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Stress and IVF - tightly entwined but can they be separated?

18 November 2007
By Dr Juliet Skinner
Medical Director, Barbados Fertility Centre, Barbados
Appeared in BioNews 434

The impact of stress and IVF outcome is complex. Many researchers have attempted to study the role of stress, some studies have suggested a strong link with high stress and poor outcome, and others have suggested no link between stress levels and IVF.

The kernel of the problem is that IVF outcome itself has many variables - age, ovarian reserve, and the number of previous failed attempts are just a few that may have profound effects on the likely chance of pregnancy. In addition, an individual stress response will also be varied, difficult to quantify and quite reasonably have a varied impact. This means that a robust study on the impact of stress on IVF outcome would need to incorporate very large numbers to make scientific conclusions.

To compound the variables we also accept that infertility itself is a stressful condition. Studies attempting to apply stress scoring systems typically used in other medical conditions generally conclude that all or most patients having IVF treatment score high on the stress Richter scale!

For many couples, a significant addition to stress of the medical condition is a financial stressor, as IVF treatments are costly. It is not as surprising then that studies carried out in countries, such as Sweden, where IVF is covered by the state, have shown no association with stress and IVF outcome. But the question is whether these studies apply to most of the world where the financial burden of IVF is borne by the couple themselves?

For those of us working in the specialty of infertility and IVF there is little doubt of a co-association of infertility and stress. Some couples appear to cope better. Other couples clearly do not cope well.

Barbados Fertility Centre (BFC) was established with a specific intent at being able to offer reduced stress IVF treatment. While the background stressors such as 'having infertility' cannot be improved, the goal is to provide IVF treatment in an environment removed away from stress - be that work, the practicalities of getting to and from appointments, family etc.

Over the last five years since BFC opened we have treated a number of couples who have had previous failed IVF cycles and have opted to consider a cycle in Barbados with a specific program designed to reduce stress around the time of egg collection and embryo transfer.  

We certainly have seen a better than expected success rate even in couples whose chances are low after two or more failed attempts. The feedback from couples opting for this is always 'how much easier the treatment felt'. Even from the physician perspective it is often remarkable the difference in the 'affect' of the couple on the first day of coming into the clinic - often visibly uptight, to the couple that we see on the day of the embryo transfer.

When asked the patient's link this more relaxed feeling to being removed from work, home and their typical lifestyle - not surprisingly as most of us are more relaxed when on holiday! Many also feel that having time together is a significant plus. Specific use of acupuncture, reflexology and massage are generally met with huge perceived benefits to the state of well being for the patient.

The only negative for treatment away from home is that couples do have to take a leap of faith that the care they are receiving is at least on par as to that they would receive in their own country. To address this concern facilities offering effectively 'medical tourism' increasingly need a stamp of approval from independent international accreditation bodies certifying that standards of care are of the high quality. One of the largest accrediting bodies of hospitals and clinics in the USA and internationally is the Joint Commission International (JCI). BFC is accredited by the JCI.

In summary: the complexity of our stress responses and potential impact on the delicate aspects of egg production, quality, subsequent embryo development and ultimate chances of conception is still not fully understood. Yet logically the step of reducing stress can only likely benefit outcome. No study has ever shown low stress levels to have a negative impact! The question remains, should all couples having IVF treatment make all efforts to remove unnecessary stressors and potentially be on 'holiday' or is it just for some people that this may have a crucial role in the outcome and chance of pregnancy?

SOURCES & REFERENCES
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