.2 (0–11)
Depression, %
Baseline 24.8 10
Follow-up 1 (4 mo) 35.4 16.3
Follow-up 2 (10 mo) 27.5 15.2
Follow-up 3 (18 mo) 26.8 15.7
Anxiety, %
Baseline 51.1 32.5
Follow-up 1 (4 mo) 53.4 41.2
Follow-up 2 (10 mo) 48.4 37.4
Follow-up 3 (18 mo) 45.6 39.4
Pasch. Fertility patients and mental health. Fertil Steril 2016.
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4. household incomes. At baseline, almost one-half had been at-
tempting conception for >2 years. The source of infertility
was 58% female only, 7% male only, 31% mixed, and 4%
no known factors. On average, participants had had about
two fertility treatment cycles during the study, with a range
up to 11. At the conclusion of the 18 months of the study,
42% were still facing infertility, 2.3% had adopted a child,
40% had delivered a baby, and 14% were currently pregnant.
Depression and Anxiety
Table 1 shows the percentage of participants who scored in
the clinical range at each assessment point for the sample
as a whole. Across all participants, 56.5% of women and
32.1% of men scored in the clinical range for depressive
symptoms at one or more assessments (at risk). Further-
more, 16.5% of women and 5.8% of men reported pro-
longed depressive symptoms (i.e., they scored in the
clinical range at at least three of the four assessments:
high risk). For anxiety, 75.9% of women and 60.6% of
men scored in the clinical range for anxiety at one or
more assessments (at risk), and 40.1% of women and
28.1% of men reported prolonged anxiety symptoms (i.e.,
they scored in the clinical range for anxiety at at least three
of the four assessments: high risk).
Patients Receiving MHS
Overall, 21% of women and 11.3% of men reported that they
had received MHS to help with their personal or relationship
issues related to their difficulty having a baby at some point
during the study period. Regarding frequency of visits, 54%
of patients who saw a therapist went for fewer than five
sessions.
To determine whether provision of MHS was targeted to
those at risk, we examined the percentage of patients who
received MHS according to level of depressive and anxiety
symptoms. At-risk women and men were significantly more
likely to see a mental health professional than non–at-risk
patients (Table 2). The same was true of high-risk women
and men. However, the vast majority of women and men
did not see a mental health professional.
Provision of Information About MHS from Fertility
Clinic
Overall, 26.7% of women and 24.1% of men reported that a
clinic where they sought fertility treatment made information
available to them about professional MHS. To determine
whether provision of information about MHS by fertility
clinics was targeted to at-risk patients, we examined the per-
centage of patients who received information about MHS ac-
cording to level of depressive and anxiety symptoms. At-risk
women and men were no more likely than other patients to
report having received information from a fertility clinic
about MHS (Table 2). Similarly, high-risk women and men
were no more likely than other patients to report having
received information from a fertility clinic about MHS
(Table 2).
Comparisons between Participants with
Successful and Unsuccessful Outcomes
We examined rates of depression, anxiety, and MHS use and
referrals for the two subgroups of patients: those who had a
successful child-related outcome by the end of the study
and those who did not (Table 3). Women who were unsuccess-
ful were more likely to be in the clinical range for depression
than successful patients at the 10-month and 18-month
TABLE 2
Mental health services (MHS) use and information as a function of depression and anxiety levels for women and men.
Depression Women Men
At risk (n [ 199) All others (n [ 153) c2
At risk (n [ 88) All others (n [ 186) c2
Received MHS 29.1 10.5 18.20b
22.7 5.9 16.83b
MHS information provided 27.1 26.1 0.04 25.0 23.7 0.06
High risk (n [ 59) All others (n [ 293) c2
High risk (n [ 16) All others (n [ 258) c2
Received MHS 28.4 18.1 9.06a
43.8 9.3 17.82b
MHS information provided 23.7 27.3 0.32 12.5 24.8 1.25
Anxiety Women Men
At risk (n [ 267) All others (n [ 85) c2
At risk (n [ 166) All others (n [ 108) c2
Received MHS 26.2 4.7 17.97b
15.7 4.6 7.94a
MHS information provided 25.5 30.6 0.86 24.1 24.1 0.00
High risk (n [ 141) All others (n [ 211) c2
High risk (n [ 77) All others (n [ 197) c2
Received MHS 29.8 15.2 10.88a
22.1 7.1 12.37b
MHS information provided 22.7 29.4 1.93 19.5 25.9 1.24
Note: Values presented as percent unless stated otherwise. At risk (for this table and all subsequent tables) indicates clinical range for depression or anxiety at at least one assessment point. High risk
(for this table and all subsequent tables) indicates clinical range for depression or anxiety at at least three or more assessment points.
a
P< .01; b
P< .001.
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5. follow-ups. They were also marginally more likely to be in the
high-risk group. Women who were unsuccessful were more
likely to be in the clinical range for anxiety than successful
patients at the 18-month follow-up. Men who were unsuc-
cessful were more likely to be in the clinical range for depres-
sion than successful patients at the baseline and marginally so
at the 10-month follow-up. They were also more likely to be
in the high-risk group. Successful child-related outcomes
were not associated with level of anxiety for men. Unsuccess-
ful women were more likely to report that they had seen a
mental health professional to help with their personal or rela-
tionship issues related to their difficulty having a baby, yet the
majority did not. Unsuccessful men were marginally more
likely to report that they had seen a mental health profes-
sional, and again, the majority did not. Successful child-
related outcomes were not associated with whether men or
women reported that a clinic where they sought fertility treat-
ment made information available to them about professional
MHS.
We then repeated the chi-square analyses within each
subgroup to determine if MHS use or referrals had been
targeted to those most at risk for distress. Results are
summarized in Supplemental Tables 1 and 2 (available
online at www.fertstert.org) for the unsuccessful and
successful groups, respectively. For both groups, results
show that at-risk and high-risk patients were more likely to
have reported receiving MHS; this was generally true for
both women and men. However, in both groups, neither at-
risk or high-risk patients were more likely to have reported
receiving MHS information. Indeed, among the unsuccessful
group, when marginally significant differences in MHS infor-
mation receipt were found (i.e., for at risk anxious women and
high risk anxious men), those not at risk reported receiving
information more often than those at risk.
DISCUSSION
Although it has frequently been suggested that patients
involved in fertility treatment may benefit from MHS to
help manage the stress of treatment, this is one of the only
known studies to examine the extent to which patients and
their partners use MHS and receive information about MHS
from their fertility treatment providers. Regarding
psychological distress, the results were consistent with past
research and indicated that both patients and their partners
experience high rates of depression and anxiety symptom-
atology during the course of fertility treatment. Of note,
although the rates of distress were high compared with other
study samples, it should be noted that these percentages
encompass the full 18-month period of the study (versus re-
flecting a cross-sectional rate of clinically significant depres-
sion or anxiety symptomatology). The results support and
extend the findings of earlier research by showing that over
an 18-month period, a majority of women and men experi-
ence clinically significant levels of depression and/or anxiety
at some point.
Regarding use of MHS, both women and their male part-
ners reported low rates of MHS use during the 18-month
study period. These results are consistent with past research
from the U.K. (7, 17). Also, as seen in past research,
distressed patients were more likely than nondistressed
patients to receive MHS (30). Still, most distressed patients
did not receive MHS; this was true even for those who
experienced prolonged distress. Those who did receive MHS
received very little (i.e., fewer than five sessions).
Finally, most patients reported that their fertility clinic
did not provide information to them about MHS. As noted
above, it has been argued that not all fertility patients need
MHS, and that clinics should identify those at high risk and
target treatment efforts to those patients (19, 20). Yet our
results indicated that highly distressed patients were no
more likely to report receiving information about MHS from
their clinic than nondistressed patients. Thus, the data
suggest that not only were referrals to MHS relatively rare,
they were not tailored to those at risk.
As expected, successful outcomes were generally associ-
ated with less distress as time passed, and we have shown
this to be true as well specifically for IVF patients (24). Also
TABLE 3
Comparison of sample subgroups (unsuccessful versus successful
child-related outcome by end of study).
Women Unsuccessful
(n [ 152)
Successful
(n [ 200) c2
Depression
Baseline 22.0 26.9 1.10
Follow-up 1 (4 mo) 37.0 34.2 0.28
Follow-up 2 (10 mo) 34.2 22.3 6.02b
Follow-up 3 (18 mo) 35.5 20.1 10.46c
At risk 59.2 54.5 0.78
High risk 21.1 13.5 3.53a
Anxiety
Baseline 49.7 52.3 0.23
Follow-up 1 (4 mo) 52.4 54.2 0.11
Follow-up 2 (10 mo) 52.0 45.5 1.40
Follow-up 3 (18 mo) 54.6 38.7 8.80c
At risk 77.0 75.0 0.18
High risk 42.1 38.5 0.47
MHS
Received MHS 26.3 17.0 4.51b
MHS information provided 28.9 25.0 0.69
Men Unsuccessful
(n [ 117)
Successful
(n [ 157) c2
Depression
Baseline 14.7 6.5 4.90b
Follow-up 1 (4 mo) 18.3 14.9 0.54
Follow-up 2 (10 mo) 20.0 11.7 3.24a
Follow-up 3 (18 mo) 19.7 12.7 2.43
At risk 35.9 29.3 1.34
High risk 9.4 3.2 4.71b
Anxiety
Baseline 34.5 31.0 0.37
Follow-up 1 (4 mo) 39.8 42.2 0.15
Follow-up 2 (10 mo) 38.2 36.9 0.05
Follow-up 3 (18 mo) 42.7 36.9 0.94
At risk 56.4 63.7 1.49
High risk 30.8 26.1 0.72
MHS
Received MHS 15.4 8.3 3.37a
MHS information provided 20.5 26.8 1.43
Note: Values presented as percent unless stated otherwise. In this table, chi-square compares
successful and unsuccessful groups. MHS ¼ mental health services.
a
P< .10; b
P< .05; c
P< .01.
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6. as expected, unsuccessful patients were generally more likely
to seek mental health services. However, we had expected
that unsuccessful patients would be more likely to receive
information from their fertility clinic about MHS, not only
because of experiencing failure, but also because they likely
spent more time during the study period in contact with the
clinic, whereas successful patients would have moved on to
obstetrical care by the end of the study. But our findings did
not bear this out. Success or failure was not associated with
whether a patient reported receiving MHS information, not
evenforthosewhowereatriskforclinicallysignificantdepres-
sion or anxiety. These findings further emphasize the lack of
tailoring MHS information to those who might need it most.
The low rates at which patients report being provided
with information about MHS is striking given: 1) the high
rates of depression and anxiety symptomatology; and 2) the
well documented stress of infertility and benefits of MHS.
In the course of fertility treatment, the number and intensity
of visits should provide ample opportunities for clinic pro-
viders and staff to observe, ask, or assess if a patient is highly
depressed or anxious. Our findings reveal that even those pa-
tients who remained unsuccessful over the 18 months of the
study rarely reported being provided with information, even
if they were experiencing prolonged depression or anxiety.
It is possible that clinics were not aware of how distressed
their patients were because patients chose not to reveal it to
their providers. For example, patients might not feel comfort-
able sharing their distress owing to the belief that ‘‘happy
cooperative patients’’ receive the best care, or out of fear of
being denied treatment. Conversely, it is possible that clinics
actually did provide information about MHS but patients did
not take note of it because they were too overwhelmed with
fertility treatment to take the time to address their mental
health needs.
The strengths of this research are that a substantial num-
ber of both men and women were studied over an 18-month
period. Although the participating clinics were chosen to
reflect the demographics of fertility clinics in the area, the
findings could have been affected by unique clinic character-
istics. Similarly, the findings may be affected by regional
forces and thus may not apply to other parts of the United
States or to other countries. It is also reasonable to consider
that the situation may have changed in the time since these
data were collected, owing to greater awareness or advocacy.
Notably, none of the participating clinics had on-site MHS,
but each clinic had a referral list of mental health providers
to share with patients. Today, only one of the five clinics
has part-time on-site mental health referral services available.
Private mental health services are available in this regional
area, but generally only with added cost to the patient.
Also, because research participation was voluntary, we do
not know about the mental needs or service use of those
who did not participate or the exact motivation for participa-
tion. For example, if patients who were particularly distressed
at the outset were more likely to participate to have the
opportunity to share their concerns, this could have overin-
flated the rate of psychological distress reported. Conversely,
if distressed patients declined to participate so as to avoid
discussing difficult topics, this could have underrepresented
the rate of psychological distress reported. Additionally,
only heterosexual couples were studied; same-sex couples
may face additional barriers to MHS (31, 32). Furthermore,
limited information regarding MHS was obtained, and
future studies could examine in greater depth how it
happened that such distressed patients did not report
receiving MHS information.
This study strongly suggests that more attention should
be paid to mental health needs of our patients. We are not
suggesting that clinic staff need to address their patients'
mental health needs themselves, but instead that clinics foster
an environment that reduces treatment burden, acknowledges
to all patients that emotional distress is a common (and
indeed expected) companion to fertility treatment, and
encourages self-care and seeking support resources. Specific
strategies that could address the gaps in care provision
include offering information about MHS: 1) at multiple times
across the treatment trajectory; 2) by multiple methods (i.e.,
website, handouts, personal referral); and 3) by multiple
providers (i.e., medical assistants, nurses, physicians). In
addition, clinics may benefit from including specially trained
mental health providers on site or as part of clinic staff (33).
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8. SUPPLEMENTAL TABLE 1
Unsuccessful child-related outcome sample: mental health services (MHS) use and information as a function of depression and anxiety levels for
women and men.
Depression Women Men
At risk (n [ 90) All others (n [ 62) c2
At risk (n [ 42) All others (n [ 75) c2
Received MHS 35.6 12.9 9.72c
31.0 6.7 12.20d
MHS information provided 24.4 35.5 2.18 21.4 20.0 0.03
High risk (n [ 32) All others (n [ 120) c2
High risk (n [ 11) All others (n [ 106) c2
Received MHS 40.6 22.5 4.28b
45.5 12.3 8.43c
MHS information provided 21.9 30.8 0.97 18.2 20.8 0.04
Anxiety Women Men
At risk (n [ 117) All others (n [ 35) c2
At risk (n [ 66) All others (n [ 51) c2
Received MHS 32.5 5.7 9.95c
22.7 5.9 6.27b
MHS information provided 24.8 42.9 4.28a
19.7 21.6 0.06
High risk (n [ 64) All others (n [ 88) c2
High risk (n [ 36) All others (n [ 81) c2
Received MHS 37.5 18.2 7.13c
33.3 7.4 12.87d
MHS information provided 23.4 33.0 1.63 11.1 24.7 2.82a
Note: Values presented as percent unless stated otherwise.
a
P< .10; b
P< .05; c
P< .01; d
P< .001.
Pasch. Fertility patients and mental health. Fertil Steril 2016.
215.e1 VOL. 106 NO. 1 / JULY 2016
ORIGINAL ARTICLE: MENTAL HEALTH, SEXUALITY, AND ETHICS
9. SUPPLEMENTAL TABLE 2
Successful child-related outcome sample: mental health services (MHS) use and information as a function of depression and anxiety levels for
women and men.
Depression Women Men
At risk (n [ 109) All others (n [ 91) c2
At risk (n [ 46) All others (n [ 111) c2
Received MHS 23.9 8.8 7.97c
15.2 5.4 4.12b
MHS information provided 29.4 19.8 2.43 28.3 26.1 0.08
High risk (n [ 27) All others (n [ 173) c2
High risk (n [ 5) All others (n [ 152) c2
Received MHS 29.6 15.0 3.53a
40.0 7.2 6.84c
MHS information provided 25.9 24.9 0.01 0.0 27.6 1.87
Anxiety Women Men
At risk (n [ 150) All others (n [ 50) c2
At risk (n [ 100) All others (n [ 57) c2
Received MHS 21.3 4.0 8.00c
11.0 3.5 2.68
MHS information provided 26.0 22.0 0.32 27.0 26.3 0.01
High risk (n [ 77) All others (n [ 123) c2
High risk (n [ 41) All others (n [ 116) c2
Received MHS 23.4 13.0 3.61a
12.2 6.9 1.12
MHS information provided 22.1 26.8 0.57 26.8 26.7 0.00
Note: Values are presented as percent unless stated otherwise.
a
P< .10; b
P< .05; c
P< .01.
Pasch. Fertility patients and mental health. Fertil Steril 2016.
VOL. 106 NO. 1 / JULY 2016 215.e2
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