Psychological and hormonal changes in the course of in vitro fertilization

  • Dalia Merari
  • Dov Feldberg
  • Avner Elizur
  • Jacob Goldman
  • Baruch Modan
Behavioral Investigations


This study was designed to investigate concurrently the psychological and hormonal changes at three critical points during in vitro fertilization (IVF) treatment. One hundred thirteen couples suffering from mechanical and unexplained infertility participated in the study and 23 of them conceived. Psychological evaluation included background questionnaires, Lubin's Depression Adjective Check List, and Spielberger's State Trait Anxiety inventory. Cortisol and prolactin levels were estimated by radioimmunoassay. The results showed that patients' anxiety and depression scores were significantly higher than the population norm. Psychological test scores and hormonal levels showed a similar pattern of change, increasing on oocyte retrieval day, decreasing on embryo transfer day, and rising again on pregnancy test day. Differences between these phases were generally significant. Differences in parameters' means between conceiving (C) and nonconceiving (NC) women were generally not significant. However, correlations between psychological measures and hormonal levels showed a clear disparity between C and NC women in the last phase. Whereas significant negative correlations were found in C patients, no relationship was found in NC patients. The findings suggest that success in IVF treatment may depend, in part, on differential modes of coping with anxiety and depression, involving hormonal or endorphin mediation.

Key words

in vitro fertilization phases depression anxiety prolactin cortisol 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Demyttenare K, Nijs P, Evers-Kiebooms G, Koninckx PR: The effect of a specific emotional stressor on prolactin, cortisol, and testosterone concentrations in women varies with their trait anxiety. Fertil Steril 1989;52:942–948PubMedGoogle Scholar
  2. 2.
    Edelman RJ, Connolly KJ: Psychological aspects of infertility. Br J Med Psychol 1986;59:209–219PubMedGoogle Scholar
  3. 3.
    Rothman D, Kaplan A: Psychosomatic infertility in the male and female.In Modern Perspectives in Psychobstetrics, J Howells (ed.). New York, Brunner Mazel, 1972Google Scholar
  4. 4.
    Daniluk JC: Infertility: Intrapersonal and interpersonal impact. Fertil Steril 1988;49:982–990PubMedGoogle Scholar
  5. 5.
    Seibel MM, Taymor ML: Emotional aspects of infertility. Fertil Steril 1982;37:137–145PubMedGoogle Scholar
  6. 6.
    Brand J, Roos SS, Van der Merwe AB: Psychological stress and infertility. 1. Psychophysiological reaction patterns. J Med Psychol 1982;55:379–384PubMedGoogle Scholar
  7. 7.
    Fang VS, Jiang HK, Lu RB, Luchns DJ: Cortisol response to ACTH infusion in depressed patients. Psychoneuroendocrinology 1988;13:497PubMedGoogle Scholar
  8. 8.
    Canoll BJ: The dexamethasone suppression test for melanenolia. Br J Psychiat 1983;140:292Google Scholar
  9. 9.
    Gormley GJ, Lowy MT, Reder AT: Glucocorticoid receptors in depression: Relationship to the dexamethasone suppression test. Am J Psychiat 1985;142:1278–1284PubMedGoogle Scholar
  10. 10.
    Seppala M, Ranta T, Hirvonen E: Hyperprolactinemia and luteal insufficiency. Lancet 1976;1:229–231PubMedGoogle Scholar
  11. 11.
    Bohnet HG, Dahler HG, Wuttle W, Schneider HPG: Hyperprolactinemic anovulatory syndrome. J Clin Endocrinol Metab 1975;42:132Google Scholar
  12. 12.
    Reinthaller A, Bieglmayer C, Dentinger J, Csaicsich P: Transient hyperprolactinemia during cycle stimulation: Influence on the endocrine response and fertilization rate of human oocytes and effects of bromocryptine treatment. Fertil Steril 1988;49:432–436PubMedGoogle Scholar
  13. 13.
    Kaupilla A, Marikainen H, Pnistola U, Reinila M, Ronnberg L: Hyperprolactinemia and ovarian function. Fertil Steril 1988;49:437–441PubMedGoogle Scholar
  14. 14.
    Lubin B: Depression Adjective Check-List: Manual, 2nd ed. San Diego, CA, Educational and Industrial Service, 1981Google Scholar
  15. 15.
    Patrick AW, Zuckerman M: An application of the state-trait concept to the need for achievement. J Res Personal 1977;11:459Google Scholar
  16. 16.
    Lomranz J, Lubin B, Medini G, Eyal N: RTD: Depression Adjective Check-List. Tel Aviv, Department of Psychology, Tel Aviv University, 1981Google Scholar
  17. 17.
    Spielberger C, Gorsuch R, Lushene R: Manual for the State Trait Anxiety Inventory (Self Evaluation Questionnaire). Palo Alto, CA, Consulting Psychology Press, 1970Google Scholar
  18. 18.
    Teichman Y, Melink H: A Hebrew Version of Spielberger's State Trait Anxiety Inventory. Tel Aviv, Tel Aviv University, Ramot, 1984Google Scholar
  19. 19.
    Morse C, Dennerstein L: Infertile couples entering an invitro fertilization programme: A preliminary survey. J Psychosom Obstet Gynecol 1985;4:207Google Scholar
  20. 20.
    Freeman EW, Boxer AS, Rickels K, Tureck R, Mastroianni L: Psychological evaluation and support in a program of in vitro fertilization and embryo transfer. Fertil Steril 1985;43:48–53PubMedGoogle Scholar
  21. 21.
    Haseltine FP, Mazure C, DeL'Aune W, Greenfeld D, Laufer N, Tarlatzis B, Polan ML, Jones EE, Graebe R, Nero F, D'Luigi AD, Fazio D, Masters J, DeCherney AH: Psychological interviews in screening couples undergoing in vitro fertilization. Ann NY Acad Sci 1985;422:504Google Scholar
  22. 22.
    Hearn MT, Yutzpe AA, Brown SE, Caspar RF: Psychological characteristics of in vitro fertilization participants. Am J Obstet Gynecol 1987;156:269–274PubMedGoogle Scholar
  23. 23.
    Newton CR, Hearn MT, Yutzpe AA: Psychological assessment and follow-up after in vitro fertilization: Assessing the impact of failure. Fertil Steril 1990;54:879–886PubMedGoogle Scholar
  24. 24.
    Seibel MM, Levin S: A new era in reproduction technologies: The emotional stages of in vitro fertilization. J Vitro Fert Embryo Transfer 1987;4:135Google Scholar
  25. 25.
    Kentenich H, Dincer C, Blankau A, Schmiady H, Stauber M: Psychosomatic reactions of couples treated with IVF. J Vitro Fert Embryo Transfer 1986;3:74 (abstr)Google Scholar
  26. 26.
    Modell E, Goldstein D, Reyes FI: Endocrine and behavioral responses to psychological stress in hyperadrogenic women. Fertil Steril 1990;53:454–459PubMedGoogle Scholar
  27. 27.
    Guttman S, Brinsmead M, Stanger J, Oliver M: Psychological profile of 180 couples undergoing IVF. J Vitro Fert Embryo Transfer 1986;3:189 (abstr)Google Scholar
  28. 28.
    Greenfeld D, Mazure C, Haseltine FP, DeCherney AH: The role of the social worker in the in vitro fertilization program. Social Work Health Care 1984;10:71Google Scholar
  29. 29.
    Harrison RF, O'Moore RR, O'Moore AM: Stress and fertility: Some modalities of investigation and treatment in couples with unexplained infertility in Dublin. J Fertil 1986;31:153–159Google Scholar
  30. 30.
    Mazure CM, De l'Aune WD, DeCherney AH: Two methodological issues in the psychological study of in vitro fertilization/embryo transfer participants. J Psychosom Obstet Gynecol 1988;9:17Google Scholar
  31. 31.
    Weinberger DA, Schwartz GE, Davidson RJ: Low-anxious, high-anxious, and repressive coping styles: Psychometric patterns and behavioral and physiological responses to stress. J Abnorm Psychol 1979;88:369–380PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1992

Authors and Affiliations

  • Dalia Merari
    • 1
  • Dov Feldberg
    • 2
  • Avner Elizur
    • 3
  • Jacob Goldman
    • 2
  • Baruch Modan
    • 4
  1. 1.School of Health Professions, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  2. 2.Department of Gynecology, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.Department of Psychotherapy, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  4. 4.Department of Epidemiology, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

Personalised recommendations