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STRESS & FERTILITY

Psychological interactions with infertility among women

Psychological factors such as depression, state-anxiety, and stress-induced changes in heart rate and cortisol are predictive of a decreased probability of achieving a viable pregnancy. A couple that is trying to conceive will undoubtedly experience feelings of frustration and disappointment if a pregnancy is not easily achieved. However, if the difficulties progress and the man and or woman are labelled as having fertility problems, then this may result in a severe insult to self-esteem, body image, and self-assessed masculinity or femininity.

Psychological characteristics of infertile patients: discriminating etiological factors from reactive changes

Women with known causes of infertility scored higher on a scale measuring frequency of thought and concerns conceiving and sexual problems than women with undetermined infertility. Men from couples with both known and undetermined causes of infertility had more sexual problems than fertile men.

Understanding Women's views towards the use of Acupuncture while undergoing IVF treatment.- Smith C and De Lacey S, 2008 In press FSA conference 2008

Conclusion; Acupuncture is an effective and low intensity procedure for increasing women's resilience in the repetitive and stress inducing time of pregnancy attempts, with or without medical treatment. The instrumental role of the acupuncture therapist in increasing resilience is a finding that has not emerged in previous studies and has implications for patient management.

The influence of stress and state anxiety on the outcome of IVF-treatment: Psychological and endocrinological assessment of Swedish women entering IVF-treatment

The main findings suggest that infertile women have a different personality profile in terms of more suspicion, guilt and hostility as compared to the fertile controls, perhaps as a response to their infertility. Their stress levels in terms of circulating prolactin and cortisol levels were elevated compared to the fertile controls. Psychological stress may affect the outcome of IVF treatment since state anxiety levels among those who did not achieve pregnancy were slightly higher than among those who became pregnant.

Building resilience: An exploration of women's perceptions of the use of acupuncture as an adjunct to IVF - De Lacey S, Smith C and Paterson C, BMC Complementary and Alternative Medicine 2009, 9:50 BioMed Central

Conclusion
This preliminary exploration, whilst confined to a small sample of women, confirms that acupuncture is indeed perceived by infertile women to have an impact to their health. All findings outlined here are reported cautiously because they are limited by the size of the sample. They suggest that further studies of acupuncture as an adjunct to IVF should systematically explore the issues of wellbeing, anxiety, personal and social resilience and women's identity in relation to sexuality and reproduction.

The concerns during assisted reproductive technologies (CART) scale and pregnancy outcomes

Women who were concerned about the medical aspects (i.e., side effects, surgery, anesthesia, not enough information, pain, and recovery) of the procedure had 20% fewer eggs retrieved and 19% fewer eggs fertilized. Women who were very concerned about missing work had 30% fewer eggs fertilized. Women who were extremely concerned about the finances associated with the procedure had a very high risk of not achieving a successful live birth delivery.

An assessment of the demand and importance of acupuncture to patients of a fertility clinic during investigations and treatment - Hinks J and Coulson C, Hum Fert 2010 Vol 13, S1 Pg 3-21 Human Fertility

Conclusions: .Previous unpublished work at BCRM showed that 85% of the patients found the named nurse system important as a coping mechanism to support them by providing continuity of care through stressful treatment. The responses to the questionnaires indicate a clear demand for acupuncture and suggest that acupuncture may be valuable to improve the general wellbeing of women during infertility investigations and treatments. If acupuncture provides an effective coping mechanism, this could support patients to persevere with increased numbers of ART(Assisted Reproductive Technologies) cycles, thereby increasing their ultimate chance of a successful pregnancy.

Psychosocial stress and treatment outcome following assisted reproductive technology

A more `hostile' mood state and higher trait anxiety were associated with a lower cumulative pregnancy rate. A Cox multiple regression model found previous pregnancy history, trait anxiety, and the POMS agreeable–hostile and elated–depressed scales to be the most important lifestyle and stress variables predictive of pregnancy. The results emphasize the importance of psychosocial stress in treatment outcome.

The effect of anxiety and depression on the outcome of in-vitro fertilization

Pre-existing psychological factors (anxiety depression) are independently related to treatment outcome in IVF/ICSI, and should therefore be taken into account in patient counselling. Psychological factors may be improved by intervention

Oxford Journals Human Reproduction Volume 16 2001, Issue 7 Pp. 1420-1423
J.M.J. Smeenk1,6, C.M. Verhaak2, A. Eugster5, A. van Minnen3, G.A. Zielhuis4 and D.D.M. Braat1
http://humrep.oxfordjournals.org/content/16/7/1420

Reproductive implications of psychological distress for couples undergoing IVF

Data validates the concept of a “stressed couple”. Adverse implications of a couple’s psychological distress (i.e. higher pessimism and dysphoria resulted in longer duration of controlled ovarian hyperstimulation and lower fertilization rates) are suggested. Partner’s depressive scores correlated with IVF failure.

Mood state as a predictor of treatment outcome after In Vitro fertilization/embryo transfer technology (IVF/ET)

After controlling for the number of treatment cycles, a significant difference was observed in the course of pregnancy over time between depressed and non-depressed women. Depressed women exhibited a lower pregnancy rate for the first treatment cycles than non-depressed women.

A Study on Psychological Strain in IVF Patients

Infertile women showed significant increases in trait anxiety and depressive symptoms than the fertile women. Anxiety and depression in the in vitro fertilization(IVF)-failed women were significantly higher than the IVF-success women. We must pay an attention to the infertile patient, especially from the initial infertility workup. We recommend psychological counselling for IVF-failed patients.

Stressful life events are associated with a poor in-vitro fertilization (IVF) outcome: a prospective study

A large number of life-events perceived as having a negative impact on quality of life may indicate chronic stress, and the results of our study indicate that stress may reduce the chances of a successful outcome following IVF, possibly through psychobiological mechanisms affecting medical end-points such as egg retrieval outcome.

Infertility-related stress in men and women predicts treatment outcome 1 year later

Fertility problem stress was associated with a poorer treatment outcome in women and men. Logistic regression indicated that women who reported more marital distress required more treatment cycles to conceive (median 3) than women reporting less marital distress (median 2). The findings provide evidence that infertility-related stress has direct and indirect effects on treatment outcome.

ASSOCIATION OF DEPRESSION AND ANXIETY WITH OOCYTE AND SPERM NUMBERS AND PREGNANCY OUTCOMES DURING IN VITRO FERTILIZATION TREATMENT

A significant correlation showed that low egg numbers were associated with higher Depression. Sperm motility was weakly correlated with Depression scores. Women with high State Anxiety score on the egg retrieval day had significant lower pregnancy rates, as did those with higher Depression.

Psychological Reports: Volume 104, Issue , pp. 796-806. June 2009
NERMIN GÜRHAN, AYGÜL AKYÜZ, DERYA ATICI, and SEZER KISA
http://www.amsciepub.com/doi/abs/10.2466/pr0.104.3.796-806

A prospective study of stress among women undergoing in vitro fertilization

Acute and chronic stress affected biologic end points (i.e., number of eggs retrieved and fertilized), as well as pregnancy, live birth delivery, birth weight, and multiple gestations.

Fertility and Sterility - Volume 76, Issue 4 , Pages 675-687, October 2001
Hillary Klonoff-Cohen, Ph.D.email address, Elaine Chu, M.D., Loki Natarajan, Ph.D., William Sieber, Ph.D.
http://www.fertstert.org/article/S0015-0282(01)02008-8/abstract

A prospective, longitudinal study of emotions and relationships in in-vitro fertilization treatment

First and last treatment cycles were associated with greater anxiety. High levels of confusion and bewilderment found during the initial cycle may indicate the need for better pretreatment information. Services must recognize the presence of high anxiety at intake and provide psychological care for those identified as particularly distressed. Emotional difficulties after failure of IVF treatment can be considered to be iatrogenic effects, and psychological services should be provided to minimize any negative psychological consequences of treatment.

Psychosocial factors discriminate oligozoospermic from normozoospermic men

The relationship between psychosocial variables and seminal status has been confirmed by comparing a group of oligozoospermic (poor sperm) and normozoospermic (normal sperm) men.

Fertility and Sterility - Volume 79, Supplement 3 , Pages 1571-1576, June 2003
Luigi De Gennaro, Ph.D.email address, Simona Balistreri, Ph.D., Andrea Lenzi, M.D., Francesco Lombardo, M.D., Michele Ferrara, Ph.D., Loredana Gandini, B.Sc
http://www.fertstert.org/article/S0015-0282(03)00374-1/abstract

Stress and human reproduction

The biological interaction between stress and infertility is the result of the action of stress hormones at the brain level, especially on the hypothalamus-pituitary and on the female reproductive organs. Stress hormones such as catecholamines (adrenalin, nonadrenaline and dopamine) and the hypothalamic-pituitary-adrenal axis interact with hormones which are responsible for normal ovulatory cycles: i.e., gonadotropin releasing hormone (GnRH), prolactin, LH and FSH. Endogenous opiates and melatonin secretion are altered by stress and interfere with ovulation.

Semen quality in fertile men in relation to psychosocial stress

These results suggest that stressful life events may be associated with decreased semen quality in fertile men. The experience of psychosocial stress may be a modifiable factor in the development of idiopathic infertility.

Association of state and trait anxiety to semen quality of in vitro fertilization patients: a controlled study

Increased levels of both state and trait anxiety were associated with lower semen volume, sperm concentration and count, reduced sperm motility, and increased sperm DNA fragmentation of IVF patients, thus influencing seminal parameters at the macroscopic and cellular/subcellular levels. Similar results were obtained in the controls. Our data confirm previous observations with state anxiety and show that trait anxiety also is negatively associated with male fertility.

Effectiveness of Eastern Body-Mind-Spirit group intervention for reducing anxiety in women undergoing in vitro fertilization

The Eastern Body-Mind-Spirit group intervention approach effectively reduces the anxiety level of women undergoing IVF treatment. Compared with the control group, the intervention group had a significant drop in State Anxiety mean score following intervention. A comparable number of embryos were transferred for each group, but there was a nonsignificant trend of a higher pregnancy rate in the intervention group.

Relationship between psychological stress and semen quality among in-vitro fertilization patients

This study provides evidence for a significant decline in semen quality of male IVF patients at egg retrieval and demonstrates an inverse relationship between semen quality and specific aspects of psychological stress.

Robert N. Clarke1, Susan C. Klock2,4, Anne Geoghegan3 and David E. Travassos1
Oxford JournalsMedicine Human Reproduction Volume 14, Issue 3Pp. 753-758 - 1998
http://humrep.oxfordjournals.org/content/14/3/753

Coping Style and Depression Level Influence Outcome in In Vitro Fertilization

Expression of negative emotions predicts depression levels and outcome in IVF. This cause of infertility should be taken into account when investigating the relation between psychologic functioning and outcome in IVF.

Fertility and Sterility - Volume 69, Issue 6 , Pages 1026-1033, June 1998
Koen Demyttenaere, M.D., Ph.D., L Bonte, M.Sc., M Gheldof, M.Sc., M Vervaeke, M.Sc., C Meuleman, M.D., D Vanderschuerem, M.D., Ph.D., T D’Hooghe, M.D., Ph.D.
http://www.fertstert.org/article/S0015-0282(98)00089-2/abstract

Stress affects uterine receptivity through an ovarian-independent pathway

Stress can cause decreased uterine receptivity through an ovarian-independent pathway. The number of implantation sites in the stress group was significantly less than that in the control group. Implantation-related genes and ovarian-hormone-responsive genes were repressed in the stress group despite ovarian hormone supplementation.

Perceived infertility-related stress correlates with in vitro fertilization outcome

Couples who conceived during their first cycle of IVF had significantly higher measures of need for parenthood and loss of sexual enjoyment, compared with couples who did not conceive. Couples who achieved ongoing pregnancies had higher scores on measures of a negative view of a child-free lifestyle, need for parenthood, and total stress than those who did not.

Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study—the LIFE study

SUMMARY ANSWER Higher levels of stress as measured by salivary alpha-amylase are associated with a longer time-to-pregnancy (TTP) and an increased risk of infertility.

STUDY QUESTION Are women's stress levels prospectively associated with fecundity and infertility?

WHAT IS KNOWN ALREADY Data suggest that stress and reproduction are interrelated; however, the directionality of that association is unclear.

Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic

Depressive and anxiety disorders were highly prevalent among women who visited an assisted reproduction clinic for a new course of the treatment. Demographic features and a history of previous assisted reproduction treatment were not risk factors for these psychiatric morbidities in the assisted reproduction clinic.

Oxford Journals Medicine Human Reproduction Volume 19, Issue 10Pp. 2313-2318
Chen TH, Chang SP, Tsai CF, Juang KD.
http://humrep.oxfordjournals.org/content/19/10/2313

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