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Stress levels may be the cause of infertility and may influence the outcome of infertility treatment.
Posted on
29 August 2017
| Last updated on 2 January 2018
The belief that psychological factors play a role in infertility is long-standing, and there is evidence that stress levels may be the cause of infertility and may influence the outcome of infertility treatment, as well as contribute to patients' decisions to continue treatment.
Stress also affects patients' reactions to pregnancy loss during infertility treatment and pregnancy complications. Moreover, psychological distress is associated with infertility treatment failure, and interventions to relieve stress are associated with increased pregnancy rates.
Prevalence of Stress
Psychological distress (e.g. anxiety and/or depressive symptoms) is common in couples with infertility and appears to be more common in the partner with the fertility problem. It is observed in different studies that anxiety was present in approximately 75 percent of women and in 60 percent of men. And depression was present in around 55 percent female and 33 percent men.
A prior history of depression is a risk factor for recurrence of symptoms during infertility evaluation and therapy, although the exact prevalence is not known. However, it is known that women with a prior history of depression are at increased risk of experiencing infertility.
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Assessment of Stress
Stress is defined as a stimulus which produces mental tension or physiological reaction, and in this case, the experience of infertility is the stimulus. Distress is the experience of anxiety or suffering, and in this case, the experience of infertility leads to the suffering.
Clinically, the doctor can assess stress by observation of the patient and inquiring about the patient's emotional state. Research shows that the main sources of stress for infertility patients are the impact of infertility on their social life, their sexual health and their relationships with their partner. If a patient is found to be stressed, they should be guided to psychiatrist or psychotherapist.
Some facilities utilise self-report questionnaires to evaluate the stress level of infertility patients. This approach may underreport the true level of distress since patients may feign emotional well-being in order to appear psychologically appropriate for infertility treatment.
In Vitro Fertilization (IVF) Patients
The level of stress in infertility patients tends to increase as treatment intensifies and as the duration of treatment continues. Therefore, in vitro fertilisation (IVF) patients would be expected to experience more stress than women early in their infertility evaluation. In addition, medications that are used to treat infertility may contribute to depressive symptoms.
Many IVF patients report depressive symptoms prior to beginning their cycle, which likely reflects the impact of repeated, unsuccessful, less invasive forms of treatment, but may reflect a prior history of mood/anxiety disorders independent of infertility. Since IVF is highly invasive and intensive, patient distress is not unanticipated. In fact, most IVF patients state that treatment is more of a psychological than a physical stressor. Nearly half of female IVF patients reported that infertility was the most upsetting experience of their lives.
Impact of stress on dropout
Infertility specialists traditionally have assumed that patients drop out of treatment for only two reasons: active censoring (their physician advises the couple to terminate treatment due to a poor prognosis) and finances (the procedure is often not covered by insurance). However, this assumption has been challenged; the majority of insurance-covered patients voluntarily terminate treatment prior to completing their allotment of covered cycles and the psychological burden of the procedures appears to be a major reason for dropout.
Impact of stress on IVF outcome
Since IVF is by far the most expensive and invasive form of infertility treatment, it is important to understand the impact of psychological distress on its outcome. It is concerning that the majority of patients report symptoms of anxiety and/or depression prior to commencing IVF treatment. If psychological distress can interfere with the success of treatment, and most patients report elevated levels of distress, then the impact of distress may be important.
Therapeutic Interventions
Research shows that psychosocial interventions could reduce negative affect and group interventions that emphasised education and skills training was highly effective in producing positive changes.
One of the psychological approaches used to manage emotional distress in infertile couples is cognitive-behavioural therapy. The content of these programmes varies, but each generally contains relaxation techniques, stress-management, coping skills training, and group support. Participants report decreases in all assessed psychological and physical symptoms, including depression, anxiety, hostility, fatigue, headaches, insomnia and abdominal pain. Research says that approximately 45 percent of patients conceive within six months of programme completion.
Summary
- Infertile women experience high levels of stress, frequently manifested as symptoms of anxiety and/or depression.
- Psychological discomfort appears to lead to premature termination of in vitro fertilisation treatment and thus to reduce pregnancy rates.
Evaluation by a psychiatrist for consideration of pharmacotherapy is indicated in women with moderate to severe symptoms of anxiety or depression but the risks and benefits must be discussed.
