Stress and anxiety-depression levels following first-trimester miscarriage: a comparison between women who conceived naturally and women who conceived with assisted reproduction


Correspondence: Dr CS Cheung, Department of Obstetrics and Gynaecology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China. Email



To compare the psychological impact following early miscarriage between women who conceived naturally and women who conceived following assisted reproduction.


Prospective cohort study.


Assisted reproduction clinic and general gynaecological unit in a university-affiliated, tertiary referral hospital.


A cohort of 150 women (75 after natural conception; 75 after assisted reproduction).


Completed semi-structured interviews using two standard questionnaires [the 12-item General Health Questionnaire (GHQ-12) and the 22–item Revised Impact of Events Scale (IES-R)], at 1, 4, and 12 weeks after a diagnosis of first-trimester miscarriage.

Main outcome measures

The GHQ–12 and IES–R scores for the two groups of women.


The GHQ-12 and IES-R scores were significantly higher in the assisted reproduction group than the scores in the natural conception group, at 4 weeks and 12 weeks after miscarriage. Further breakdown of the scores revealed significantly higher hyperarousal symptoms at 4 and 12 weeks in the assisted reproduction group, indicating the traumatic effect of miscarriage to these women.


Following first-trimester miscarriage, subfertile women who conceived after assisted reproduction had higher stress and anxiety-depression levels, and experienced more traumatic impact from the event, than those after natural conception. A timely support and psychological intervention would be beneficial in the management of this group of women.