Abstract
Stress is a risk factor for impaired general, mental, and reproductive health. The role of physiological and supraphysiological estradiol concentrations in stress perception and stress processing is less well understood. We, therefore, conducted a prospective observational study to investigate the association between estradiol, stress perception, and stress-related cognitive performance within serial measurements either during the natural menstrual cycle or during fertility treatment, where estradiol levels are strongly above the physiological level of a natural cycle, and consequently, represent a good model to study dose-dependent effects of estradiol. Data from 44 women receiving in vitro fertilization (IVF) at the Department of Reproductive Endocrinology in Zurich, Switzerland was compared to data from 88 women with measurements during their natural menstrual cycle. The German version of the Perceived Stress Questionnaire (PSQ) and the Cognitive Bias Test (CBT), in which cognitive performance is tested under time stress were used to evaluate subjective and functional aspects of stress. Estradiol levels were investigated at four different time points during the menstrual cycle and at two different time points during a fertility treatment. Cycle phases were associated with PSQ worry and cognitive bias in normally cycling women, but different phases of fertility treatment were not associated with subjectively perceived stress and stress-related cognitive bias. PSQ lack of joy and PSQ demands related to CBT in women receiving fertility treatment but not in women with a normal menstrual cycle. Only strong changes of the estradiol level during fertility treatment were weakly associated with CBT, but not with subjectively experienced stress. Our research emphasizes the multidimensional character of stress and the necessity to adjust stress research to the complex nature of stress perception and processing. Infertility is associated with an increased psychological burden in patients. However, not all phases of the process to overcome infertility do significantly increase patient stress levels. Also, research on the psychological burden of infertility should consider that stress may vary during the different phases of fertility treatment.Clinical trial registration: ClinicalTrials.gov # NCT02098668.
Highlights
A variety of research results support an involvement of steroid hormones in the perception and processing of stress
85 women were investigated during their natural menstrual cycle and 44 during a fertility treatment
Infertility is well-known to be associated with stress (Cousineau and Domar, 2007; Gameiro et al, 2013; Rockliff et al, 2014; Pasch et al, 2016), our findings show no significant differences in the perceived stress level as well as the cognitive bias test between women receiving fertility treatment and women in their natural cycle
Summary
A variety of research results support an involvement of steroid hormones in the perception and processing of stress. The prevalence of affective disorders and stress-related disorders such as port-traumatic stress disorder (PTSD) is two to three times higher in women (Kessler et al, 2005; Tolin and Foa, 2006; Bromet et al, 2011; Zoladz and Diamond, 2013) These sex differences start at puberty and persist until menopause (Kessler et al, 1994; Zahn-Waxler et al, 2008). Longitudinal measurements have demonstrated that in healthy women, the sex hormones do not consistently and robustly relate to negative affect or cognitive performance when assessed across two consecutive menstrual cycles (Hengartner et al, 2017; Leeners et al, 2017) In sight of such results, many of the associations interpreted as consequences of hormonal variations have to be attributed to methodological limitations
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