Stress at the initiation of fertility treatment affects IVF outcomes

Abstract

OBJECTIVE: To assess whether self-reported stress levels and stress-associated behaviors affect IVF pregnancy rates. DESIGN: Retrospective cohort. MATERIALS AND METHODS: Charts of 217 consecutive women undergoing their first IVF cycle at a private infertility center between January 2006 and December 2008 were reviewed. All women completed a standardized medical history questionnaire at their initial visit in which they quantified their level of infertility-related stress using a score from 1 to 10. Patient characteristics (age, FSH, ethnicity, history of anxiety or depression), intermediate IVF outcomes (eggs retrieved, endometrial thickness), and pregnancy outcomes (positive βHCG, clinical pregnancy, and live birth rate) were analyzed. Data were adjusted for stress-related behaviors such as smoking, caffeine intake, and exercise. Statistical analyses were performed using Stata v10. RESULTS: We found a significant correlation between stress and IVF outcomes. Stress levels were linearly related to βHCG positivity (OR 1.18, p=0.02) and clinical pregnancy (OR 1.16, p=0.03). A similar trend was noted for live birth rate (OR 1.12, p=0.09). We also observed a strong inverse linear relationship between age and stress levels (β= -0.09, p=0.03), even after adjusting for FSH, smoking, alcohol intake, and exercise. Smoking negatively impacted clinical pregnancy (OR 0.24, p<0.01) and live birth rate (OR 0.26, p=0.01). Stress was unrelated to ethnicity. CONCLUSION: Our study demonstrates better IVF pregnancy rates in women reporting higher stress levels. Infertility-related stress significantly decreased with age, perhaps reflecting lower expectations for successful treatment. These findings highlight the importance of assessing stress levels during infertility evaluations and the need for a better understanding of the physiologic consequences of stress. Some stress may actually be beneficial in achieving pregnancy. Future studies comparing both psychological and biochemical markers of stress may lead to improved IVF outcomes.