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From an evolutionary standpoint, it makes sense that a woman suffering from mental depression would have trouble conceiving. Alice D. Domar, Ph.D., director of the Mind/Body Center for Women???s Health at Boston IVF says, ???A depressed woman is not capable of caring for herself, let alone a baby. Depression may have been a natural way of contraception during times of starvation or war.??? But if a woman is feeling depressed because she???s not getting pregnant, that???s another story.

Here???s Domar???s thesis: a woman who wants very much to be a mother starts trying to conceive of women reproduction health. She doesn???t get pregnant right away, and she starts to worry, particularly if she???s older. After failing to get pregnant for a couple of months, depression may set in, which in turn interferes with delicate hormonal balance required for conception. Egg quality may be reduced, the release of eggs delayed or the implantation of a fertilized egg in the uterus prevented. Each month she fails to get pregnant, her depression deepens, her hormonal fluctuation continues and her fertility is hampered further. If the woman has a pre-existing depression, as some 12.4 million American women do, infertility is even more likely.

Certainly, not all cases of infertility are triggered by depression: Many couples have specific medical conditions that contribute to their fertility problems, and not all depressed women have trouble conceiving. But some 20 percent of infertility is unexplained, and in many cases assisted reproductive techniques such as IVF should work but, for no obvious reason, don???t. It is in those cases that Domar says depression may play a crucial part. ???There is a very complex cascade of hormones that need to coordinate to produce a pregnancy,??? she says. ???If even one of those is off, as happens when a woman is depressed, it can prevent conception.???

Research supports the depression-infertility connection. In one of her own studies, published in 1999 in the Journal of the American Medical Women???s association, Domar found that the more depressed a woman was when she started a mind-body infertility program, the more likely she was to conceive within six months of completing a program that included depression-reduction techniques. In a Brown University study publish in 1995, women with a history of depressive symptoms were nearly twice as likely to report infertility as were women without a history of such symptoms. And a 2001 study by researchers at the University of California, San Diego, found that the most-depressed women in study were 93 percent less likely to get pregnant with IVF or gamete intrafallopian transfer (GIFT) than were the least-depressed women. A half-dozen or so other studies have showed similar results.

In her 10-week mind-body infertility programs, Domar administers a standard depression test to women at the beginning and end of the program. The average score at the start of the program is 15, which indicates mild to moderate depression. By the time the age depression score goes down to 5, which is about the same as for the average fertile woman.

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