Abstract
BackgroundThe role of stress in reproduction, particularly during treatment for infertility, has been of considerable interest; however, few studies have objectively measured stress and anxiety over the course of the IVF cycle or compared the experience of first-time and repeat patients.MethodsThis prospective cohort pilot study enrolled 44 women undergoing IVF at a university-based clinic to complete the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS) and Infertility Self-Efficacy Scale (ISES) at three time points prior to ovarian stimulation (T1), one day prior to oocyte retrieval (T2), and 5–7 days post embryo transfer (T3).ResultsMean STAI State scores were significantly elevated at all three time points (p<0.01). STAI State and PSS mean values did not change over time and did not differ in first-time vs. repeat patients. Self-efficacy (ISES) scores declined over time, with a greater decline for repeat patients. Of the 36 women who completed a cycle, 15 achieved clinical pregnancy. Using logistic regression modeling, all scores at T2 were correlated with pregnancy outcome with lower scores on the STAI State and PSS and higher scores on the ISES associated with higher pregnancy rates.ConclusionsStress and anxiety levels remained elevated across all cycles. Women with lower stress and anxiety levels on the day prior to oocyte retrieval had a higher pregnancy rate. These results emphasize the need to investigate stress reduction modalities throughout the IVF cycle.
Highlights
The role of stress in reproduction, in relation to assisted reproductive technologies such as IVF, has long been a topic of interest
Demographics did not differ between first-time and repeat IVF patients except for FSH, which was higher in the repeat patients and number of embryos transferred, which was higher in the repeat patients with a pvalue approaching significance
Mean State-Trait Anxiety Inventory (STAI)-State scores were significantly elevated over the normative population mean of 35.20 at all three time points
Summary
The role of stress in reproduction, in relation to assisted reproductive technologies such as IVF, has long been a topic of interest. The utility in discovering the answers lies in strengthening the efficacy of our fertility treatment approaches, and in understanding the experience of infertility and its treatment as a quality of life issue. A number of tested instruments have been developed to assess and measure stress, in particular relating stress to concepts of anxiety, self-efficacy, and coping, among others. The role of stress in reproduction, during treatment for infertility, has been of considerable interest; few studies have objectively measured stress and anxiety over the course of the IVF cycle or compared the experience of first-time and repeat patients
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