Psychological distress affects IVF outcomes

Study suggests stress and outcome may be related

There is no doubt that undergoing infertility treatment is stressful, with high rates of anxiety and depression reported by many patients. Mind/body therapies designed to help women reduce stress earlier in the treatment process result in higher pregnancy rates, but little is known specifically about the impact of these therapies on women undergoing in vitro fertilization (IVF).

A new study published June 1 in Fertility and Sterility, a publication of the American Society of Reproductive Medicine, shows that women who participate in a mind/body program for stress reduction while undergoing IVF treatment have a significantly higher pregnancy rate than those who do not (52% versus 20%).

"The intersection of stress and fertility is a controversial one, but we do know that stress can reduce the probability of conception," said principal investigator Alice Domar, Ph.D, OB/GYN, Beth Israel Deaconess Medical Center and Executive Director of the Domar Center for Mind/Body Health at Boston IVF.

In 1987, Domar introduced the Mind/Body Program for Infertility at the BIDMC main campus in Boston, later moving it to Boston IVF in Waltham in 2002. The goal of the program is to help couples learn effective relaxation and stress management strategies while attempting to conceive. The ten week stress management program focuses on "cognitive behavior therapy, relaxation training, negative health behavior modification and social support components."

To study the effects of the Mind/Body Program on IVF pregnancy outcomes, Domar's team approached women who were about to begin treatment at Boston IVF and who met the study criteria: 40 years or under with normal hormonal levels. None of the participants had previously participated in a mind/body group.

Participants were randomized into a study group that entered the Mind/Body Program for Infertility or a control group who received no mind/body intervention. All patients underwent IVF treatment. Domar tracked the groups through two IVF cycles.

In the first cycle, there was no difference in conception rates between the study group and the control group. "We noticed that only half of the study group had begun the Mind/Body Program and those who had started the program were only a couple of sessions in," said Domar. "This seemed to rule out the possibility of a placebo affect. The mere suggestion of help with stress, it seems, does not increase the pregnancy rate."

In the second cycle, the majority of the patients in the study group had at least five sessions under their belts. "By that point, they had acquired some real life skills to deal with their stress," said Domar. "And that's when we saw the significant increase in pregnancy rates."

Domar found that 52 percent of the women participating in the Mind/Body Program for Infertility became pregnant compared with 20 percent of the control group participants, a statistically significant difference.

"The study supports the theory that psychological distress may be an important detriment to IVF outcome," the authors write.

"We worked with a small group, about a 100 women total, so we'll need to continue with a larger group of patients to see if the results bear out," said Domar. "But there is a strong indication that stress levels and IVF outcomes are linked and that intervening with mind/body therapies can help."