Advertisement

Journal of Assisted Reproduction and Genetics

, Volume 30, Issue 11, pp 1451–1458 | Cite as

Reproductive implications of psychological distress for couples undergoing IVF

  • Hayley S. Quant
  • Athena Zapantis
  • Michael Nihsen
  • Kris Bevilacqua
  • Sangita JindalEmail author
  • Lubna Pal
Assisted Reproduction Technologies

Abstract

Objective

To study implications of psychological distress on in vitro fertilization (IVF) outcome of an infertile couple.

Methods

Prospective study in an academic infertility practice setting. Couples undergoing embryo transfer (ET) following IVF were offered participation. Female patient (n = 89) and partner (n = 77) completed questionnaires reflecting dysphoria (POMS) and pessimism (LOT) after undergoing ET. Relationship between dysphoria and pessimism and implications of individual and couple’s psychological distress on IVF cycle parameters and outcomes were assessed using multivariable analyses.

Results

Statistically significant correlations between dysphoria and pessimism were observed within the individual and between partners, (p < 0.01). Higher couple pessimism correlated with longer duration of controlled ovarian hyperstimulation (COH, p = 0.02); higher partner psychological distress related to lower fertilization rate (FR, p = 0.03). On adjusted analyses, partner’s depression score was an independent predictor of reduced likelihood of clinical pregnancy (p = 0.03).

Conclusions

Our data validate the concept of a “stressed couple”. Adverse implications of a couple’s psychological distress for gamete biology (longer duration of COH and lower FR with increasing distress) are suggested. Partner’s depressive scores negatively correlated with IVF success. These findings suggest the importance of including partner’s evaluation in studies that focus on effects of psychological stress on IVF outcome; future studies should examine whether interventions aimed at reducing psychological stress for the infertile couple may improve IVF cycle success.

Keywords

Stress Mood Dysphoria Pessimism POMS LOT Infertility IVF 

Notes

Acknowledgments

The authors wish to thank the patients and the staff at MIRMH for their participation in making this work a reality.

Declaration of interest statement

The authors report no declarations of interest.

Supplementary material

10815_2013_98_MOESM1_ESM.doc (26 kb)
Supplemental Figure Linear correlation was observed between psychological distress scores of the female patients and their partners. (DOC 26 kb)

References

  1. 1.
    Seibel MM, Taymor ML. Emotional aspects of infertility. Fertil Steril. 1982;37:137–45.PubMedGoogle Scholar
  2. 2.
    Freeman EW, Boxer AS, Rickels K, Tureck R, Mastroianni Jr L. Psychological evaluation and support in a program of in vitro fertilization and embryo transfer. Fertil Steril. 1985;43:48–53.PubMedGoogle Scholar
  3. 3.
    Chen TH, Chang SP, Tsai CF, Juang KD. Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Hum Reprod. 2004;19:2313–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Kee BS, Jung BJ, Lee SH. A study on psychological strain in IVF patients. J Assist Reprod Genet. 2000;17:445–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Cwikel J, Gidron Y, Sheiner E. Psychological interactions with infertility among women. Eur J Obstet Gynecol Reprod Biol. 2004;117:126–31.PubMedCrossRefGoogle Scholar
  6. 6.
    Wasser SK, Sewall G, Soules MR. Psychosocial stress as a cause of infertility. Fertil Steril. 1993;59:685–9.PubMedGoogle Scholar
  7. 7.
    Stoleru S, Teglas JP, Spira A, Magnin F, Fermanian J. Psychological characteristics of infertile patients: discriminating etiological factors from reactive changes. J Psychosom Obstet Gynaecol. 1996;17:103–18.PubMedCrossRefGoogle Scholar
  8. 8.
    Boivin J, Takefman JE. Stress level across stages of in vitro fertilization in subsequently pregnant and nonpregnant women. Fertil Steril. 1995;64:802–10.PubMedGoogle Scholar
  9. 9.
    Boivin J, Schmidt L. Infertility-related stress in men and women predicts treatment outcome 1 year later. Fertil Steril. 2005;83:1745–52.PubMedCrossRefGoogle Scholar
  10. 10.
    Csemiczky G, Landgren BM, Collins A. 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. 2000;79:113–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Demyttenaere K, Bonte L, Gheldof M, Vervaeke M, Meuleman C, Vanderschuerem D, et al. Coping style and depression level influence outcome in in vitro fertilization. Fertil Steril. 1998;69:1026–33.PubMedCrossRefGoogle Scholar
  12. 12.
    Klonoff-Cohen H, Chu E, Natarajan L, Sieber W. A prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer. Fertil Steril. 2001;76:675–87.PubMedCrossRefGoogle Scholar
  13. 13.
    Klonoff-Cohen H, Natarajan L. The concerns during assisted reproductive technologies (CART) scale and pregnancy outcomes. Fertil Steril. 2004;81:982–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Sanders KA, Bruce NW. Psychosocial stress and treatment outcome following assisted reproductive technology. Hum Reprod. 1999;14:1656–62.PubMedCrossRefGoogle Scholar
  15. 15.
    Smeenk JM, Verhaak CM, Eugster A, van Minnen A, Zielhuis GA, Braat DD. The effect of anxiety and depression on the outcome of in-vitro fertilization. Hum Reprod. 2001;16:1420–3.PubMedCrossRefGoogle Scholar
  16. 16.
    Thiering P, Beaurepaire J, Jones M, Saunders D, Tennant C. Mood state as a predictor of treatment outcome after in vitro fertilization/embryo transfer technology (IVF/ET). J Psychosom Res. 1993;37:481–91.PubMedCrossRefGoogle Scholar
  17. 17.
    Ebbesen SM, Zachariae R, Mehlsen MY, Thomsen D, Hojgaard A, Ottosen L, et al. Stressful life events are associated with a poor in-vitro fertilization (IVF) outcome: a prospective study. Hum Reprod. 2009;24:2173–82.PubMedCrossRefGoogle Scholar
  18. 18.
    Gurhan N, Akyuz A, Atici D, Kisa S. Association of depression and anxiety with oocyte and sperm numbers and pregnancy outcomes during in vitro fertilization treatment. Psychol Rep. 2009;104:796–806.PubMedCrossRefGoogle Scholar
  19. 19.
    Anderheim L, Holter H, Bergh C, Moller A. Does psychological stress affect the outcome of in vitro fertilization? Hum Reprod. 2005;20:2969–75.PubMedCrossRefGoogle Scholar
  20. 20.
    Harlow CR, Fahy UM, Talbot WM, Wardle PG, Hull MG. Stress and stress-related hormones during in-vitro fertilization treatment. Hum Reprod. 1996;11:274–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Lovely LP, Meyer WR, Ekstrom RD, Golden RN. Effect of stress on pregnancy outcome among women undergoing assisted reproduction procedures. South Med J. 2003;96:548–51.PubMedCrossRefGoogle Scholar
  22. 22.
    Slade P, Emery J, Lieberman BA. A prospective, longitudinal study of emotions and relationships in in-vitro fertilization treatment. Hum Reprod. 1997;12:183–90.PubMedCrossRefGoogle Scholar
  23. 23.
    Cooper BC, Gerber JR, McGettrick AL, Johnson JV. Perceived infertility-related stress correlates with in vitro fertilization outcome. Fertil Steril. 2007;88:714–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Cheong YC, Hung Yu Ng E, Ledger WL. Acupuncture and assisted conception. Cochrane Database Syst Rev. 2008:CD006920.Google Scholar
  25. 25.
    El-Toukhy T, Sunkara SK, Khairy M, Dyer R, Khalaf Y, Coomarasamy A. A systematic review and meta-analysis of acupuncture in in vitro fertilisation. BJOG. 2008;115:1203–13.PubMedCrossRefGoogle Scholar
  26. 26.
    Barrell GK. Immunological influences on reproductive neuroendocrinology. Soc Reprod Fertil Suppl. 2007;64:109–22.PubMedGoogle Scholar
  27. 27.
    Lancastle D, Boivin J. Dispositional optimism, trait anxiety, and coping: unique or shared effects on biological response to fertility treatment? Health Psychol. 2005;24:171–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Domar AD, Clapp D, Slawsby EA, Dusek J, Kessel B, Freizinger M. Impact of group psychological interventions on pregnancy rates in infertile women. Fertil Steril. 2000;73:805–11.PubMedCrossRefGoogle Scholar
  29. 29.
    Ng EH, So WS, Gao J, Wong YY, Ho PC. The role of acupuncture in the management of subfertility. Fertil Steril. 2008;90:1–13.PubMedCrossRefGoogle Scholar
  30. 30.
    Domar AD, Meshay I, Kelliher J, Alper M, Powers RD. The impact of acupuncture on in vitro fertilization outcome. Fertil Steril. 2009;91:723–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Schenker JG, Meirow D, Schenker E. Stress and human reproduction. Eur J Obstet Gynecol Reprod Biol. 1992;45:1–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Harrison KL, Callan VJ, Hennessey JF. Stress and semen quality in an in vitro fertilization program. Fertil Steril. 1987;48:633–6.PubMedGoogle Scholar
  33. 33.
    Ragni G, Caccamo A. Negative effect of stress of in vitro fertilization program on quality of semen. Acta Eur Fertil. 1992;23:21–3.PubMedGoogle Scholar
  34. 34.
    Clarke RN, Klock SC, Geoghegan A, Travassos DE. Relationship between psychological stress and semen quality among in-vitro fertilization patients. Hum Reprod. 1999;14:753–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Kondoh E, Okamoto T, Higuchi T, Tatsumi K, Baba T, Murphy SK, et al. Stress affects uterine receptivity through an ovarian-independent pathway. Hum Reprod. 2009;24:945–53.PubMedCrossRefGoogle Scholar
  36. 36.
    Lorr M, McNair D, Heuchert J, Droppleman L. Profile of mood states. Canada: Multi-Health Systems Inc.; 2003.Google Scholar
  37. 37.
    Scheier MF, Carver CS. Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychol. 1985;4:219–47.PubMedCrossRefGoogle Scholar
  38. 38.
    Pellicer A, Ruiz M. Fertilization in vitro of human oocytes by spermatozoa collected in different stressful situations. Hum Reprod. 1989;4:817–20.PubMedGoogle Scholar
  39. 39.
    Poland ML, Giblin PT, Ager JW, Moghissi KS. Effect of stress on semen quality in semen donors. Int J Fertil. 1986;31:229–31.PubMedGoogle Scholar
  40. 40.
    Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B. Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality. Arch Androl. 1997;39:155–61.PubMedCrossRefGoogle Scholar
  41. 41.
    Zhang M, Huang G, Lu F, Paulus WE, Sterzik K. Influence of acupuncture on idiopathic male infertility in assisted reproductive technology. J Huazhong Univ Sci Technolog Med Sci. 2002;22:228–30.PubMedCrossRefGoogle Scholar
  42. 42.
    Meeker JD, Benedict MD. Infertility, pregnancy loss and adverse birth outcomes in relation to maternal secondhand tobacco smoke exposure. Curr Womens Health Rev. 2013;9(1):41–49.Google Scholar
  43. 43.
    Hershlag A, Paine T, Kvapil G, Feng H, Napolitano B. In vitro fertilization-intracytoplasmic sperm injection split: an insemination method to prevent fertilization failure. Fertil Steril. 2002;77:229–32.PubMedCrossRefGoogle Scholar
  44. 44.
    Kolibianakis EM, Venetis CA, Bontis J, Tarlatzis BC. Significantly lower pregnancy rates in the presence of progesterone elevation in patients treated with GnRH antagonists and gonadotrophins: a systematic review and meta-analysis. Curr Pharm Biotechnol. 2011.Google Scholar
  45. 45.
    Orvieto R, Meltzer S, Rabinson J, Zohav E, Anteby EY, Nahum R. GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of endometrial receptivity. Fertil Steril. 2008;90:1294–6.PubMedCrossRefGoogle Scholar
  46. 46.
    van Loendersloot LL, van Wely M, Limpens J, Bossuyt PM, Repping S, van der Veen F. Predictive factors in in vitro fertilization (IVF): a systematic review and meta-analysis. Hum Reprod Update. 2010;16:577–89.PubMedCrossRefGoogle Scholar
  47. 47.
    Vartiainen H, Saarikoski S, Halonen P, Rimon R. Psychosocial factors, female fertility and pregnancy: a prospective study–part I: fertility. J Psychosom Obstet Gynaecol. 1994;15:67–75.PubMedCrossRefGoogle Scholar
  48. 48.
    Hjollund NH, Jensen TK, Bonde JP, Henriksen TB, Andersson AM, Kolstad HA, et al. Distress and reduced fertility: a follow-up study of first-pregnancy planners. Fertil Steril. 1999;72:47–53.PubMedCrossRefGoogle Scholar
  49. 49.
    Collodel G, Moretti E, Fontani V, Rinaldi S, Aravagli L, Sarago G, et al. Effect of emotional stress on sperm quality. Indian J Med Res. 2008;128:254–61.PubMedGoogle Scholar
  50. 50.
    Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study. Andrologia. 2000;32:31–9.PubMedGoogle Scholar
  51. 51.
    Pei J, Strehler E, Noss U, Abt M, Piomboni P, Baccetti B, et al. Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertil Steril. 2005;84:141–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Hayley S. Quant
    • 1
  • Athena Zapantis
    • 1
  • Michael Nihsen
    • 1
  • Kris Bevilacqua
    • 1
  • Sangita Jindal
    • 1
    Email author
  • Lubna Pal
    • 1
  1. 1.Einstein College of Medicine/Montefiore Medical CenterHartsdaleUSA

Personalised recommendations