Stress and Anxiety Scores in First and Repeat IVF Cycles: A Pilot Study

Abstract

BackgroundThe role of stress in reproduction, particularly during treatment for infertility, has been of considerable interest; however, few studies have objectively measured stress and anxiety over the course of the IVF cycle or compared the experience of first-time and repeat patients.MethodsThis prospective cohort pilot study enrolled 44 women undergoing IVF at a university-based clinic to complete the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS) and Infertility Self-Efficacy Scale (ISES) at three time points prior to ovarian stimulation (T1), one day prior to oocyte retrieval (T2), and 5–7 days post embryo transfer (T3).ResultsMean STAI State scores were significantly elevated at all three time points (p<0.01). STAI State and PSS mean values did not change over time and did not differ in first-time vs. repeat patients. Self-efficacy (ISES) scores declined over time, with a greater decline for repeat patients. Of the 36 women who completed a cycle, 15 achieved clinical pregnancy. Using logistic regression modeling, all scores at T2 were correlated with pregnancy outcome with lower scores on the STAI State and PSS and higher scores on the ISES associated with higher pregnancy rates.ConclusionsStress and anxiety levels remained elevated across all cycles. Women with lower stress and anxiety levels on the day prior to oocyte retrieval had a higher pregnancy rate. These results emphasize the need to investigate stress reduction modalities throughout the IVF cycle.

Gender differences in emotional reactions to in vitro fertilization treatment: a systematic review

“…The mean anxiety score for women was higher at the time of the β-HCG dosage (the pregnancy test) than at pretreatment (ZAS, m = 32.64 vs. 31.95) [9]. No differences in anxiety level were detected between women who had received the first cycle and those who had undergone a repeated cycle of IVF treatment [30].…”

“…Women and/or men's anxiety was explored in ten studies using different instruments: STAI [28][29][30], the Zung Anxiety Scale (ZAS) [9,26], MAACL [10,31], SAS [27,32], and PRIME-MD [17]. The incidence of anxiety in women was high on the day of the oocyte retrieval (ZAS ≥ 40, 33.3 %; PRIME-MD, anxiety disorder: 14.8 %) [17,26], within 2 h after the embryo transfer (SAS 40, 38.5 %) [27], and 20 days after the embryo transfer (SAS > 40, 25.9 %) [32].…”

“…Four of the studies reported that anxiety levels (or the prevalence of anxiety [32]) in T4 were higher than at pretreatment, but the differences were not significant [10,29,30]. One study also reported that the state anxiety of women in T1, 1 day before the oocyte retrieval, and T4 was higher than in normal people (STAI-S, m = 41.45 vs. 41.63 vs. 42.06 vs. 35.20) [30]. To conclude, women were more likely than men to show a higher level/incidence of anxiety at the time of the oocyte retrieval, pre-and post-embryo transfer, and before the pregnancy test.…”

Anxiety and depression in women undergoing infertility treatment

“…In a pilot study on a group of 44 women, an increased level of anxiety in the psychometric scales was found in women undergoing IVF treatment during the whole course of therapy [14]. It was also found that women initially who had a lower level of anxiety before the oocyte retrieval, had a higher pregnancy rate [14].…”

“…It seems however that stress related to infertility can negatively affect the outcomes of infertility treatment. Infertile women seem to be more affected by stress compared to their male partners [10][11][12][13][14], which may be due to their direct involvement in invasive ART procedures. In our work we present a review of current literature on anxiety and depressive disorders in women undergoing infertility treatment, including the influence of anxiety and depression on infertility treatment outcome and the effect of ART procedures on the risk of anxiety and depression.…”