Counselling and Support
I often get asked by my patients whether or not stress impacts on the chances of pregnancy. There are a number of studies that do suggest there is an association between stress and pregnancy outcome following the use of assisted reproductive technologies.
Researchers at the University of California, San Diego found that patients who worry about certain aspects of their assisted reproductive technology are likely to produce fewer eggs and have a lesser chance of becoming pregnant than others who are more unconcerned. In this well designed prospective study 150 women completed questionnaires at their initial fertility clinic visit, and at the time of their IVF procedure. The questionnaires, developed from a survey of the scientific literature on stress and in vitro fertilization, focused on concerns specific to IVF – side effects, surgery, anaesthesia, pain recovery, finances, missing work and having a baby.
They found that women who are concerned about the medical aspects of the procedure had 20% fewer eggs retrieved and 19% fewer eggs fertilized, than women who were less inclined to worry about it. Furthermore, women who are very concerned about missing work had an astounding 30% fewer eggs fertilized. Those who were very concerned about finances associated with the procedure, had a significantly higher risk of not delivering a live infant. Furthermore, these results were adjusted for different variables that could also play a role in predicting the outcome of IVF – specifically, age, race, smoking, type of infertility, number of previous attempts to become pregnant, and number of children already born, were all taken into account.
Further studies have shown that women/couples who have a good support network in place overall have better outcomes. We at the Victoria Fertility Centre acknowledge the effects that stress can have both on the experience of the process of in vitro fertilization as well as on the outcome. As much as possible, we encourage all patients to visit with our reproductive psychologist to help identify any potential stressors that need attention. The journey of fertility is a very private affair, and this often will lead to our patients feeling isolated and in many cases unsupported by friends and loved ones through the entire process. With the help of our reproductive psychologist, we encourage our patients to address the stress related issues and modify them as much as possible. We also encourage any form of activities such as yoga, acupuncture, exercise, massage therapy, music, etc., which may be helpful.
Personally, I also believe that stress can have a considerable effect on the immune system, which is so important for successful embryo implantation and ongoing pregnancy. It still remains a medical mystery as to how the immune system adapts to the foreign protein and genetic material in an implanting embryo. The immune system in the female is incredibly sophisticated. It is therefore not surprising that it is more prone to malfunction – and this is reflected in the fact that we see immune related disorders more commonly in women than men, for example: systemic lupus erythematosis, rheumatoid arthritis, thyroid dysfunction, and so on. It is common knowledge to all of us that when we are over-stressed and fatigued we are more prone to illnesses, typically, flu-like illnesses, cold sores, herpes outbreaks and so on. This has to be all related to our immune system. It therefore would be no surprise to extrapolate that stress may adversely affect the female immune system when it comes to reproduction.
Healthy mind and healthy body are therefore imperative for optimizing both the IVF experience and the outcome.