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Infertility and the Mind/Body Connection

Excerpts taken from article written by Alice D. Domar, PhD for femalepatient.com

The relationship between stress and infertility has been recognized since biblical times.1 Nonetheless, most infertility patients today are told that their stress level has nothing to do with their ability to conceive. However, recent research indicates that distress may indeed influence the outcome of infertility treatment, and that psychological interventions are associated with increased pregnancy rates.

Psychological Impact

Women who experience infertility report increased levels of distress, as this condition has an impact on virtually every aspect of their lives—ie, partner relationships, sex life, employment, relationships with fertile family members and friends, financial stability, and even religious beliefs. In addition, many infertile women are blamed by others for their condition.

  • One study showed that Infertile women are significantly more depressed than their fertile counterparts, with depression and anxiety levels equivalent to women with heart disease, cancer or HIV positive status. 3
  • In a study of 112 infertile women who were interviewed by a psychiatrist prior to treatment, 40.2% met criteria for a psychiatric disorder. 2 The most common diagnosis was an anxiety disorder (23.2%), followed by major depressive disorder (17%); this compares with an average prevalence of 3%.
  • Another study reported that 54% of patients reported mild depressive symptoms prior to IVF, and 19% had moderate to severe levels. 5
  • Almost 50% of IVF patients reported that infertility was the most upsetting experience of their lives. 6
  • Most IVF patients report that treatment is more of a psychological stressor than a physical one. 4

While it is not surprising that infertility patients experience psychological symptoms after unsuccessful treatment, it is troubling that the majority of patients also report such symptoms prior to treatment. If psychological distress can interfere with the success of treatment and most patients are affected, then the impact of distress can not be overestimated.

Distress & Pregnancy Rates

Of the 21 studies on stress and IVF identified in the literature, 15 support the theory that distress adversely affects pregnancy rates, 2 found a trend, 3 found no relationship between distress and pregnancy, and one study did not supply data to support any conclusion. Some highlights include:

  • A recent study showed that women who were the most anxious and depressed prior to their IVF treatment cycle were 93% less likely to conceive than the least distressed women. 14
  • Women with a history of depression were nearly twice as likely to report infertility as women without such history. 3
  • In a study with women undergoing donor sperm insemination, those with higher levels of anxiety prior to undergoing inseminations took significantly longer to conceive and were also significantly more likely to miscarry that those with lower levels of anxiety.
  • Women undergoing IVF who were “worried” about the medical aspects of their treatments had 20% fewer eggs retrieved and 19% fewer eggs fertilized. 15
  • Women who were not depressed before starting IVF treatment had a conceptions rate twice as high as women who were depressed before treatment. 2

Mind/Body Interventions & Outcome

Mind/Body Wellness Programs for Infertility generally include training in relaxation, stress management, and coping skills, plus group support.  The main goal of these programs is to increase the chance of conception by reducing the damaging effects of depression and chronic stress.  Research has shown the following outcomes:

  •  In a study conducted at Harvard Medical School on 184 women going through infertility, of those who went through the Mind/Body Program for Infertility, 55% had a viable pregnancy within one year.  This is compared to only 20% of the control group achieving a viable pregnancy in one year. 37
  • The study also found significant differences in psychological status, with the mind/body patients reporting improvement, the support group reporting no change, and the control subjects reporting an increase in psychological symptoms. 38
  • The same study found that more women in the mind/body group (42  %) conceived their babies naturally, without medical intervention, than did those in the control group (20 % ) and the support group (11 %).  37
  • Several other published and unpublished studies have found that patients who learn mind/body techniques are significantly more likely to conceive with approximately 45% - 55% of patients conceiving within a year of program completion. 35, 36, 37, 38
  • Participants attending the 10 week mind/body program report significant decreases in depression, anxiety, hostility, fatigue, headaches, insomnia, and abdominal pain. 35
  • The mechanism whereby such interventions increase pregnancy rates is unknown. However, in a randomized, prospective study that assessed natural killer cell activity in a group of 74 infertile women, 50% were randomized to a five-session mind/body group and 50% served as routine care controls.39
  • Psychological distress and natural killer cell activity decreased significantly in the mind/body intervention group, while the control group had no change. In addition, 38% of the intervention subjects conceived during the 1-year follow-up compared with only 13.5% of the controls. 39

Conclusion

Infertile women report elevated levels of distress, which may in turn contribute to their infertility. Highly distressed patients have lower pregnancy rates, and are more likely to terminate treatment. Preliminary research indicates that psychological interventions can decrease emotional symptoms and increase pregnancy rates. Specifically, mind/body approaches show the greatest promise in symptom improvement, and also appear to promote pregnancy. Because mind/body programs are easy to administer and utilize a group format, they are highly cost-effective as well.

References
    1       Chiff I, Schiff M. The biblical diagnostician and the anorexic bride. Fertil  Steril. 1998;69(1):8-10.
    2       Chen TH, Chang SP, Tsai CF, Juang KD. Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Hum  Reprod. 2004;19(10):2313-2318.
    3     Domar AD, Broome A, Zuttermeister PC, Seibel M, Friedman R. The prevalence and predictability of depression in infertile women. Fertil  Steril. 1992;58(6):1158-1163.
    4     Eugster A, Vingerhoets AJ. Psychological  aspects of in vitro fertilization: a review. Soc Sci Med. 1999;48(5):575-589.
    5     Demyttenaere K, Bonte L, Gheldof M, et al. Coping style and depression level influence outcome in in vitro fertilization. Fertil  Steril. 1998;69(6):1026-1033.
    6     Freeman EW, Boxer AS, Rickels K, Tureck R, Mastroianni L Jr. Psychological evaluation and support in a program of in vitro fertilization and embryo transfer. Fertil  Steril. 1985;43(1):48-53.
    7     Baram D, Tourtelot E, Muechler E, Huang KE. Psychological adjustment following unsuccessful in vitro fertilization. J  Psychosom Obstet Gynaecol. 1988;9:181-190.
   14     Klonoff-Cohen H, Chu E, Natarajan L, Sieber W. A prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer. Fertil  Steril. 2001;76(4):675-687.
   15     Klonoff-Cohen H, Natarajan L. The Concerns During Assisted Reproductive Technologies (CART) scale and pregnancy outcomes. Fertil  Steril. 2004;81(4):982-988.
   35     Domar AD, Seibel MM, Benson H. The mind/body program for infertility: a new behavioral treatment approach for women with infertility. Fertil  Steril. 1990;53(2):246-249.
   36     Lemmens GM, Vervaeke M, Enzlin P, et al. Coping with infertility: a body-mind group intervention programme for infertile couples. Hum  Reprod. 2004;19(8):1917-1923.
    37     Domar AD, Clapp D, Slawsby EA, Dusek J, Kessel B, Freizinger M. Impact of group psychological interventions on pregnancy rates in infertile women. Fertil  Steril. 2000;73(4):805-811.
    38     Domar AD, Clapp D, Orav J, Kessel B, Freizinger M. The impact of group psychological interventions on distress in infertile women. Health  Psychol. 2000;19(6):568-575.
    39     Hosaka T, Matsubayashi H, Sugiyama Y, Izumi S, Makino T. Effect of psychiatric group intervention on natural-killer cell activity and pregnancy rate. Gen  Hosp Psychiatry. 2002; 24(5):353-356.