The survival and biological fitness of a species rely on its capacity to reproduce. In most animal species, the potential for successful reproduction depends on both the male and female physiological and mental health.
While fertility and pregnancy have received attention from ancient times until this day, the investigation of the female’s fertility-pregnancy-brain-behavior axis has been limited.

Female fertility is dependent on an extensive array of factors and has been regulated through the centuries, varying in methods. According to a recent CDC report, in the United States alone, in the years 2015-2017, approximately 65% of women aged 15-49 reported using contraceptives. Specifically pertaining to oral contraceptives and their actions, these have been potentially associated with changes in neurotransmission, neuroanatomy, memory, and emotional behavior, including a possible increase in the likelihood to develop depression, as well as the potential risk for pathologies outside the neuropsychological axis (e.g. cardiovascular system).
Conversely, the issue of infertility is being addressed thanks to developing reproductive technologies. Infertility can potentially be both a cause and effect of physiological and mental stress. Additional factors that are potentially linked to infertility include obesity, certain sexually transmitted diseases (STDs) and induced abortion (medical or surgical), which has also been reported to be linked to possible negative future pregnancy outcomes (e.g. miscarriage).
An estimated 10-22% of pregnancies end in miscarriage. Considering losses prior to knowledge of pregnancy, these rates may be even higher. However, not all reproductive loss is spontaneous. In the US alone, circa 20% of pregnancies end in induced abortion. Given that distinct negative consequences have been reported in both miscarriage (spontaneous abortion) and induced abortion, the overall well-being of women who undergo a pregnancy loss requires appropriate monitoring. As a result, these reproductive outcomes and their psychoneuroendocrinological consequences merit further investigation.

Given the magnitude of the impact of the fertility-pregnancy-brain-behavior axis on the overall wellbeing of a significant proportion of the population, we aim to promote an interdisciplinary collaboration integrating knowledge from behavioral neuroscientists, endocrinologists, neurophysiologists, psychologists, neurobiologists and clinicians to provide a better understanding of the:

• relationship between fertility/infertility and distress
• regulation of fertility through contraception and the potential neuropsycho-endocrinological effects
• relationship between pregnancy termination (induced or natural) and the resulting behavioral effects from a neurological, neuroendocrinological and psychological perspective
• impact of this knowledge on the medical field, in the hope of providing better evidence-based health care for women.

Keywords: fertility-pregnancy-brain-behavior axis, mental health, behavior, neuroendocrinology, distress

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The survival and biological fitness of a species rely on its capacity

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