The role of procedural vs. chronic stress and other psychological factors in IVF success rates

Background: Assisted reproductive technology (ART) including in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT) are universally available for infertile couples. Currently, 123,200 ART cycles are performed each year in the US, and >99% of these are IVF treatments. It is well documented that live birth success rates decrease significantly with advancing age, from 37% (<35 years), to 29% (35-37 years), to 20% (38-40 years), and finally 11% (41-42 years). Female and male lifestyle habits such as psychological stress could additionally influence IVF success rates, although there is no conclusive experimental evidence that lower stress levels result in better fertility treatment outcomes. Inconsistent and contradictory findings on the effects ofpsychosocial stress on IVF outcomes could be explained by the lack of distinction made between acute (i.e., procedural) and chronic (i.e., lifetime) emotional stress responses. This discrepancy could also pertain to anxiety, depression, and coping styles. Hence, the purpose of this chapter is to assess the impact of procedural and chronic psychological factors on IVF endpoints. Methods: An exhaustive computerized search of the published literature was conducted using 8 databases and employing strict eligibility criteria. A total of 372 abstracts were retrieved, and 322 were excluded. Only a smattering of articles (n=50) met the inclusion criteria. Studies that examined the effects of chronic and procedural anxiety, depression, coping styles, marital satisfaction, and stress on IVF outcomes were evaluated. Gender effects were also considered. Results: Higher levels of anxiety and ineffective coping at the time of the procedure were both associated with decreases in pregnancy, implantation, and fertilization rates in women. In addition, higher procedural stress negatively impacted pregnancy. In contrast, chronic depression and negative mood were associated with lower pregnancy rates. Marital satisfaction and gender related stress differences had no effect on any IVF endpoints. Thus, procedural anxiety, coping, and stress (i.e., hormones) appeared to affect pregnancy success rates, whereas the effects of depression and mood on pregnancy were found at baseline. Consequently, different psychological factors may have diverse effects at various IVF endpoints. Summary: The field of reproductive endocrinology requires more prospective studies that simultaneously evaluate the relationship among multiple psychological factors, and the time points at which these factors are measured (i.e., baseline vs. procedural), on the array of IVF endpoints (i.e., live births). If the results suggested in this chapter are confirmed in subsequent studies, then reducing stressors at the time of the procedure may diminish the number of treatment cycles and increase pregnancy and live birth delivery success rates after undergoing IVF. Similarly, treatment of existing depression and negative mood prior to beginning the IVF cycle may be beneficial.