Uterine Contraction Frequency at the Time of Embryo Transfer (ET) Is Correlated With Anxiety Levels

Abstract

Objective: Circumstantial evidence indicates that the psychological status may impact on uterine contractility. During pregnancy, high anxiety levels have been associated with increased uterine contractility and preterm labor (Omer et al, 1988). In the non pregnant woman, uterine contraction (UC) frequency is high in a fraction of women on the day of ET which is detrimental to embryo implantation (Fanchin et al, 1998). Because the patient anxiety status has been shown to influence IVF-ET outcome (Stoleru et al, 1997), we elected to investigate the possible association between anxiety levels and UC in IVF-ET cycles. Design: Prospective study on the effects of anxiety (defined as “acute” or state anxiety and “chronic” or trait anxiety) on UC in IVF-ET. Materials and Methods: 48 women, aged 25–38, undergoing 48 GnRH-a and hMG/hCG cycles for IVF-ET were studied prospectively. Just before ET, state and trait anxiety levels were rated using standardized questionnaires (State-Trait Anxiety Inventory-STAI, which scores range from 20 to 80). Concomitantly, women underwent continuous monitoring of their blood pressure and cardiac frequency, serum cortisol levels were measured, and 2-minute sagittal ultrasound scans of the uterus were obtained with a 7.0 MHz vaginal probe (Siemens Elegra, France), and digitized with an image analysis system (IôDP, France) for the assessment of UC frequency. Three days after ET (ET+3), women underwent similar evaluation except for the trait anxiety measurement. Results: On the day of ET, overall mean trait and state anxiety scores were 40.1 ± 1.3 and 37.1 ± 1.8, respectively (mean ± SE). At ET+3, state anxiety scores did not change significantly (35.6 ± 1.5). Trait anxiety scores correlated positively with serum cortisol levels (r=0.36; P<0.02) but not with blood pressure and cardiac frequency. As illustrated, on the day of ET, UC rate correlated positively with trait anxiety scores. State-anxiety scores failed to correlate with hormones and UC on the days of ET and ET+3. Conclusion: The significant correlation between trait anxiety status and UC frequency at the time of ET provides plausible explanation for the reported relationship between high anxiety levels and poor IVF-ET outcome. These results instigate further investigation into the effectiveness of psychological care of IVF-ET patients to reduce uterine contractility at the time of ET and improve IVF-ET outcome.