Should fertilization treatment start with reducing stress?

A bidirectional causal relationship study between mental disorders and male and female infertility

Background

The relation between mental disorders (MDs) and infertility can be reciprocal. But exactly which MD affects infertility remains controversial. Our aim was to use Mendelian randomization (MR) to explore bidirectional causality between 15 MDs and male infertility and female infertility.

Methods

The data of MDs, male infertility, and female infertility were derived from published genome-wide association studies (GWAS). The inverse variance weighted method was considered to be the main analytical approach. Sensitivity analysis was performed using MR-Egger, Cochran's Q, radial MR, and MR-PRESSO tests.

Results

Our results found that mood disorders (OR, 1.4497; 95% CI, 1.0093 - 2.0823; P = 0.0444) and attention deficit hyperactivity disorder (OR, 1.3921; 95% CI, 1.0943 - 1.7709; P = 0.0071) were positively correlated with male infertility, but obsessive-compulsive disorder (OR, 0.8208; 95% CI, 0.7146 - 0.9429; P = 0.0052) was negatively associated with male infertility. For females, anorexia nervosa (OR, 1.0898; 95% CI, 1.0070 - 1.1794; P = 0.0329), attention deficit hyperactivity disorder (OR, 1.1013; 95% CI, 1.0041 - 1.2079; P = 0.0406), and major depressive disorder (OR, 1.1423; 95% CI, 1.0213 - 1.2778; P = 0.0199) increased risk of infertility. In reverse relationship, female infertility increased the incidence of bipolar disorder (OR, 1.0009; 95% CI, 1.0001 - 1.0017; P = 0.0281).

Conclusion

We demonstrated the association between five MDs and male or female infertility. Female infertility was also found to be associated with an increased risk of one MD. We look forward to better designed epidemiological studies to support our results.

Relationship between sleep disorders and female infertility among US reproductive-aged women

PURPOSE

Sleep disorders are a risk factor for a wide variety of dysfunctions of endocrine, metabolic, cardiovascular, and neurological diseases. However, the risk of sleep disorders to female infertility has not been thoroughly explored. Our study aimed to examine whether or not sleep disorders increase the risk of female infertility.

METHODS

Cross-sectional data on sleep disorders and fertility history were obtained from the National Health and Nutrition Examination Survey 2013-2018. Women aged 20 to 40 years old were enrolled in our study. Weighted multivariable logistic regression models and stratified analysis by age, smokers, and patient health questionnaire-9 (PHQ-9) score were conducted to estimate the effect of sleep disorders on female infertility.

RESULT

Among 1820 reproductive-age females, 248 individuals had infertility and 430 individuals had sleep disorders. Two weighted logistic regression models found that sleep disorders were an independent risk factor for infertility. After adjusting for the covariates (age, race/ethnicity, marital status, education level, poverty income ratio, body mass index (BMI), waist circumference, PHQ-9 score, smokers, drinkers, and sleeping hours), the risk of infertility was 2.14-fold higher in individuals with sleep disorders than in those without. The further stratified analysis demonstrated that the relationship between sleep disorders and infertility was maintained and that the risk was higher particularly in infertile women aged 40-44 years, with PHQ-9 score greater than 10, and smokers.

CONCLUSION

A strong association was found between sleep disorders and female infertility, and the association remained after adjusting for other confounding factors.

On screen experiment showed that becoming a parent for the first time shifted people's priorities from themselves to their infant at 1 year of age

AIM

This study used a screen-based perceptual matching task to see how non-parents, people trying to get pregnant, and those who had given birth prioritised shapes and labels relating to self or infant conditions.

METHODS

The study took place at Aarhus University Hospital in Denmark from December 2016 to November 2021. Recruitment methods included family planning clinics, social media, online recruitment systems and local bulletin boards. The modified perceptual matching task linked five shapes to five labels, including self and infant.

RESULTS

We found that 67 males and females with a mean age of 24.4 ± 3 years, who had no plans to become parents in the near future, reacted faster and more accurately to self-shapes and labels (p < 0.001), which validated the experiment. The 56 participants aged 27.1 ± 4.4 years who were actively trying to become parents showed no statistically significant prioritisation. A subset of 21 participants aged 28.7 ± 4.4 years showed faster response times to infant than self-shapes and labels 1 year after giving birth (p < 0.001).

CONCLUSION

Healthy first-time parents showed faster reactions to infant than self-conditions 1 year after giving birth, in contrast to the other two groups.

Psycho-emotional stress, folliculogenesis, and reproductive technologies: clinical and experimental data

Modern life, especially in large cities, exposes people to a high level of noise, high density of population, disrupted sleeping, large amount of excessive and controversial information as well as to other negative factors; all this may cause chronic psycho-emotional stress. The latest publications often use the term “Syndrome of megalopolis”, which means disruption of sleeping, high anxiety, and altered reproductive function. Medical treatment of infertility may also be considered as a stress factor, especially when infertility lasts for years and is aggravated with emotional frustration. Long-lasting distress may worsen health in general and suppress reproductive function, in particular. The review presents the data on the effects of maternal stress on folliculogenesis, especially when assisted reproductive technologies (ARTs) are used. Clinical data are presented alongside data from laboratory animal experiments. Different maternal stress models are taken into account in respect of their inf luence on oocyte maturation and embryo development. The interfering of psycho-emotional stress and reproductive function is the focus of the review. In these situations, exogenous hormones compensate for the stress-related disruption of the hypothalamic-pituitary-gonadal axis. When ARTs are implemented, stress-induced disruption of oogenesis is realized not via a decrease in hypothalamic and pituitary hormones, but by other ways, which involve paracrine mechanisms described in this review. Based on the literature analysis, one may conclude that stress negatively affects oocyte maturation in the ovary and suppresses subsequent embryo development. The role of some ovarian paracrine factors, such as BDNF, GDF-9, HB-EGF, TNF-α, and some others has been elucidated

Human fertility and sleep disturbances: A narrative review

INTRODUCTION

Many factors may be hidden behind the global fertility decline observed in Western countries. Alongside the progressively increased age of infertile couples, environmental and behavioural factors, including non-optimal lifestyle habits, should be considered. Among these, sleep disorders have been suggested to be linked to human fertility.

METHODS

This is a narrative review, describing first sleep physiology, its disturbances, and the tools able to quantify sleep dysfunction. Then, we consider all available studies aimed at investigating the connection between sleep disorders and human fertility, providing a comprehensive view on this topic.

RESULTS

Forty-two studies investigating the relationship between sleep habits and human reproduction were included. All the published evidence was grouped according to the aspect of human fertility considered, i.e. i) female reproductive functions, ii) male reproductive functions, iii) natural conception and iv) assisted reproduction. For each of the sub-groups considered, the connection between sleep dysregulation and human fertility was classified according to specific sleep characteristics, such as sleep duration, quality, and habits. In addition, possible physio-pathological mechanisms proposed to support the link between sleep and fertility were summarized.

CONCLUSION

This review summarizes the most relevant findings about the intricate and still largely unknown network of molecular pathways involved in the regulation of circadian homeostasis, to which sleep contributes, essential for reproductive physiology. Thus, many mechanisms seem correlate sleep disorders to reproductive health, such as adrenal activation, circadian dysregulation, and genetic influences. This review highlights the need to properly designed trials on the topic.

Unraveling the Balance between Genes, Microbes, Lifestyle and the Environment to Improve Healthy Reproduction

Humans’ health is the result of a complex and balanced interplay between genetic factors, environmental stimuli, lifestyle habits, and the microbiota composition. The knowledge about their single contributions, as well as the complex network linking each to the others, is pivotal to understand the mechanisms underlying the onset of many diseases and can provide key information for their prevention, diagnosis and therapy. This applies also to reproduction. Reproduction, involving almost 10% of our genetic code, is one of the most critical human’s functions and is a key element to assess the well-being of a population. The last decades revealed a progressive decline of reproductive outcomes worldwide. As a consequence, there is a growing interest in unveiling the role of the different factors involved in human reproduction and great efforts have been carried out to improve its outcomes. As for many other diseases, it is now clear that the interplay between the underlying genetics, our commensal microbiome, the lifestyle habits and the environment we live in can either exacerbate the outcome or mitigate the adverse effects. Here, we aim to analyze how each of these factors contribute to reproduction highlighting their individual contribution and providing supporting evidence of how to modify their impact and overall contribution to a healthy reproductive status.

SARS-CoV-2 and the reproductive system: known and the unknown..!!

Background

COVID-19 is the most recent zoonotic outbreak of coronaviruses. Mostly, it invades the cells of the respiratory system by binding to the receptor angiotensin-converting enzyme 2 (ACE2) which is also present in other organs like the kidney, testis, ovaries, breast, heart, and intestine, rendering them prone to be infected. The reproductive potential is a must for the sustenance of any species and it is our prime duty to safeguard the reproductive system of the present generation from such a deadly virus. The previously reported coronaviruses like severe acute respiratory syndrome coronavirus (SARS-CoV) had a detrimental impact on reproductive organs. There is a dearth of sufficient research to provide substantial evidence for the harmful effects of this novel virus on the reproductive system. Hence, our review compiles the knowledge available until now to boost research in this regard and to take the necessary steps in time.

Main body of abstract

Here we tried to compile all the data available on the effect of SARS-CoV-2 on the reproductive system as well as vertical transmission of the virus. All related articles published from February to August 2020 were reviewed and thoroughly analyzed. SARS-CoV-2 has been found to affect the sperm concentration and motility, thus degrading the fertility of males. In females, it is suspected that this virus affects the oocyte quality and ovarian function, resulting in infertility or miscarriage. Traces of SARS-CoV-2 virus have also been found in the breast milk of the infected mothers and the semen of infected males. Vertical transmission of SARS-CoV-2 has also been reported in some cases.

Conclusion

Based on the literature review, SARS-CoV-2 seems to have the potential of affecting both male and female reproductive tracts. This review brings together the findings and observations made in the area of reproductive health during the current pandemic. The reproductive system of the young population is preordained for subsequent disorders, infertility, reduced sperm count, and motility. Therefore, the research and medical practices should focus on possible vulnerability being posed by SARS-CoV-2 to the gametes and future generations. We, hereby, recommend close monitoring of young and pregnant COVID-19 patients concerning reproductive health with utmost priority.

Does Hypnofertility-Based Nursing Care Affect Cortisol Levels, Fertility Preparedness, and Pregnancy Outcomes in Women Undergoing In Vitro Fertilization? A Randomized Controlled Trial

This study used Hypnofertility-based interventions to determine whether these interventions would lead to increased fertility preparedness and pregnancy outcomes and decreased cortisol levels in women undergoing In Vitro Fertilization (IVF) treatment. This randomized, controlled, prospective study was conducted from November 2017 through March 2019 in 61 Turkish women with unexplained infertility (intervention group: 30, control group: 31). Hypnofertility-based nursing care included affirmations, visualization, imagination, and relaxation from the first day of treatment until the day of the pregnancy test. The Fertility Preparedness Scale, a saliva sample for cortisol level, and the pregnancy test results were used for data collection. Hypnofertility-based nursing care decreased the cortisol levels of women in the intervention group compared to that in the control group (p = 0.00). Though fertility preparedness was higher in the intervention group, the difference was not statistically significant (p = 0.13). Although interventions relieved the women during the treatment process, there was no anticipated effect on pregnancy outcomes (p = 0.75). Hypnofertility-based nursing care significantly reduce the cortisol levels, suggesting that the intervention helped women relax.

The effectiveness of a collaborative infertility counseling (CIC) on pregnancy outcome in women undergoing in vitro fertilization: a randomized trial

Background

The optimal objective of infertility treatments is to increase pregnancy rate. The aim of this study was to assess the effectiveness of a collaborative counseling program on pregnancy rate in women undergoing in vitro treatment.

Methods

This was a parallel group randomized trial on a sample of 60 women attending to an infertility research center affiliated to Mashhad University of Medical Sciences for fertility treatment. Women were randomly assigned to an intervention or a control group. Then, a five-session program offered to the intervention group while the control group received nothing expect the usual care. The primary outcome for the study was positive pregnancy test at the end of study. Statistical analyses including independent samples t-test were performed to explore the data.

Results

The outcome analysis showed that there were no significant differences in pregnancy rate between the intervention and the control groups (P = 0.298). Also, there were no significant differences in follicle and embryo numbers between two groups. However, a significant difference was observed between two groups in terms of oocyte numbers where the intervention group had more oocyte (P = 0.014).

Conclusion

Overall the findings indicated that the collaborative infertility counseling did not improve treatment success in infertile women undergoing in vitro fertilization.

Trial registration

IRCT201110267915N1. Registered 2014.07.25-Retrospectively registered (http://en.irct.ir/trial/8359).

Effect of an altered hormonal environment by blood plasma collected after adrenocorticotropic administration on embryo development and gene expression in porcine embryos

Early embryonic development may be affected by adrenal hyperactivity in stressful situations which may lead to endocrine changes in the embryo environment. A sensitive period in porcine embryo development is the 4-cell stage when the embryo genome activation occurs. A mixed in vivo-in vitro system was implemented to test whether an altered milieu around this stage could affect embryo development and blastocyst quality in the porcine model. After in vitro maturation and fertilisation, presumptive zygotes were exposed for 24 h to plasma collected after ovulation from adrenocorticotropic hormone (ACTH)-treated, non-ACTH-treated sows; and, medium without plasma, supplemented with bovine serum albumin. Subsequently, embryo development and differences in gene expression were tested among treatments. Cleavage and blastocyst rates did not differ between treatments. Blastocyst quality by morphology assessment was similar when all the resulting blastocysts were included in the analysis. However, when only expanded blastocysts (and onwards) were included in the analysis, the blastocysts from the non-ACTH plasma group showed better quality score. Blastocyst quality by morphological assessment was not mirrored by the transcription levels of various important genes for embryo development whose gene expression profile did not significantly differ among groups. It is likely that the effect of the altered environment provided by plasma from ACTH-treated sows was too short to affect embryo development. Therefore, a brief exposure to an altered endocrine environment may not have harmful consequences for the embryo once fertilisation occurs.

Potential risks of SARS-CoV-2 infection on reproductive health

The outbreak of 2019 novel coronavirus disease (COVID-19) has become a major pandemic threat worldwide. Such a public health emergency can greatly impact various aspects of people's health and lives. This paper focuses on its potential risks for reproductive health, including the reproductive system and its functioning, as well as gamete and embryo development, which could be affected by the virus itself, drug treatments, chemical disinfectants and psychological effects related to panic during the COVID-19 outbreak.

Acupuncture and Laser Acupuncture as Treatments for Emotional Distress in Infertile Women in Japan

Objectives: Needle and laser acupuncture are often used to improve the success rate of assisted reproductive technology (ART). This study examined whether needle or laser acupuncture ameliorated the emotional distress experienced by infertile women undergoing in vitro fertilization and embryo transfer (IVF-ET) or intracytoplasmic sperm injection (ICSI). Materials and Methods: Fifty-one infertile women who were undergoing IVF-ET or ICSI received needle acupuncture (needle-acupuncture group; n = 32) or laser acupuncture treatment (laser-acupuncture group; n = 19). The emotional distress experienced by the infertile women was evaluated using 2 questionnaires-the Profile of Mood States (POMS) and the State-Trait Anxiety Inventory (STAI)-both before and after 3 months of treatment. Results: In the needle-acupuncture group, the POMS detected significant post-treatment reductions in tension/anxiety (P < 0.001), depression/dejection (P < 0.001), anger/hostility (P < 0.001), confusion (P < 0.05), and total mood disturbance (TMD; p < 0.001). However, the POMS scores for vigor/activity and fatigue were not altered significantly after the treatment. In the STAI, both State and Trait scores had significantly decreased after the acupuncture (P < 0.001 and P < 0.05, respectively). In the laser-acupuncture group, the POMS detected significantly lower tension/anxiety (P < 0.05) and vigor/activity (P < 0.05) scores after the treatment. However, the POMS did not detect significant changes in depression/dejection, anger/hostility, fatigue, confusion, or TMD after the treatment. Furthermore, neither the STAI-State nor the STAI-Trait score had significantly decreased after the laser acupuncture treatment. Conclusions: These results indicate that needle and laser acupuncture ameliorate the emotional distress experienced by women who are undergoing IVF-ET or ICSI.

Infertility and mental disorders in women. Communication 1

This paper presents the definition, epidemiology, etiological factors, and approaches to classifying infertility and describes the relationship between mental health and infertility in women. The problem of idiopathic infertility is analyzed from both obstetric/gynecological and psychiatric positions. The psychological factors influencing the reproductive function of a woman are disclosed. Mental health disorders potentiating infertility are considered. Attention is paid to that mental disorders are insufficiently and untimely diagnosed in women with reproductive disorders, that certain forms of psychopathology are masked by functional gynecological disorders, and that obstetricians/gynecologists have no specialized ideas of women's mental health, which may lead to unsuccessful infertility therapy.

Prophylactic SSRI treatment for women suffering from mood and anxiety symptoms undergoing in vitro fertilization-a prospective placebo-controlled study

To explore the mood protective effect of prophylactic SSRI treatment on women undergoing IVF suffering from moderate affective and anxiety symptoms. In a randomized double blind, placebo-controlled, parallel design study, 41 women diagnosed with an Adjustment Disorder, who were undergoing IVF treatments, were randomized into two groups; a study group (n = 22) administered escitalopram 10 mg/day, and a control group (n = 19) administered placebo for a total of 8 weeks before and during the IVF treatment cycle. Patients were assessed at the onset of drug treatment and at embryo transfer. The main outcome measure was the difference in mean score severity rating of depression and anxiety symptoms on the CES-D and Zung questionnaires between groups at the time of embryo transfer. Secondary outcome measures included the MHI rating subscales addressing aspects of psychological distress and coping. At the day of embryo transfer (6 weeks of drug treatment), the CES-D average score for the treatment group was 6.40 (6.71) and 27.47 (4.29) on the Zung Self-Rating Anxiety Scale, while the placebo group scored an average of 15.83 (8.69) and 33.17 (6.95) receptively. These findings were significant (p = .004, p = .015 receptively) and were endorsed by the scoring on the MHI questionnaire subscales. Short-term treatment with SSRI may serve as a prophylactic treatment against the perpetuation and possible worsening of depressive and anxiety symptoms in women undergoing IVF treatments. Further studies concerning pharmacological interventions in larger samples and studies addressing screening for psychological stress indicators in this population are warranted.

Non-Apnea Sleep Disorder Increases the Risk of Subsequent Female Infertility-A Nationwide Population-Based Cohort Study

Study Objectives

Non-apnea sleep disorder (NASD) increases the risk of hypertension, type 2 diabetes mellitus, chronic kidney disease, cardiovascular disease, and stroke. However, the risk and the time interval of NASD to female infertility has not been thoroughly understood. Our study aimed to determine whether NASD increases the subsequent risk of female infertility.

Methods

This study utilized outpatient and inpatient data from the Longitudinal Health Insurance Database between 2000 and 2010 in Taiwan. We enrolled 50,154 females aged 20 to 45 years old and diagnosed with NASD as outpatients ≥2 times or hospitalized, 16,718 of them who matched our criteria were assigned to the study group. For each NASD patient, two comparison patients were frequency matched by age (each 5-year span), index date, and comorbidities as the control cohort with a total of 33,436 patients. We conducted Cox proportional hazard regression analysis to estimate the effects of NASD on female infertility.

Results

The NASD cohort had an adjusted hazard ratio (HR) of subsequent female infertility of 3.718-fold higher than that of the cohort without sleep disorders. In the stratified age group, NASD had the highest impact on 26-30 years old, with an adjusted HR of 5.146 followed by 31-35 years old (adjusted HR = 3.356). The Kaplan-Meier analysis also showed that in the sixth year of follow-up, the incidence of female infertility was higher in the NASD cohort than in the general population cohort till the end of the follow-up.

Conclusions

Our study demonstrates that NASD patients are at a higher risk of developing female infertility.

The relationship of the psychological coping and adjustment strategies of infertile women with the success of assisted reproductive technology

Background

The success of assisted reproductive techniques plays a very important role in the quality of life of infertile couples and decreases the negative behavior states of infertility.

Objective

This study aimed at determining the relationship between psychological coping and adjustment strategies with the success of assisted reproductive technology (ART).

Materials and Methods

This correlational study was conducted on 204 women visiting Milad Infertility Center in Mashhad during 2015-2016. The research instruments included Fertility Adjustment Scale and Infertility Coping Strategies Scale. The positive result of two pregnancy tests within 48 hours was considered as the success of ART.

Results

The mean and standard division score of adjustment in the group achieved treatment success (34.3±8.2) exceeded the group failed (33.6±8.8), the difference was not statistically significant (p= 0.381). Also, there was no significant difference between groups in the median and interquartile range of total coping strategies 81 (13) vs. 79.5 (12.25), (p= 0.369). Based on the logistic regression model for one increased transferred embryo, the chance of getting pregnant is 1.3 times, and for each unit increase in FSH level, the chance of ART success decreases 18%.

Conclusion

The results of this study showed that there is no relationship between psychological coping and adjustment strategies with ART success. However, the number of transferred fetus and tirthday FSH are introduced as factors that are related to the success of ART.

Lifestyle and fertility: the influence of stress and quality of life on female fertility

There is growing evidence that lifestyle choices account for the overall quality of health and life (QoL) reflecting many potential lifestyle risks widely associated with alterations of the reproductive function up to the infertility. This review aims to summarize in a critical fashion the current knowledge about the potential effects of stress and QoL on female reproductive function. A specific literature search up to August 2017 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science and Google Scholar. Current review highlights a close relationship in women between stress, QoL and reproductive function, that this association is more likely reported in infertile rather than fertile women, and that a vicious circle makes them to have supported each other. However, a precise cause-effect relationship is still difficult to demonstrate due to conflicting results and the lack of objective measures/instruments of evaluation.

Case-based care for pre-existing or new-onset mood disorders in patients undergoing infertility therapy

The inability to conceive is an immensely stressful event in a woman's life. Thus, it is no surprise that women with infertility have twice the rates of depressive symptoms as women without infertility. Incidence of depression in the general female population is approximately 20% compared to almost 40% in infertile females. Based on this information, we expect many individuals with infertility to have pre-existing mood disorders requiring ongoing treatment. In addition, we expect a subset of women to develop a mood disorder during infertility treatment due to related stressors. The reproductive endocrinology team must understand the impact of stress on pregnancy outcomes, the types of treatment options, and the safety and use of various medications. The goal of this case-based commentary is to summarize information on the relationship between stress and infertility and to offer a guide for a range of treatment options that include non-pharmacologic and pharmacologic therapies.

Illness Cognitions, Anxiety, and Depression in Men and Women Undergoing Fertility Treatments: A Dyadic Approach

Background

Emotional response to infertility is mediated by numerous interrelated psychological variables such as personality, health perceptions, cognitive appraisals, coping, and social support. While men and women respond to infertility differently, illness cognitions are a vital component of their emotional adjustment. The aim of this study is to compare the infertile men and women undergoing fertility treatments on perceived distress, helplessness, acceptance, benefits, anxiety, and depression.

Materials and Methods

Eighty-one infertile couples, undergoing intrauterine insemination participated in the study. They were assessed on the presence of infertility distress using the fertility problem inventory, for psychiatric morbidity using the Mini International Neuropsychiatric Interview, for affective disturbances using the Hamilton Anxiety and Depression scales, and for illness cognitions using the Illness Cognition Questionnaire.

Statistical Analysis

Data are analyzed using SPSS version 15. The paired sample t-test is performed for assessing differences on normally distributed data. The Wilcoxon Signed-Rank test is performed for assessing differences in medians obtained on data that was skewed.

Results and Discussion

Infertile women (wives) were more emotionally distressed, anxious, and depressed than men (husbands). Gender-wise differences were found for perceptions of helplessness and acceptance of infertility. Infertility was perceived to be a nonbeneficial event for both partners investigated.

Conclusion

Negative cognitions and affective disturbances may contribute to higher treatment burden in couples seeking-assisted conception. The present study suggests that psychosocial intervention for couples plays a central role and should be integrated within the conventional treatments for infertility.

Description and evaluation of experimental models for uterine transplantation in pigs

Objective

To evaluate the technique of uterine transplantation and the use of drugs used in the process of immunosuppression.

Methods

We included 12 sows, and immunosuppression was performed with minimal doses of cyclosporine, and cross-match was done to exclude the possibility of blood incompatibility. Hysterectomy was performed in the donor under general anesthesia, with the removal of the aorta and inferior vena cava in monobloc, and anastomosis of these vessels was made in the recipient.

Results

Six experiments were performed, and on the immediate postoperative period, five animals had good reperfusion. However, on the seventh postoperative day, histological analysis showed rejection in five animals.

Conclusion

The experimental model of uterine transplantation is feasible, but monitoring doses of immunosuppressants is pivotal to prevent rejection episodes.

Linking Stress and Infertility: A Novel Role for Ghrelin

Infertility affects a remarkable one in four couples in developing countries. Psychological stress is a ubiquitous facet of life, and although stress affects us all at some point, prolonged or unmanageable stress may become harmful for some individuals, negatively impacting on their health, including fertility. For instance, women who struggle to conceive are twice as likely to suffer from emotional distress than fertile women. Assisted reproductive technology treatments place an additional physical, emotional, and financial burden of stress, particularly on women, who are often exposed to invasive techniques associated with treatment. Stress-reduction interventions can reduce negative affect and in some cases to improve in vitro fertilization outcomes. Although it has been well-established that stress negatively affects fertility in animal models, human research remains inconsistent due to individual differences and methodological flaws. Attempts to isolate single causal links between stress and infertility have not yet been successful due to their multifaceted etiologies. In this review, we will discuss the current literature in the field of stress-induced reproductive dysfunction based on animal and human models, and introduce a recently unexplored link between stress and infertility, the gut-derived hormone, ghrelin. We also present evidence from recent seminal studies demonstrating that ghrelin has a principal role in the stress response and reward processing, as well as in regulating reproductive function, and that these roles are tightly interlinked. Collectively, these data support the hypothesis that stress may negatively impact upon fertility at least in part by stimulating a dysregulation in ghrelin signaling.

Sleep in women undergoing in vitro fertilization: a pilot study

OBJECTIVE

Sleep disturbances are thought to be frequent in women undergoing IVF despite minimal research of this hypothesis. Our goal was to longitudinally assess sleep duration and disturbances in women undergoing IVF and assess impact of habitual sleep duration on oocytes retrieved, an important outcome in IVF.

METHODS

Actigraphy and questionnaire batteries containing sleep and psychometric instruments were performed prior to and throughout 24 IVF cycles.

RESULTS

TST <7 h was present in 46%, 57%, 69%, and 42% of baseline, stimulation, post-oocyte retrieval, and post-embryo transfer recordings. ESS >10 was noted in 24%, 33%, and 36% of cycles during baseline, stimulation, and post-embryo transfer. PSQI >5 was noted in 57%, 43%, and 29% of cycles during baseline, stimulation, and post-embryo transfer. TST (F = 2.95, p = 0.04) and ESS (F = 4.36, p = 0.02) were the only sleep metrics in which a significant main effect of time was found by mixed models analysis. The final linear regression model chosen by stepwise selection to best explain the variability in oocytes retrieved included anti-mullerian hormone, day three follicle stimulating hormone, and baseline TST and explained 40% of the variance in oocytes retrieved (adjusted R² = 0.40, p = 0.03). Although not statistically significant, a trend towards a linear association between baseline TST and oocytes retrieved was seen with an increase of oocytes retrieved by 1.5 for every hour increase in TST (p = 0.09).

CONCLUSIONS

This is the first study to describe, with subjective and objective measures, sleep disturbances present throughout the IVF cycle. Importantly, a trend towards a linear relationship between TST and oocytes retrieved was found in this pilot study. Sleep may be a modifiable target to improve outcomes in women undergoing IVF and further investigations are needed.

Gender differences in perception of psychosocial distress and coping mechanisms among infertile men and women in Saudi Arabia

The objective of the study was to evaluate the differences in psychosocial distress and coping mechanisms among infertile men and women in Saudi Arabia (SA). We performed a cross-sectional study of infertile patients (206 women and 200 men) attending infertility clinics in three referral hospitals in Riyadh, SA. A semi-structured questionnaire was developed to assess socio-demographic, clinical and psychosocial variables. Infertility-related psychosocial pressures were reported in 79 (39.7%) male and 97 (47.3%) female participants (p = 0.123). Males suffered more from intrusive questions and pressure to conceive, remarry or get divorced, while females were stressed more from psychological and emotional exhaustion, marital discord, attitudes of mothers-in-law or society, and persistent desire by the husband to have children. To cope with infertility, females engaged more in religious activities (p < 0.001) and spoke more to someone regarding their problems (p < 0.001). To solve their infertility problems, 50% tried to find solutions via the internet, and 38.5% of males and 51% of females reported using alternative medicines (p = 0.012). The patients with infertility in SA face multiple psychosocial stressors related to their infertility, and cope differently based on the gender and culture-specific knowledge of infertility. The female participants were significantly more affected from psychosocial stressors and the persistent desire by their spouse to have children.

Factors that influence in vitro fertilization treatment outcomes of Chinese men: A cross-sectional study

BACKGROUND

The thought of producing offspring has rooted in Chinese culture after thousands of years of feudal society. Infertility in men would bear significant psychological distress in this social environment.

PURPOSE

In this study, we explored the association between the outcomes of IVF treatment and anxiety, depression, marital satisfaction, communication, sexual relationship and social support.

METHODS

A cross-sectional study was conducted. A total of 202 Chinese men who received IVF treatment for the first time were investigated using socio-demographic questionnaire, Self-Rating Anxiety Scale, Self-Rating Depression Scale, ENRICH Marital Inventory and Social Support Rating Scale on the first day of IVF treatment.

RESULTS

The overall prevalence of depression and anxiety was 49.1% and 27.2%, respectively. Subjects with IVF failure had higher levels of depression and anxiety, lower levels of "Marital satisfaction", "communication" and "Sexual relationship" and social support. Logistic regression analysis indicated that depression, anxiety, marital satisfaction and sexual relationship were independent predictors of IVF failure.

CONCLUSION

The prevalence of depression and anxiety in Chinese men undergoing IVF was higher than that in other countries. These findings suggest that anxiety, depression, marital satisfaction, and sexual relationship are important factors leading to IVF failure. Therefore, it is important to provide psychological aid to male patients undergoing IVF treatment.

Differences in psychophysical well-being and signs of depression in couples undergoing their first consultation for assisted reproduction technology (ART): an Italian pilot study

OBJECTIVE

The data we refer to belong to a longitudinal research project starting at the first contact of individual couples with the Infertility Unity; they were then followed-up till pregnancy or failure of treatments. The study aims at investigating in depth the emotional state of patients admitted for first consultation. Specifically, we investigated the emotional state of the two members of an infertile couple, considering also their biomedical and socio-demographic characteristics.

STUDY DESIGN

This is a cross-sectional study evaluating a consecutive series of 309 couples, consulting for the first time our Infertility Unit for a multidisciplinary diagnostic evaluation in relation to their infertility. The multidisciplinary equip is composed of a gynaecologist, an andrologist and a clinical psychologist. Two standardized instruments were administered by the clinical psychologist to the two members of the couple: the Edinburgh Depression Scale (EDS) and the General Health Questionnaire-form 12 (GHQ-12), for screening of non-somatic signs of depression and psychophysical well-being, respectively. Couples were eligible for the study if they had not received any prior ART treatment in our Unit and were able to read and understand Italian. In addition, they had to agree to provide informed consent for the study.

RESULTS

We obtained a response in 62% of all eligible couples. There were two major unexpected findings:

CONCLUSION

Psychological and counselling services dedicated to ART should consider also socio-demographic data and always specifically consider gender differences, not only a couple's psychology and its dynamics.

Treatment of Infertility in Men with Post-traumatic Stress Disorder (PTSD) with the Method of Intrauterine Insemination

Objective:

Our objective was to determine the effect of PTSD on changing the quality of sperm in veterans with PTSD, and the percentage of successful procedures intrauterine insemination (IUI) as a first-line treatment of male infertility patients with post-traumatic stress disorder (PTSD).

Patients and methods:

The study is designed as a prospective observational study. The study was started from February 2013 until May of 2014. Our study included a total of 51 patients who were treatment for infertility in private Hospital for gynecology, endocrinology and infertility, IVF Center in Peja, and those who were outpatients treated for chronic PTSD in the Polyclinic, Biolab-Zafi, in Klina the Republic of Kosovo. All subjects divide into two groups; The first, consisting of 21 respondents to the participants of the war in Kosovo, which was established diagnosis of PTSD. The second group of 30 who have not lived in Kosovo for the time War, and without signs of PTSD.

Results:

Subjects with PTSD were somewhat older than the control group (p = 0.235) but it was not a significant difference (44.5 ± 5.6 vs 43.8 ± 2.3). When the question of type of infertility, secondary infertility is significantly higher in patients with PTSD (62% vs 20%) (Table 2). The total number of sperm and semen volume no significant differences between the two groups (p > 0.05). Sperm motility showed a significant reduction in cases of PTSD (p <0.0001), from observation semen parameters were found more abnormal forms of spermatozoa in the ejaculate cases with PTSD (p < 0.0001) (Table 2). The percentage of pregnancies IUI procedure was slightly higher in patients with PTSD than the control group without PTSD (19% vs. 16.6%).

Conclusion:

A combination of analytical oriented psychotherapy techniques and assisted reproductive techniques (ART) such as IUI procedures, increases the chances for healing infertility in patients with PTSD.

Treatment of Infertility in Men with Post-traumatic Stress Disorder (PTSD) with the Method of Intrauterine Insemination

OBJECTIVE

Our objective was to determine the effect of PTSD on changing the quality of sperm in veterans with PTSD, and the percentage of successful procedures intrauterine insemination (IUI) as a first-line treatment of male infertility patients with post-traumatic stress disorder (PTSD).

PATIENTS AND METHODS

The study is designed as a prospective observational study. The study was started from February 2013 until May of 2014. Our study included a total of 51 patients who were treatment for infertility in private Hospital for gynecology, endocrinology and infertility, IVF Center in Peja, and those who were outpatients treated for chronic PTSD in the Polyclinic, Biolab-Zafi, in Klina the Republic of Kosovo. All subjects divide into two groups; The first, consisting of 21 respondents to the participants of the war in Kosovo, which was established diagnosis of PTSD. The second group of 30 who have not lived in Kosovo for the time War, and without signs of PTSD.

RESULTS

Subjects with PTSD were somewhat older than the control group (p = 0.235) but it was not a significant difference (44.5 ± 5.6 vs 43.8 ± 2.3). When the question of type of infertility, secondary infertility is significantly higher in patients with PTSD (62% vs 20%). The total number of sperm and semen volume no significant differences between the two groups (p > 0.05). Sperm motility showed a significant reduction in cases of PTSD (p <0.0001), from observation semen parameters were found more abnormal forms of spermatozoa in the ejaculate cases with PSD (p < 0.0001) (Table 2). The percentage of pregnancies IUI procedure was slightly higher in patients with PTSD than the control group without PTSD (19% vs. 16.6%).

CONCLUSION

A combination of analytical oriented psychotherapy techniques and assisted reproductive techniques (ART) such as IUI procedures, increases the chances for healing infertility in patients with PTSD.

Sleep, sleep disturbance, and fertility in women

Sleep and sleep disturbances are increasingly recognized as determinants of women's health and well-being, particularly in the context of the menstrual cycle, pregnancy, and menopause. At present, however, little is known about whether fertility is affected by sleep quantity and quality. That is, to what degree, and by what mechanisms, do sleep and/or its disturbances affect fertility? The purpose of this review is to synthesize what is known about sleep disturbances in relation to reproductive capacity. A model is provided, whereby stress, sleep dysregulation, and circadian misalignment are delineated for their potential relevance to infertility. Ultimately, if it is the case that sleep disturbance is associated with infertility, new avenues for clinical intervention may be possible.

Blood plasma collected after adrenocorticotropic hormone administration during the preovulatory period in the sow negatively affects in vitro fertilization by disturbing spermatozoa function

Successful fertilization is essential for reproduction and might be negatively affected by stressful events, which could alter the environment where fertilization occurs. The aim of the study was to determine whether an altered hormonal profile in blood plasma caused by adrenocorticotropic hormone (ACTH) administration could affect in vitro fertilization in the pig model. In experiment 1, gametes were exposed for 24 hours to plasma from ACTH-treated, non-ACTH-treated sows, or medium with BSA. Fertilization, cleavage, and blastocyst rates were lower in the ACTH group compared with the no ACTH or BSA control groups (P < 0.01). In experiment 2, the exposure of matured oocytes for 1 hour before fertilization to the same treatments did not have an impact on their ability to undergo fertilization or on embryo development. In experiment 3, spermatozoa were incubated for 0, 1, 4, and 24 hours under the same conditions. There was no effect of treatment on sperm viability. The percentage of acrosome-reacted spermatozoa remained higher in the ACTH group compared with the non-ACTH-treated group through the incubation period (P < 0.001). Protein tyrosine phosphorylation (PTP) patterns were also affected by treatment (P < 0.001). The presence of an atypical PTP pattern was higher in the ACTH group at all the analyzed time points compared with the BSA and no ACTH groups (P < 0.001). In conclusion, this altered environment may not affect oocyte competence but might affect the sperm fertilizing ability through alterations in the acrosome reaction and correct sequence of PTP patterns.

Time-course changes of steroidogenic gene expression and steroidogenesis of rat Leydig cells after acute immobilization stress

Leydig cells secrete testosterone, which is essential for male fertility and reproductive health. Stress increases the secretion of glucocorticoid (corticosterone, CORT; in rats), which decreases circulating testosterone levels in part through a direct action by binding to the glucocorticoid receptors (NR3C1) in Leydig cells. The intratesticular CORT level is dependent on oxidative inactivation of glucocorticoid by 11β-hydroxysteroid dehydrogenase 1 (HSD11B1) in Leydig cells. In the present study, we investigated the time-course changes of steroidogenic gene expression levels after acute immobilization stress in rats. The plasma CORT levels were significantly increased 0.5, 1, 3 and 6 h after immobilization stress, while plasma testosterone levels were significantly reduced 3 and 6 h, after stress and luteinizing hormone (LH) did not change. Immobilization stress caused the down-regulation of Scarb1, Star and Cyp17a1 expression levels in the rat testis starting at the first hour of stress, ahead of the significant decreases of plasma testosterone levels. Other mRNA levels, including Cyp11a1, Hsd3b1 and Hsd17b3, began to decline after 3 h. Hsd11b1 and Nos2 mRNA levels did not change during the course of stress. Administration of glucocorticoid antagonist RU486 significantly restored plasma testosterone levels. In conclusion, Scarb1, Star and Cyp17a1 expression levels are more sensitive to acute stress, and acute immobilization stress causes the decline of the steroidogenic pathway via elevating the levels of glucocorticoid, which binds to NR3C1 in Leydig cells to inhibit steroidogenic gene expression.

Depression and coping strategies of Chinese women undergoing in-vitro fertilization

OBJECTIVES

To explore the relationship between coping strategies and depression, and the risk factors of depression among Chinese women in infertile couples undergoing in-vitro fertilization (IVF).

STUDY DESIGN

Two hundred and eighty-eight women undergoing IVF completed the Center for Epidemiologic Studies Short Depression Scale and the Brief COPE Inventory. Demographic data were collected, hormone levels were tested and oocyte numbers were counted.

RESULTS

The incidence of depression was 22.6%. The prevalence of depression was higher among women who had been married for >8 years, women who had been infertile for >6 years and women with a family income ≤3000 CNY/month. High basal follicle-stimulating hormone, oocyte number and denial score were associated with greater risk of depression. High oestradiol (basal and peak), and substance use and humour scores were associated with lower risk of depression.

CONCLUSION

Many women in infertile couples undergoing IVF have depression. Preventive interventions should be provided for women with risk factors of depression, such as long duration of marriage, long duration of infertility, low monthly family income, high basal follicle-stimulating hormone, low serum oestradiol, high oocyte number, and use of denial as a coping strategy.

Auricular acupressure reduces anxiety levels and improves outcomes of in vitro fertilization: a prospective, randomized and controlled study

The study was to explore whether auricular acupressure (AA) can relieve anxiety during the period from trans-vaginal oocyte retrieval to the embryo transfer in IVF treatment and whether AA can improve the outcomes of IVF. 305 infertile patients with tubal blockage who were referred for IVF were included. The women were randomized into a control group with 102 cases, a Sham-AA group with 102 cases and an AA group with 101 cases. The anxiety levels were rated with Spielberger's State Trait Anxiety Inventory and the Amsterdam Preoperative Anxiety and Information Scale. Data of clinical pregnancy rate (CPR), implantation rate (IR) and live birth rate (LBR) were obtained. The levels of neuropeptide Y (NPY) and transforming growth factor alpha (TGF-alpha) in the follicular fluids were detected with ELISA. After treatment, in AA group, the levels of state anxiety, preoperative anxiety and need-for-information were significantly lower, whereas CPR, IR, LBR and NPY levels in the follicular fluids were markedly higher than Sham-AA group and control group. We concluded that AA could help to reduce anxiety levels associated with IVF and improves the outcomes of IVF partly through increasing the levels of NPY in the follicular fluids.

The ambiguity of patient-centred practices: the case of a Dutch fertility clinic

When in-vitro fertilization (IVF) was introduced in the 1970s, doctors were criticized for not properly informing prospective users about its possible risks and limited success rates as well as for medicalizing fertility problems. Nowadays, many fertility clinics are seeking to improve their accountability to stakeholders through patient-centred practices. Based on an ethnographic study of a Dutch fertility clinic, outspoken in its aims to provide patient-centred medicine and to empower clients, this paper addresses how patient-centred medicine affects couples' decision-making to use IVF and related reproductive technologies. The author contends that while patient-centred practices facilitate informed decision-making and support couples emotionally, they may also have unintended disciplining and normalizing effects. The information and support provided, the trust couples have in clinic staff, the ongoing visualization of conception mediated by medical technology--all can be seen as practices that strengthen lay people's 'medical gaze' in how they come to view their bodies, fertility problems and possible solutions. These unintended effects are labelled 'the ambiguity of patient-centeredness' as they (may) interfere with processes of autonomous decision-making.

The ambiguity of patient-centred practices: the case of a Dutch fertility clinic

When in-vitro fertilization (IVF) was introduced in the 1970s, doctors were criticized for not properly informing prospective users about its possible risks and limited success rates as well as for medicalizing fertility problems. Nowadays, many fertility clinics are seeking to improve their accountability to stakeholders through patient-centred practices. Based on an ethnographic study of a Dutch fertility clinic, outspoken in its aims to provide patient-centred medicine and to empower clients, this paper addresses how patient-centred medicine affects couples’ decision-making to use IVF and related reproductive technologies. The author contends that while patient-centred practices facilitate informed decision-making and support couples emotionally, they may also have unintended disciplining and normalizing effects. The information and support provided, the trust couples have in clinic staff, the ongoing visualization of conception mediated by medical technology – all can be seen as practices that strengthen lay people's ‘medical gaze’ in how they come to view their bodies, fertility problems and possible solutions. These unintended effects are labelled ‘the ambiguity of patient-centeredness’ as they (may) interfere with processes of autonomous decision-making.

The fertility quality of life (FertiQoL) questionnaire in Taiwanese infertile couples

OBJECTIVE

To characterize the fertility quality of life (QoL) in Taiwanese infertile couples using an objective measurement tool-the FertiQoL questionnaire, and establish a reference level of QoL for clinical applications and future studies.

MATERIALS AND METHODS

The FertiQoL tool, a self-report questionnaire, was distributed to seven infertility centers across Taiwan for infertile couples who were undergoing the treatment of in vitro fertilization. The online version of the FertiQoL questionnaire was issued on the website of Taiwan Society for Reproductive Medicine and was opened to the public.

RESULTS

A total of 534 copies of eligible FertiQoL questionnaires were collected. The total scores for the Core FertiQoL and Treatment FertiQoL are 55.12 ± 13.72 and 56.40 ± 10.96, respectively. Both the Core and Treatment FertiQoL were significantly higher in the males of infertile couples than the females (60.63 ± 14.07 vs. 54.39 ± 13.52, p = 0.001, and 59.13 ± 12.44 vs. 56.03 ± 10.71, p = 0.035, respectively). Significantly better QoL was found in infertile patients in the Southern Taiwan, with a Core FertiQoL of 58.21 ± 12.70 and a Treatment FertiQoL of 58.79 ± 10.15.

CONCLUSION

The results of this study provide a baseline QoL in infertile couples in Taiwan, and could potentially be used as a guide for clinical counseling and future works.

Assessment of Anxiety in Pregnancy Following Assisted Reproductive Technology (ART) and Associated Infertility Factors in Women Commencing Treatment

Background:

Successful pregnancy is the ultimate goal of almost all couples. However, this pleasant event is usually accompanied psychological and behavioral changes and can result in stress in women, particularly women who pregnant by assisted reproductive technology methods (ARTs).

Objectives:

This study aims to determine the anxiety level during pregnancy and its relation with infertility factors in women who has been pregnant by Assisted Reproduction Technology (ART) methods.

Patients and Methods:

A total number of 100 ARTs pregnant women who came to three infertility centers in Tehran from August to November 2009 participated in this descriptive cross sectional study. The rational for selecting the subjects was their availability to the researcher at the time of the research. Anxiety was measured by Beck Anxiety Inventory and for obtaining the infertility data, a questionnaire designed by the researcher was given to the subjects. Data were statistically analyzed using the inferential statistic of chi-square.

Results:

Study results showed that 34 % of subjects were anxious (moderate and sever levels in total). There are significant relations between infertility duration, history of treatment failure and anxiety level (P = 0.03) (P = 0.02). There were no statistically significant relationships with regard to other variables.

Conclusions:

Infertility duration and history of treatment failure in ARTs pregnant women are two factors that affect the anxiety level during pregnancy.

Embryonic diapause in humans: time to consider?

BACKGROUND

When a competent blastocyst stage embryo finds itself in an unreceptive uterus, it delays development. In around one hundred species representing various orders, this delay is known to be reversible, but this phenomenon - termed embryonic diapause (ED) - is not considered a general characteristic of all mammals.

PRESENTATION OF THE HYPOTHESIS

Recently, however, we demonstrated that a non-diapausing species, the sheep, is capable of ED, suggesting the hypothesis that this is in fact an ancestral trait common to all mammals, including humans.

TESTING THE HYPOTHESIS

In spite of the obvious difficulties in testing this idea, we propose a combination of indirect observations on human fertility patients, and direct study of the embryos of non-human primates.

IMPLICATIONS OF THE HYPOTHESIS

Support for our hypothesis would require revision of obstetric interventions routinely performed when a human pregnancy extends beyond the due date.

Depression in Chinese men undergoing different assisted reproductive technique treatments: prevalence and risk factors

PURPOSE

To explore the prevalence and risk factors for depression in men undergoing different assisted reproductive technique (ART) treatments in Chinese population.

METHOD

This was a prospective study of 844 men undergoing ART treatments. All men were distributed to four groups, according to they received treatments. The treatments included IUI (intrauterine insemination), IVF(in vitro fertilization), ICSI(intra cytoplasmatic sperm injection) and TESA/PESA (percutaneous epididymal sperm aspiration/testicular sperm aspiration). Their symptoms of depression were measured with use of the Center for Epidemiologic Studies of Depression scale(CES-D). Data were collected about age, BMI, education, duration of marriage, duration of infertility, smoking, type of infertility, infertility causes, history of ejaculation failure, and financial burden of the treatment. We estimated the prevalence of depressive symptom in men undergoing different ART and used logistic regression models to identify risk factors for depression in different groups.

RESULTS

The overall prevalence of depression was 13.3 % for men undergoing ART treatments: 14.5 % of IUI group, 12.4 % of IVF group, 19.2 % of ICSI group and 6.2 % of TESA/PESA group. Prevalence of depression among IUI group, IVF group and ICSI group were not significantly different. For IUI group, the factors were found to increase depression risk were treatment financial burden and duration of marriage, to decrease depression risk was age. For IVF group, the risk factors independently associated with depression were both male and female infertility, unexplained infertility, and history of ejaculation failure.

CONCLUSION

In a sample of Chinese men undergoing ART treatments, the prevalence of depression was higher than other country. The risk factors for depression varied in different ART treatments groups. when routine screening to identify the sub-group of vulnerable men which need counselling before ART treatments, we should also consider which pattern of ART treatments the man underwent.

Validation of the controlled ovarian stimulation impact measure (COSI): assessing the patient perspective

BACKGROUND

Controlled Ovarian Stimulation (COS) is the first step for in vitro fertilization (IVF) treatment, a treatment often described and experienced as stressful to patients and their partners. COS also requires concerted efforts by the patients in administering medication and general compliance to treatment protocols. Little is known about the impacts on patients that may be specific to this important first step in treatment. The absence of a conceptually sound and well-validated measure assessing patient experience and functioning during ovarian stimulation has been an obstacle to understanding the impacts of ovarian stimulation on women pursuing IVF. To address this gap, the Controlled Ovarian Stimulation Impact Measure (COSI) was developed based upon accepted methods for designing patient reported outcome (PRO) measures. The purpose of this study was to psychometrically validate the COSI.

METHODS

267 patients from three countries (Ireland, United Kingdom, United States) were administered the COSI. Psychometric validation was conducted according to an a priori statistical analysis plan.

RESULTS

The final 28-item COSI was found to have robust scale structure with four domains: Interference in Daily Life (Work and Home), Injection Burden, Psychological Health and Compliance Worry. Internal consistency of all domains was adequate (between 0.80 to 0.87) as was test-retest reliability (between 0.72-0.87). All a-priori hypotheses for convergent and known-groups validity tests were met.

CONCLUSIONS

There is a measurable impact of COS on patient functioning and well-being. The COSI is a well-developed and validated PRO measure of this impact. Future work should include examination of responsiveness and confirmation of concepts in non-western countries.

Effect of blood plasma collected after adrenocorticotropic hormone administration during the preovulatory period in the sow on oocyte in vitro maturation

Reproduction may be affected by stressful events changing the female endocrine or metabolic profile. An altered environment during oocyte development could influence the delicate process of oocyte maturation. Here, the effect of simulated stress by media supplementation with blood plasma from sows after adrenocorticotropic hormone (ACTH) administration during the preovulatory period was assessed. Oocytes were matured for 46 hours in the presence of plasma from ACTH-treated sows, or plasma from NaCl-treated control sows, or medium without plasma (BSA group). The plasma used had been collected at 36 and 12 hours (±2 hours) before ovulation (for the first 24 hours + last 22 hours of maturation, respectively). Subsequent fertilization and embryo development were evaluated. Actin cytoskeleton and mitochondrial patterns were studied by confocal microscopy both in the oocytes and the resulting blastocysts. Nuclear maturation did not differ between treatments. Subtle differences were observed in the actin microfilaments in oocytes; however, mitochondrial patterns were associated with the treatment (P < 0.001). These differences in mitochondrial patterns were not reflected by in vitro outcomes, which were similar in all groups. In conclusion, an altered hormonal environment provided by a brief exposure to plasma from ACTH-treated sows during in vitro oocyte maturation could induce alterations in actin cytoskeleton and mitochondrial patterns in oocytes. However, these changes might not hamper the subsequent in vitro embryo development.

Stress and anxiety scores in first and repeat IVF cycles: a pilot study

Background

The 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.

Methods

This 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).

Results

Mean 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.

Conclusions

Stress 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.

Facial attractiveness is related to women's cortisol and body fat, but not with immune responsiveness

Recent studies suggest that facial attractiveness indicates immune responsiveness in men and that this relationship is moderated by stress hormones which interact with testosterone levels. However, studies testing whether facial attractiveness in women signals their immune responsiveness are lacking. Here, we photographed young Latvian women, vaccinated them against hepatitis B and measured the amount of specific antibodies produced, cortisol levels and percentage body fat. Latvian men rated the attractiveness of the women's faces. Interestingly, in women, immune responsiveness (amount of antibodies produced) did not predict facial attractiveness. Instead, plasma cortisol level was negatively associated with attractiveness, indicating that stressed women look less attractive. Fat percentage was curvilinearly associated with facial attractiveness, indicating that being too thin or too fat reduces attractiveness. Our study suggests that in contrast to men, facial attractiveness in women does not indicate immune responsiveness against hepatitis B, but is associated with two other aspects of long-term health and fertility: circulating levels of the stress hormone cortisol and percentage body fat.

Women's psychological profile and psychiatric diagnoses and the outcome of in vitro fertilization: is there an association?

The influence of psychological processes and psychiatric syndromes on the outcome of fertility treatments is not well understood. In this prospective study, we investigated the effect of baseline psychiatric diagnosis and situational psychiatric symptoms on several biological outcome factors of in vitro fertilization treatments (IVF). Women undergoing their first IVF treatment (n = 108) were interviewed before treatment for the presence of a lifetime DSM-IV-TR disorder. Questionnaires measuring state depression (Center for Epidemiologic Studies Depression scale), anxiety (State Trait Anxiety Inventory), and psychiatric symptomatology (Brief Symptom Inventory) were administered at ovulation induction. Outcome variables were number of retrieved and fertilized oocytes, chemical pregnancy, and a take home baby. Situational anxiety, depression, or other psychiatric symptoms had no effect on any of the outcome measures. Women diagnosed with mood or anxiety disorder prior to the onset of the IVF treatment showed a higher, though not statistically significant, pregnancy success rate compared to women without a diagnosis (57 % compared to 38 %). We speculate that in women with such psychopathology, chronic stress results in biological effects that impede successful implantation, thus impairing fertility. Fertility treatment using the IVF paradigm may bypass this negative effect, resulting in high success rates. This hypothesis should be further explored.