Stress and anxiety scores in first and repeat IVF cycles: a pilot study

Kathy Turner, Margaret F Reynolds-May, Emily M Zitek, Rebecca L Tisdale, Allison B Carlisle, Lynn M Westphal, Kathy Turner, Margaret F Reynolds-May, Emily M Zitek, Rebecca L Tisdale, Allison B Carlisle, Lynn M Westphal

Abstract

Background: The role of stress in reproduction, particularly during treatment for infertility, has been of considerable interest; however, few studies have objectively measured stress and anxiety over the course of the IVF cycle or compared the experience of first-time and repeat patients.

Methods: This prospective cohort pilot study enrolled 44 women undergoing IVF at a university-based clinic to complete the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS) and Infertility Self-Efficacy Scale (ISES) at three time points prior to ovarian stimulation (T1), one day prior to oocyte retrieval (T2), and 5-7 days post embryo transfer (T3).

Results: Mean STAI State scores were significantly elevated at all three time points (p<0.01). STAI State and PSS mean values did not change over time and did not differ in first-time vs. repeat patients. Self-efficacy (ISES) scores declined over time, with a greater decline for repeat patients. Of the 36 women who completed a cycle, 15 achieved clinical pregnancy. Using logistic regression modeling, all scores at T2 were correlated with pregnancy outcome with lower scores on the STAI State and PSS and higher scores on the ISES associated with higher pregnancy rates.

Conclusions: Stress and anxiety levels remained elevated across all cycles. Women with lower stress and anxiety levels on the day prior to oocyte retrieval had a higher pregnancy rate. These results emphasize the need to investigate stress reduction modalities throughout the IVF cycle.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Participant completion.
Figure 1. Participant completion.

References

    1. Arnetz BB, Ekman R, editors (2006) Stress in Health and Disease. Weinheim: Wiley-VCH.
    1. Spielberger CD (1983) Manual for the State-Trait Anxiety Inventory. In. Palo Alto, CA: Consulting Psychologists Press, Inc.
    1. Dunkel-Schetter C, Lobel M (1991) Psychological reactions to infertility. In: Stanton AL, Dunkel-Schetter C, editors. Infertility: Perspectives from Stress and Coping Research. New York: Plenim, 29–60.
    1. Eugster A, Vingerhoets AJ (1999) Psychological aspects of in vitro fertilization: a review. Social Science & Medicine 48: 575–89.
    1. Verhaak CM, Smeenk JM, Evers AW, Kremer JA, Kraaimaat FW, et al. (2007) Women’s emotional adjustment to IVF: a systematic review of 25 years of research. Hum Reprod Update 13: 27–36.
    1. Klonoff-Cohen H, Chu E, Natarajan L, Sieber W (2001) A prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer. Fertil Steril 76: 675–87.
    1. Ardenti R, Campari C, Agazzi L, La Sala GB (1999) Anxiety and perceptive functioning of infertile women during in-vitro fertilization: exploratory survey of an Italian sample. Hum Reprod 14: 3126–32.
    1. Boivin J (2003) A review of psychosocial interventions in infertility. Soc Sci Med 57: 2325–41.
    1. Chan CH, Ng EH, Chan CL, Ho, Chan TH (2006) Effectiveness of psychosocial group intervention for reducing anxiety in women undergoing in vitro fertilization: a randomized controlled study. Fertil Steril 85: 339–46.
    1. Lintsen AM, Verhaak CM, Eijkemans MJ, Smeenk JM, Braat DD (2009) Anxiety and depression have no influence on the cancellation and pregnancy rates of a first IVF or ICSI treatment. Hum Reprod 24: 1092–8.
    1. Mahajan NN, Turnbull DA, Davies MJ, Jindal UN, Briggs NE, et al. (2010) Changes in affect and state anxiety across an in vitro fertilization/intracytoplasmic sperm injection cycle. Fertil Steril 93: 517–26.
    1. Merari D, Feldberg D, Elizur A, Goldman J, Modan B (1992) Psychological and hormonal changes in the course of in vitro fertilization. J Assist Reprod Genet 9: 161–9.
    1. Serafini P, Lobo DS, Grosman A, Seibel D, Rocha AM, et al. (2009) Fluoxetine treatment for anxiety in women undergoing in vitro fertilization. Int J Gynaecol Obstet 105: 136–9.
    1. Terzioglu F (2001) Investigation into effectiveness of counseling on assisted reproductive techniques in Turkey. J Psychosom Obstet Gynaecol 22: 133–41.
    1. Yong P, Martin C, Thong J (2000) A comparison of psychological functioning in women at different stages of in vitro fertilization treatment using the mean affect adjective check list. J Assist Reprod Genet 17: 553–6.
    1. Campagne DM (2006) Should fertilization treatment start with reducing stress? Hum Reprod 21: 1651–8.
    1. Domar AD, Clapp D, Slawsby EA, Dusek J, Kessel B, et al. (2000) Impact of group psychological interventions on pregnancy rates in infertile women. Fertil Steril 73: 805–11.
    1. Hosaka T, Matsubayashi H, Sugiyama Y, Izumi S, Makino T (2002) Effect of psychiatric group intervention on natural-killer cell activity and pregnancy rate. Gen Hosp Psychiatry 24: 353–6.
    1. de Klerk C, Hunfeld JA, Heijnen EM, Eijkemans MJ, Fauser BC, et al. (2008) Low negative affect prior to treatment is associated with a decreased chance of live birth from a first IVF cycle. Hum Reprod 23: 112–6.
    1. Lovely LP, Meyer WR, Ekstrom RD, Golden RN (2003) Effect of stress on pregnancy outcome among women undergoing assisted reproduction procedures. South Med J 96: 548–51.
    1. Milad MP, Klock SC, Moses S, Chatterton R (1998) Stress and anxiety do not result in pregnancy wastage. Hum Reprod 13: 2296–300.
    1. Wichman CL, Ehlers SL, Wichman SE, Weaver AL, Coddington C (2011) Comparison of multiple psychological distress measures between men and women preparing for in vitro fertilization. Fertil Steril 95(2): 717–21.
    1. Boivin J, Takefman JE (1995) Stress level across stages of in vitro fertilization in subsequently pregnant and nonpregnant women. Fertil Steril 64(4): 802–10.
    1. Harlow CR, Fahy UM, Talbot WM, Wardle PG, Hull MG (1996) Stress and stress-related hormones during in-vitro fertilization treatment. Hum Reprod 11(2): 274–9.
    1. Bringhenti F, Martinelli F, Ardenti R, La Sala GB (1997) Psychological adjustment of infertile women entering IVF treatment: differentiating aspects and influencing factors. Acta Obstet Gynecol Scand 76(5): 431–7.
    1. Stoleru S, Cornet D, Vaugeois P, Fermanian J, Magnin F, et al. (1997) The influence of psychological factors on the outcome of the fertilization step of in vitro fertilization. J Psychosom Obstet Gynaecol 18(3): 189–202.
    1. Csemiczky G, Landgren BM, Collins A (2000) The influence of stress and state anxiety on the outcome of IVF-treatment: psychological and endocrinological assessment of Swedish women entering IVF-treatment. Acta Obstet Gynecol Scand 79(2): 113–8.
    1. Kee BS, Jung BJ, Lee SH (2000) A study on psychological strain in IVF patients J Assist Reprod Genet. 17(8): 445–8.
    1. Sanders KA, Bruce NW (1999) Psychosocial stress and treatment outcome following assisted reproductive technology. Hum Reprod 14(6): 1656–62.
    1. Beerendonk C, Hendriks J, Scheepers H, Braat D, Merkus J, et al. (1999) The influence of dietary sodium restriction on anxiety levels during an in vitro fertilization procedure. J Psychosom Obstet Gynaecol 20(2): 97–103.
    1. Bloch M, Azem F, Aharonov I, Ben Avi I, Yagil Y, et al. (2010) GnRH-agonist induced depressive and anxiety symptoms during in vitro fertilization-embryo transfer cycles. Fertil Steril 95(1): 307–9.
    1. Gallinelli A, Roncaglia R, Matteo ML, Ciaccio I, Volpe A, et al. (2001) Immunological changes and stress are associated with different implantation rates in patients undergoing in vitro fertilization-embryo transfer. Fertil Steril 76(1): 85–91.
    1. Demyttenaere K, Nijs P, Evers-Kiebooms G, Koninckx PR (1994) Personality characteristics, psychoendocrinological stress and outcome of IVF depend upon the etiology of infertility. Gynecol Endocrinol 8(4): 233–40.
    1. Cohen S, Williamson G (1988) Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, editors. The Social Psychology of Health. Newbury Park, CA: Sage 31–67.
    1. Tiplady S, Jones G, Campbell M, Johnson S, Ledger W (2013) Home ovulation tests and stress in women trying to conceive: a randomized controlled trial. Hum Reprod 28(1): 138–51.
    1. Lee TY, Sun GH, Chao SC, Chen CC (2000) Development of the coping scale for infertile couples. Arch Androl 45(3): 149–54.
    1. Cousineau TM, Green TC, Corsini EA, Barnard T, Seibring AR, et al. (2006) Development and validation of the Infertility Self-Efficacy scale. Fertil Steril 85: 1684–96.
    1. Balk J, Catov J, Horn B, Gecsi K, Wakim A (2010) The relationship between perceived stress, acupuncture, and pregnancy rates among IVF patients: a pilot study. Complement Ther Clin Pract 16(3): 154–7.
    1. Li W, Newell-Price J, Jones GL, Ledger WL, Li TC (2012) Relationship between psychological stress and recurrent miscarriage. Reprod Biomed Online 25(2): 180–9.
    1. Smith CA, Ussher JM, Perz J, Carmady B, de Lacey S (2011) The effect of acupuncture on psychosocial outcomes for women experiencing infertility: a pilot randomized controlled trial. J Altern Complement Med 17(10): 923–30.
    1. Kovárová P, Smith CA, Turnbull DA (2010) An exploratory study of the effect of acupuncture on self-efficacy for women seeking fertility support. Explore 6(5): 330–4.
    1. Pinto-Gouveia J, Galhardo A, Cunha M, Matos M (2012) Protective emotional regulation processes towards adjustment in infertile patients. Hum Fertil 15(1): 27–34.
    1. Galhardo A, Cunha M, Pinto-Gouveia J (2013) Measuring self-efficacy to deal with infertility: Psychometric properties and confirmatory factor analysis of the Portuguese version of the infertility self-efficacy scale. Res Nurs Health 36(1): 65–74.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner