Clinical characteristics of the enrolled infertile couples

As shown in Fig. 1, there were 1290 infertile couples undergoing ART in our center between January 2016 and December 2018. Four couples were excluded because they had a history of mental illness or psychiatric disorders. In addition, 11 couples who failed to complete ART treatment, 5 couples who were present with complications during the ART treatment, and 23 couples who could not complete the survey, were excluded. Therefore, a total of 1247 infertile couples were enrolled in this study. The clinical characteristics of the 1247 infertile couples were shown in Table 1. The age was 31.64 ± 5.11 years for female partners and 33.33 ± 5.88 years for male partners. The college degree was dominant in infertile couples and accounted for 54.5%(679/1247) and 55.6% (693/1247) in males and females, respectively. The majority of male partners were employed (96.8%,1207/1247), but 249 (20%) of female partners were unemployed. The duration of infertility was 3.55 ± 2.59 years. The causes of infertility were 40.3%(503/1247) for female factors, 20.3%(253/1247) for male factors, 36.3% (453/1247) for both female and male factors, and 3.0%(38/1247) for unknown factors.

Fig. 1

Flowchart of participant enrollment and study design. SAS, Self-Rating Anxiety Scale; SDS, Self-Rating Depression Scale; ART, assisted reproductive technology; OHSS, ovarian hyperstimulation syndrome; Visit 1, the initiation day; Visit 2, the oocyte retrieval day; Visit 3, the embryo transplantation day

Table 1 The clinical characteristics of 1247 infertile couplesFemale was more likely to have anxiety than male in infertile couples

To analyze the psychological state of infertile couples, the anxiety and depression of 1247 infertile couples planning ART were assessed using SAS and SDS. As shown in Table 2, the prevalence of anxiety in female partners was 13.5% (168/1247) and was higher than that in male partners [8.7% (108/1247)] (p < 0.05). Of them,148 females (88.1%,148/168) were mild anxiety, and 20 females (11.9%, 20/168) were moderate anxiety (p < 0.05). Mild, moderate, and severe anxiety accounted for 76.9% (83/108), 21.3% (23/108), and1.9% (2/108) among 108 male partners with anxiety, respectively. The number of mild anxiety was significantly more than those of moderate, and severe anxiety (both p < 0.05). The prevalence of depression was 9.4%(117/1247) and 7.9%(99/1247) in female and male partners, respectively (p = 0.2). Similar to anxiety, most of them were mild depression, which was 75.2% (88/117) and 78.8% (78/99) in female and male partners, respectively, and were higher than moderate, and severe depression (all p < 0.05).

Table 2 The prevalence of anxiety and depression in 1247 infertile couples

Among 1247 infertile couples, 233 females (18.7%, 233/1247) had anxiety and/or depression, of whom 52 females (22.3%,52/233) were comorbidity of anxiety and depression (Fig. 2A). A total of 171 males (13.7%, 171/1247) had anxiety and/or depression, of whom 36 males (21.1%, 36/171) were comorbidity of anxiety and depression (Fig. 2B). The prevalence of anxiety and/or depression in females was higher than that in males (18.7% vs 13.7%, p = 0.0009). 238 infertile couples with one or both partners (19.1%,238/1247) had anxiety. Of them, 38 infertile couples (16.0%,38/238) had anxiety in both partners (Fig. 2C). 176 infertile couples with one or both partners (14.1%,176/1247) had depression. Of them, 40 infertile couples (22.7%,40/176) had depression in both partners (Fig. 2D). The prevalence of anxiety was higher than depression in infertile couples (19.1% vs 14.1%, p = 0.0008). A total of 323 infertile couples (25.9%,323/1247) with at least one partner had anxiety, depression, or both (Fig. 2E).

Fig. 2

The prevalence of anxiety and depression in 1247 infertile couples. A The prevalence of anxiety and depression in female partners; B The prevalence of anxiety and depression in male partners; (C)The prevalence of anxiety in 1247 infertile couples; (D)The prevalence of depression in 1247 infertile couples; (E)The prevalence of anxiety and depression in 1247 infertile couples. A, anxiety; D, depression; F, female; M, male

The levels of anxiety and depression were positively associated between female and male partners in infertile couples

To investigate the interaction of different psychological disorders in infertile couples, we analyzed the association of SAS and SDS scores between female and male partners. As shown in Fig. 3A&B, female SAS and SDS scores were both positively associated with male SAS and SDS scores (r = 0.52 and r = 0.50, both p < 0.0001, respectively). In addition, female SAS scores were correlated with their own SDS scores (r = 0.63, p < 0.0001) (Fig. 3C). Male SAS scores were correlated with their own SDS scores (r = 0.62, p < 0.0001) (Fig. 3D).

Fig. 3

The Correlation of SAS and SDS scores before treatment. A The correlation of SAS scores between female and male partners; (B) The correlation of SDS scores between female and male partners; (C) The correlation between female SDS scores and female SAS scores; (D) The correlation between male SDS scores and male SAS scores

Their own or partners’ anxiety or depression were risk factors for anxiety and depression in infertile couples

To further discover the risk factors for anxiety and depression in infertile couples, we analyzed the association between the education levels, age, the causes of infertility, no children, their partners’ anxiety/depression, their own anxiety/depression, duration of disease, the state of employment, and the anxiety/depression using multivariate logistic regression. As shown in Table 3, no children (odds ratio (OR) 2.12, p = 0.04), their own depression (OR 6.03, p < 0.0001), their partners’ anxiety (OR 3.45, p < 0.0001), unemployment (OR 1.69, p = 0.02) were associated with female anxiety. In addition, compared to the above college degree, a high school degree (OR 5.49, p = 0.04), and a college degree (OR 4.84, p = 0.04) were also risk factors for female anxiety. Their own depression (OR 3.42, p < 0.0001) and their partners’ anxiety (OR 6.94, p < 0.0001) were positively associated with male anxiety. Their own anxiety (OR 5.88, p < 0.0001) and their partners’ depression (OR 6.67, p < 0.0001) were positively associated with female depression. Similarly, their own anxiety (OR 7.14, p < 0.0001) and their partners’ depression (OR 6.67, p < 0.0001), were positively associated with male depression.

Table 3 Multivariate analysis of the risk factors associated with anxiety and depression of infertile couplesThe SAS and SDS scores of infertility couples during ART significantly declined

To investigate the dynamic change of psychological states undergoing ART, we compared the SAS and SDS scores of 1247 infertility couples on the initiation day (Visit 1), oocyte retrieval day (Visit 2), and embryo transplantation day (Visit 3). As shown in Fig. 4A, female SAS scores were 39.81 ± 8.62,38.22 ± 8.46, and 37.79 ± 8.83 on Visit 1, Visit 2, and Visit 3, respectively, which significantly decreased compared to Visit 1(both p < 0.0001). Female SDS scores were 38.67 ± 10.04, 37.78 ± 10.28, and 37.78 ± 10.83 on Visit 1, Visit 2 and Visit 3, respectively. The scores on Visit 2 and Visit 3 were lower than that on Visit 1(both p < 0.0001) (Fig. 4B). Similar to females, male SAS and SDS scores on Visit 2 and Visit 3 were all lower than those on Visit 1(all p < 0.0001) (Fig. 4C&D).

Fig. 4

The SAS and SDS scores of infertility couples during the ART treatment. (A) Female SAS scores of 1247 infertility couples on Visit 1, Visit 2 and Visit 3; (B) Female SDS scores of 1247 infertility couples on Visit 1, Visit 2 and Visit 3; (C) Male SAS scores of 1247 infertility couples on Visit 1, Visit 2 and Visit 3; (D) Male SDS scores of 1247 infertility couples on Visit 1, Visit 2 and Visit 3. Visit 1, the initiation day; Visit 2, the oocyte retrieval day; Visit 3, the embryo transplantation day. The red lines showed as mean ± SD; The red dotted lines indicated that the SAS score was 50 and the SDS score was 53, respectively