The experience of Infertility is extremely stressful for all people.The goals of this chapter are to provide the mental health practitioner with an understanding of the relationship between infertility in men and women and psychiatric illnesses. Patients with a history of major depression are at an increased risk of recurrence of major depression during infertility evaluation and treatment, and women who have had recurrent miscarriages are especially high risk for depression. Some patients will need to continue their antidepressants during the infertility process and pregnancy, and in this chapter we will discuss the risks and benefits associated with antidepressants in this population. Research on the interaction of the infertility medications and bipolar disorder destabilization is lacking, but it is important for the mental health practitioner to recognize that the dramatic hormonal changes associated with ovarian stimulation may lead to increased lability, especially if the medications have the side effect of insomnia. While some mood stabilizers such as lamotrigine are considered relatively safe to take in pregnancy, others, such as valproic acid are associated with congenital abnormalities and should be discontinued. Personality disorder patients may also react to the stress of infertility treatment with primitive defenses that are difficult for the infertility treatment team to manage, such as acting out and splitting. In this chapter, we will discuss the intersection of personality disorders and psychiatry and we will also provide guidance about when to recommend that patients defer or stop infertility treatment due to psychiatric illnesses.

Chronic anovulation is a very common disorder in polycystic ovary syndrome (PCOS) patients wishing to conceive. In these patients, ovulation induction resulting in restoration of a regular menstrual cycle with monofollicular ovulation may normalize the probability of pregnancy. This may be achieved either by increasing the follicle-stimulating hormone (FSH) serum concentration or by improving the endocrine ovarian milieu resulting in enhanced FSH responsiveness of the ovaries. Later on, this favorable endocrine milieu may also benefit implantation, embryo development and reduce risks in pregnancy for mother and child. A combination of both strategies could be used to individualize treatment in a patient-tailored way: for every patient an optimal effective treatment plan based on specific individual characteristics. Although there has been a tendency to ultimately skip ovulation induction and start in vitro fertilization (IVF) immediately because this would result in better pregnancy chances, this choice neglects the significant risks and physical burden of IVF treatment and significant higher costs. Ovulation induction in PCOS patients, as discussed in this chapter, is a very successful treatment option with a cumulative single live birth of greater than 70% during a 24-month follow-up period.