Stress Management and Resilience Training (SMART) therapy for couples undergoing in vitro fertilization (IVF): a randomized clinical trial (RCT)

Differences in perceived stress during ovarian stimulation between women with infertility and those pursing oocyte cryopreservation

OBJECTIVE

To determine whether the purpose of ovarian stimulation (oocyte cryopreservation [OC] versus in vitro fertilization (IVF) is associated with perceived stress before or after ovarian stimulation; and whether perceived stress is associated with ovarian stimulation outcomes.

DESIGN

Prospective cohort study.

SETTING

Academic practice.

PATIENTS

Women undergoing their first ovarian stimulation cycle as part of a randomized clinical trial, the Learning from Online Video Education (LOVE) study (NCT02979990).

INTERVENTIONS

Questionnaire before and after ovarian stimulation.

MAIN OUTCOME MEASURES(S)

Perceived stress scale (PSS) scores before and after stimulation. The number of oocytes collected was a secondary measure.

RESULTS

After adjustment for age, income, race, education, financial assistance, and fertility diagnosis, the indication for treatment (IVF vs. OC) was a significant predictor of pretreatment PSS scores. IVF participants had higher pretreatment scores (18.01 ± 6.43) than did OC participants (15.62 ± 5.61). Posttreatment PSS scores did not differ between the two groups. IVF participants experienced a decrease of 0.85 ± 2.34 points in PSS scores after treatment, whereas OC participant scores were stable over time. The trajectory of PSS scores differed between the two groups and neared significance. Financial support was a significant predictor of pretreatment and posttreatment PSS scores for the entire cohort. Neither pretreatment nor posttreatment PSS was predictive of the number oocytes collected.

CONCLUSION

Compared with OC patients, IVF patients have higher stress levels, which decrease after ovarian stimulation. Perceived stress does not affect oocyte yield.

The impact of stress on fertility treatment

PURPOSE OF REVIEW

The goal of this review was to summarize the recent research on the relationship between stress and assisted reproductive technology treatment.

RECENT FINDINGS

Women and men with infertility report high levels of distress that can impact their quality of life. There are numerous psychosocial interventions, including cognitive behavior therapy and/or self-help ones, which may decrease distress, increase patient retention and improve pregnancy rates.

SUMMARY

Patient distress is an important factor to consider. Decreasing burden of care may lead to significant improvements in assisted reproductive technology outcome.

Addressing the emotional barriers to access to reproductive care

Health care professionals make the medical care of infertility patients a priority, with the goal of achieving a singleton pregnancy for each. Patients who never seek out care, who do not return for treatment after the diagnostic workup, or who drop out of treatment are rarely noticed. Yet this is the outcome for the majority of patients, and the primary reason after financial for treatment termination is the emotional aspect. Attending to the psychological needs of our patients must become a higher priority, to provide all patients true access to care.