The number of people choosing to freeze their eggs has been rising steadily for the past several years. At the same time, antidepressant use in the US has also been on the rise, especially during and after the peak of the COVID-19 pandemic. It goes without saying that given both these trends, many of the people who are freezing their eggs are also people who struggle with mental health conditions. If you’re on any medications for your mental health and you’re considering freezing or donating your eggs, you may be wondering if you’ll need to stop your antidepressant during the process. This is a common question and we’ll be answering it in today’s article so read on to find out.
What is egg freezing?
Before we dive into the world of antidepressants, let’s briefly talk about what egg freezing even is. In a nutshell, egg freezing (aka oocyte cryopreservation) is a way to collect some of your eggs and preserve them for future use. The process takes about 10-14 days and involves taking hormone medication to stimulate your ovaries to grow mature eggs. The eggs are collected during a 30-minute outpatient procedure called an egg retrieval and then frozen until you’re ready to use them.
Given how expensive egg freezing can get, you might be wondering why so many people are choosing to do it. There are many reasons but most of them go back to the same core issue: egg freezing is a way to keep your reproductive options open for later by preserving younger, healthier eggs for future use.
Research has shown that many people are delaying starting their families for reasons that can be personal, professional, financial, psychological, or all of the above. In our own survey of Cofertility users, we asked over 28,000 gen Z and millennial women about their family planning and goals. The majority of responders (73%) said that building their career or going back to school is the most important thing to them right now. This was followed by traveling (53%), finding a life partner (43%) and cultivating new hobbies (32.1%). Additionally, egg freezing has received more and more media attention over the last several years which has certainly helped to increase public awareness of this intervention as a way to keep future fertility options as open as possible.
The low-down on antidepressants
Antidepressants are a group of drugs used to treat depression. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are the 2 classes (or types) of antidepressants that are most often prescribed but atypical antidepressants are another, newer class that are also used in certain cases. Each class of antidepressant has a different mechanism for how it changes neurochemical levels in the brain to improve the symptoms of depression and other mood disorders. When used correctly, they can improve mood, increase energy levels, and enhance overall functioning. Antidepressants as well as other drugs like benzodiazepines have also been found to be effective as anti-anxiety medications, though only two SSRIs are specifically FDA-approved for anxiety disorders.
Use of both antidepressants and anti-anxiety medications has been rising for over a decade in the US. According to the Centers for Disease Control and Prevention (CDC), 13.2% of adults aged 18 and over use antidepressant medications. Women, older adults, and non-Hispanic whites are the highest users.
Overall, during the decade between 2009 and 2018, antidepressant use increased to 14% from 11% and in all age groups, it was higher among women than it was in men.
Based on these stats, it’s fair to ask why women are more depressed than men. The answer is complicated but women aren’t necessarily more depressed than men. While there is some evidence that fluctuating hormones and more sensitivity to internalized triggers (like relationship drama) may contribute to higher rates of depression in women, there’s also the simple fact that women are more likely to actually go see a doctor to take care of their symptoms. As a result, they are more likely to report depressive symptoms, be diagnosed, and be prescribed appropriate medication.
Do antidepressants affect cycle outcomes?
Alright, let’s get into the reason you’re here: do antidepressants affect egg freezing or in vitro fertilization (IVF) cycle outcomes? The most commonly used antidepressant (SSRIs) and anti-anxiety medications (benzodiazepines) don’t have any clear, long-term impacts on egg quantity or quality, ovulation, or chances of conception (though SSRIs do have short-term effects on sperm).
Studies of people using IVF to conceive suggest no effect of SSRI use on hormone levels, number of eggs retrieved, number of eggs that develop into blastocysts, number of embryos rated as “high quality,” or number of embryos transferred. So overall, antidepressants do not appear to affect cycle outcomes.
Let’s dive deeper into this. Since we know SSRIs and other antidepressants often work by changing levels of neurochemicals in the brain like serotonin, there is also the question of whether or not these medications influence reproductive hormones. Unfortunately, there are fewer studies to look at when assessing this (because most studies are done on men in order to avoid the hormonal fluctuations seen in women–lame, we know) but one study did look at almost 1,000 people with ovaries. The study found no differences in menstrual cycle characteristics as a function of SSRI use and no significant differences in pregnancy rates. Other larger studies have had similar findings and showed no differences in chances of conception between people using or not using SSRIs or benzodiazepines.
One thing to note though: there is some evidence that SSRIs increase prolactin levels and very high prolactin levels can mess with your period and prevent you from ovulating. That being said, there are other studies that have not shown this link between SSRI use and prolactin levels and even the studies that do, haven’t shown that prolactin levels are elevated to a high enough level to affect ovulation.
In the context of natural fertility, there is one sneaky, easy-to-miss way that these meds could impact chances of conception — by lowering your sex drive. Having sex less often during your fertile window could definitely lower chances of conception (the general rec is to have sex every 1-2 days in that window). However, how much an antidepressant affects sexual function will be different from person to person and will depend on the specific medication being used.
The CDC and the American Society for Reproductive Medicine (ASRM) consider antidepressant use to be safe during fertility treatments. Other organizations like the American Psychological Association (APA) and the American College of Obstetricians & Gynecologists (ACOG) also recommend that people do not change their SSRI or benzodiazepine use once they’re pregnant unless instructed to by their provider.
Can you donate eggs if you’re on an SSRI?
This is a pretty common question for people considering donating their eggs. Current use of SSRIs or other antidepressants is considered a “relative exclusion criteria” by the ASRM. This means that it does not automatically disqualify someone from being an egg donor, however, it will be reviewed on a case by case basis by the fertility provider or clinic. Current use of antidepressants may be totally fine with one clinic, but not with another. Many providers feel that common antidepressants are overprescribed in the face of more situational challenges, like the pandemic or other big life changes. Some antidepressant use may also point to another medical condition that would disqualify someone.
Here’s a list of rejection criteria from the ASRM that would automatically make someone ineligible to donate:
- Having been institutionalized for a mental health disorder
- A positive family history of psychiatric disorders
- Two or more first-degree relatives with substance use disorders
- A history of emotional, sexual, or physical abuse without professional treatment
- Excessive stress
- Relationship instability
If you’re interested in what the psych screening for an egg donor entails, you can find more information about it here.
We’re here to help
There’s a lot to consider when it comes to egg donation–and the psychological aspect of the screening is only one part of a larger process to ensure we’re doing right by you and by the receiving parents. The Cofertility team is here to guide you through every single step. By donating your eggs, you’re doing something remarkable for a family in need. We know that everyone’s situation is different, so our job is to make the process feel equally remarkable for you. Whether you continue or discontinue antidepressants during your own process is going to be a decision you make after weighing the risks and benefits and talking to your fertility provider. Whatever you end up choosing for yourself, our team is here to support you through it.