O-131: Negative emotion predicts poor outcome in poor prognosis IVF patients

Abstract

ObjectiveTo explore the effects of depressive symptoms, emotionality, and other psychological variables on IVF treatment outcome.DesignProspective, longitudinal study in which self-report questionnaire data were collected from women undergoing IVF with fresh eggs (N = 595) on Day 3 of their treatment cycle and outcomes collected post-treatment. As a covariate, number of prior cycles was obtained from the SART database.Materials and methodsQuestionnaires completed in the waiting room measured the following psychological variables: positive and negative emotion (Positive and Negative Affect Schedule), depressive symptoms (Center for Epidemiological Studies Depression Scale), overall satisfaction with life (Satisfaction With Life Scale), and optimism (Attributional Style Questionnaire). For all analyses, participants were grouped into good, average, and poor prognostic groups and. Poor prognosis patients met one of the four criteria: over 40 years old, FSH level greater than or equal to 14, diminished ovarian reserve, or endometrial insufficiency. In the current sample, 23%, 40%, and 57% of poor, average, and good prognosis patients achieved clinical pregnancy, respectively.ResultsControlling for number of previous IVF cycles, negative emotion inversely predicted embryo quality, measured as average number of cells in the four highest-quality embryos on Day 3 post-transfer (partial r = -.32, p < .01) among women of poor prognosis (n = 106). Patients for whom there was no fetal heartbeat (FHMax) at 6 weeks were an average of 0.4 standard deviations higher in negative emotion than patients for whom there was a fetal heartbeat at six-weeks (Cohen’s d = .40), although this trend failed to achieve significance (p < .15). Similarly, patients who failed to achieve clinical pregnancy were on average 0.3 standard deviations higher in negative emotion than patients who achieved clinical pregnancy; again this trend failed to achieve significance (p < .23). Embryo quality was also predicted inversely by depressive symptoms (r = -.27, p < .02) and positively by satisfaction with life (r = .22, p < .05) but not by positive emotion (r = .06) nor optimism (r = .01). No significant relationships between psychological variables and outcome were observed among women of good (n = 216) or average prognosis (n = 136).ConclusionPrior findings on the effects of psychological variables on IVF outcome have been mixed. We speculate that the inconsistency of findings derives, at least in part, from poorly validated measures of psychological variables and the failure to examine whether these relationships depend on underlying factors affecting prognosis. In the current study, we find a robust relationship between negative emotion and embryo quality among poor prognosis but not among good or average prognoses IVF patients. Further research should explore the possibility that interventional measures affecting depression and emotion could positively affect clinical outcomes in poor prognosis IVF patients. ObjectiveTo explore the effects of depressive symptoms, emotionality, and other psychological variables on IVF treatment outcome. To explore the effects of depressive symptoms, emotionality, and other psychological variables on IVF treatment outcome. DesignProspective, longitudinal study in which self-report questionnaire data were collected from women undergoing IVF with fresh eggs (N = 595) on Day 3 of their treatment cycle and outcomes collected post-treatment. As a covariate, number of prior cycles was obtained from the SART database. Prospective, longitudinal study in which self-report questionnaire data were collected from women undergoing IVF with fresh eggs (N = 595) on Day 3 of their treatment cycle and outcomes collected post-treatment. As a covariate, number of prior cycles was obtained from the SART database. Materials and methodsQuestionnaires completed in the waiting room measured the following psychological variables: positive and negative emotion (Positive and Negative Affect Schedule), depressive symptoms (Center for Epidemiological Studies Depression Scale), overall satisfaction with life (Satisfaction With Life Scale), and optimism (Attributional Style Questionnaire). For all analyses, participants were grouped into good, average, and poor prognostic groups and. Poor prognosis patients met one of the four criteria: over 40 years old, FSH level greater than or equal to 14, diminished ovarian reserve, or endometrial insufficiency. In the current sample, 23%, 40%, and 57% of poor, average, and good prognosis patients achieved clinical pregnancy, respectively. Questionnaires completed in the waiting room measured the following psychological variables: positive and negative emotion (Positive and Negative Affect Schedule), depressive symptoms (Center for Epidemiological Studies Depression Scale), overall satisfaction with life (Satisfaction With Life Scale), and optimism (Attributional Style Questionnaire). For all analyses, participants were grouped into good, average, and poor prognostic groups and. Poor prognosis patients met one of the four criteria: over 40 years old, FSH level greater than or equal to 14, diminished ovarian reserve, or endometrial insufficiency. In the current sample, 23%, 40%, and 57% of poor, average, and good prognosis patients achieved clinical pregnancy, respectively. ResultsControlling for number of previous IVF cycles, negative emotion inversely predicted embryo quality, measured as average number of cells in the four highest-quality embryos on Day 3 post-transfer (partial r = -.32, p < .01) among women of poor prognosis (n = 106). Patients for whom there was no fetal heartbeat (FHMax) at 6 weeks were an average of 0.4 standard deviations higher in negative emotion than patients for whom there was a fetal heartbeat at six-weeks (Cohen’s d = .40), although this trend failed to achieve significance (p < .15). Similarly, patients who failed to achieve clinical pregnancy were on average 0.3 standard deviations higher in negative emotion than patients who achieved clinical pregnancy; again this trend failed to achieve significance (p < .23). Embryo quality was also predicted inversely by depressive symptoms (r = -.27, p < .02) and positively by satisfaction with life (r = .22, p < .05) but not by positive emotion (r = .06) nor optimism (r = .01). No significant relationships between psychological variables and outcome were observed among women of good (n = 216) or average prognosis (n = 136). Controlling for number of previous IVF cycles, negative emotion inversely predicted embryo quality, measured as average number of cells in the four highest-quality embryos on Day 3 post-transfer (partial r = -.32, p < .01) among women of poor prognosis (n = 106). Patients for whom there was no fetal heartbeat (FHMax) at 6 weeks were an average of 0.4 standard deviations higher in negative emotion than patients for whom there was a fetal heartbeat at six-weeks (Cohen’s d = .40), although this trend failed to achieve significance (p < .15). Similarly, patients who failed to achieve clinical pregnancy were on average 0.3 standard deviations higher in negative emotion than patients who achieved clinical pregnancy; again this trend failed to achieve significance (p < .23). Embryo quality was also predicted inversely by depressive symptoms (r = -.27, p < .02) and positively by satisfaction with life (r = .22, p < .05) but not by positive emotion (r = .06) nor optimism (r = .01). No significant relationships between psychological variables and outcome were observed among women of good (n = 216) or average prognosis (n = 136). ConclusionPrior findings on the effects of psychological variables on IVF outcome have been mixed. We speculate that the inconsistency of findings derives, at least in part, from poorly validated measures of psychological variables and the failure to examine whether these relationships depend on underlying factors affecting prognosis. In the current study, we find a robust relationship between negative emotion and embryo quality among poor prognosis but not among good or average prognoses IVF patients. Further research should explore the possibility that interventional measures affecting depression and emotion could positively affect clinical outcomes in poor prognosis IVF patients. Prior findings on the effects of psychological variables on IVF outcome have been mixed. We speculate that the inconsistency of findings derives, at least in part, from poorly validated measures of psychological variables and the failure to examine whether these relationships depend on underlying factors affecting prognosis. In the current study, we find a robust relationship between negative emotion and embryo quality among poor prognosis but not among good or average prognoses IVF patients. Further research should explore the possibility that interventional measures affecting depression and emotion could positively affect clinical outcomes in poor prognosis IVF patients.