Reduced Fertility and Fecundity among Patients with Bipolar I Disorder and Schizophrenia in Egypt

Mansour, Hader; Kandil, Kareem; Wood, Joel; Fathi, Warda; Elassy, Mai; Ibrahim, Ibtihal; Salah, Hala; Yassin, Amal; Elsayed, Hanan; Tobar, Salwa; El-Boraie, Hala; Eissa, Ahmed; Elhadidy, Mohamed; Ibrahim, Nahed E; El-Bahaei, Wafaa; Nimgaonkar, Vishwajit L

Abstract

OBJECTIVE
To evaluate reproduction among patients with bipolar I disorder (BP1) or schizophrenia (SZ) in Egypt.
METHODS
BP1 patients (n=113) were compared with community based, demographically balanced controls (n=124) and SZ patients (n=79, DSM-IV). All participants were evaluated using structured interviews and corroborative data were obtained from relatives. Standard indices of procreation were included in multivariate analyses that incorporated key demographic variables.
RESULTS
Control individuals were significantly more likely to have children than BP1 or SZ patients (controls 46.8%, BP1 15.9%, SZ 17.7%), but the BP1-SZ differences were non-significant. The average number of children for BP1 patients (0.37+/-0.9) and SZ patients (0.38+/-0.9) was significantly lower than for controls (1.04+/-1.48) (BP1 vs controls, p<0.001; SZ vs controls, p<0.001). The frequency of marriages among BP1 patients was nominally higher than the SZ group, but was significantly lower than controls (BP1: 31.9% SZ: 27.8% control: 57.3%). Even among married individuals, BP1 (but not SZ) patients were childless more often than controls (p=0.001). The marital fertility, i.e., the average number of children among patients with conjugal relationships for controls (1.8+/-1.57) was significantly higher than BP1 patients (1.14+/-1.31, p=0.02), but not significantly different from SZ patients (1.36+/-1.32, p=0.2).
CONCLUSION
Selected reproductive measures are significantly and substantially reduced among Egyptian BP1 patients. The reproductive indices are similar among BP1 and SZ patients, suggesting a role for general illness related variables. Regardless of the cause/s, the impairment constitutes important, under-investigated disability.