Can Stress Decrease Outcome of IVF Cycle?

As fertility care providers, a frequent question we are asked is "Does stress affect my chances of a successful outcome?" This is a difficult question to answer, because few substantial studies have been conducted. However, some viable data is starting to trickle in. Researchers from the UC San Diego Dept. of Family and Preventive Medicine, working with a number of IVF centers, tried to assess the impact of patient worries on their IVF outcomes Konoff-Cohen et al, Fert Ster: Vol 81, No 4, 982-988). In this prospective study, 151 women completed questionnaires pre and post IVF or GIFT treatment regarding their concerns about medical aspects of their treatment (not achieving desired results, side effects, surgery, anesthesia, not enough information, pain, recovery) and financial aspects (missing work, finances). It is important to note that only the questionnaires completed pre-treatment provided data for this study, since not enough post-treatment questionnaires were returned. Women who were concerned about the medical aspect of the procedures had 20% fewer eggs retrieved and 19% fewer fertilized, than women who were less inclined to worry about it. Women who were concerned about missing work had 30% fewer eggs fertilized. Those who were very concerned about the financial implications of their treatment cycle had a greater risk of not achieving a live birth. These results were adjusted for different variables that could also affect success rates such as age, race, smoking, type of infertility, previous treatment attempts, and prior live births. However, other important predictors of outcome were not adjusted for, such as FSH and antral follicle count. While these findings may appear to show dramatic differences, it is important to note that these differences (20-30% fewer eggs, 19% fewer fertilized) clinically represented a decrease of only ONE fewer embryo transferred. The greatest decrease was seen in women > 35 yrs old, and those who had already done a treatment cycle. This study represents an interesting look at the issues of personal concerns and IVF/GIFT outcomes, and calls for further studies to understand the potential physiological effects that may mediate these outcomes. Other related studies are also worth noting. For instance, a well-done study (Domar), which we described in the November/December 2003 issue of Fertility Flash, has shown that women participating in support groups while in IVF treatment seem to have increased pregnancy rates. A recently published study (Facchinetti) has looked at changes in physiological markers (heart rate, blood pressure, cortisol levels) in women undergoing IVF treatment and participating in support groups, showing evidence of physiological changes for those in support groups. These physiological changes are consistent with those seem in lower stress situations. These collective studies suggest that one can best prepare for IVF by being as informed as possible about expectations of one's treatment cycle (treatment procedures and financial impact). It may also be helpful to consider joining a support group. Fertility clinics can help patients by trying to alleviate patient's concerns and making the IVF experience as smooth as possible.

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