Having infertility is stressful. Participating in fertility treatments like IVF is stressful
but does psychological stress reduce the chance for IVF success?
Does stress reduction improve the odds of IVF success?
OK infertility patients, I want you to tell me how many times you have heard this: All you have
to do is relax and you will get pregnant. Put it in the comments. Its a really insulting statement
which ignores the fact that infertility is a disease just like diabetes or cancer.
Measuring psychological stress is tricky. In general, there are two methods. The first
method is easy. Ask a person if they feel stress or not. This is known as
perceived stress. You can get a little more complicated by having them complete
more extensive questionnaires or surveys which calculate stress scores The second method
involves the measurement of hormones or other markers in the blood. In the studies
I am going to talk about today, they all used one or both methods to try to measure stress.
Many studies have shown that couples with infertility
exhibit high levels of stress. Studies of women undergoing IVF
treatment have shown that stress increases as the treatment progresses. Stress levels
peak right before the egg retrieval but then decrease between the retrieval and transfer.
IVF is stressful. No big shock there but does the stress encountered during IVF
make it less likely for women to become pregnant?
A few small studies performed in the 1990s and early 2000s gave mixed results. I am
going to talk about them later. The first really large and well done study was published in 2009
in the Netherlands. In this study, 783 women from five different centers undergoing their
first attempt at IVF completed questionnaires to determine their levels of anxiety and depression.
They found no difference in the chance for the IVF cycle to be
cancelled before completion and no difference in the chance for pregnancy.
This was true whether they measured their stress before treatment started or right
before the egg retrieval. Conclusion of study number 1 - Stress had no impact on IVF success.
Another large study from Sweden was published in 2017. This study looked at nearly 500 women
and not only measured perceived stress but also a hormone called cortisol which commonly goes up
during times of psychological stress. This study also found no relationship between stress and
pregnancy rates. They also failed to find any link between stress and egg quality or embryo quality.
Remember earlier when I said there were a bunch of smaller studies on this topic and that the results
were mixed? This means that some of those smaller studies showed stress had a negative impact on
pregnancy rates and some did not. Smaller studies are more difficult to interpret because they have
more statistical uncertainty. One way to be able to make more definite conclusions
is to combine the data from the smaller studies into one larger study. This is called a meta
analysis. If you follow this channel, you know that I talk about meta analysis a lot.
This meta analysis looked at 14 different studies about
psychological stress and IVF pregnancy rates. When they combined all of the data,
there were over three thousand five hundred IVF patients included. This study also
concluded that psychological stress did NOT reduce the likelihood of pregnancy with IVF.
The best available evidence proves that stress does not lower your chance for IVF success.
In other words, Don’t stress about Stress”
Should you enroll in some sort of stress reduction program anyway? It depends on why you are doing
it. If you are trying to simply improve your chance for pregnancy, then I would say “No”.
Studies like this one have found that coping and relaxation interventions did not improve
the chance for pregnancy. On the other hand, if stress is producing adverse effects like
anger, lack of sleep or depression, then by all means do whatever you can to reduce
stress. Other than cost and time, there is probably little downside, so why not?
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