Perceived Infertility-Related Stress Correlates With In Vitro Fertilization Outcome

Abstract

Stress can have significant effects on patient wellbeing and the success of treatment regimens. The goal of this study was to determine the effect of perceived infertility-related stress as measured by the Fertility Problem Inventory (FPI) on pregnancy rates for an in vitro fertilization (IVF) program. Retrospective analysis. Couples who underwent their first IVF cycle between May 2002 and April 2005 and had FPI testing were studied. The FPI is a validated questionnaire which tests five scales of perceived infertility-related stress: social concern, sexual concern, relationship concern, negative view of a childfree lifestyle and need for parenthood as well as a composite or global stress score. Patient charts were retrospectively analyzed for age, gravidity, parity, serum HCG, total number of oocytes retrieved and number of embryos transferred. The primary outcome was total pregnancy rate. One hundred twenty-nine couples underwent their first IVF cycle, with both partners completing the FPI prior to treatment, between May 2002 and April 2005. Sixty-nine patients (53%) had a positive serum HCG compared to 60 (47%) with a negative serum HCG or a cancelled cycle. There were no significant differences between the group with a positive serum pregnancy test compared to the group with a negative serum pregnancy test with regard to age of the female partner (34±1 vs. 35±1, p=0.06), age of the male partner (35±1 vs. 36±1, p=0.29), gravidity (1.0±0.2 vs. 1.2±0.2, p=0.23), parity (0.4±0.1 vs. 0.4±0.1, p=0.80), total number of oocytes retrieved (10±1 vs. 10±1, p=0.98), total gonadotropins used (39.5±1.8 amps vs. 43.2±2.4, p=0.20) or the number of embryos transferred (2.4±0.1 vs. 2.3±0.1, p=0.36). When both partners are analyzed together, couples who conceived had significantly higher scores for sexual concern (31.4±1.2 vs. 28.1±1.1, p=0.05) and need for parenthood (72.5±1.5 vs. 66.6±1.6, p=0.01) but no differences in social concern, relationship concern, negative view of a childfree lifestyle or global stress. Independent analysis of female partners who became pregnant demonstrated significantly higher scores in the need for parenthood scale (37.7±1.0 vs. 34.0±1.1. p=0.01) with a trend toward higher scores for sexual concern (16.9±0.9 vs. 14.7±0.8, p=0.06), negative view of a childfree lifestyle (26.9±1.0 vs. 24.8±0.8, p=0.11) and global stress (123.3±3.1 vs. 115.4±3.7, p=0.10). There were no significant differences between pregnant and nonpregnant female partners with regard to social concern or relationship concern. There were no significant differences between the male partners of couples that did or did not become pregnant for any of the parameters measured. Couples who conceived in this study exhibited statistically higher scores on measures of need for parenthood and loss of sexual enjoyment. These results suggest that patients who experience more infertility-related stress as measured by the FPI may be more emotionally invested in IVF and thus more likely to conceive.