Psychological stress and infertility
- Alice D Domar, PhD
Alice D Domar, PhD
- Associate Professor of Obstetrics, Gynecology and Reproductive Biology (part-time)
- Harvard Medical School
The belief that psychologic factors play a role in infertility is long-standing, and there is evidence that stress levels may influence the outcome of infertility treatment, as well as contribute to patients' decisions to continue treatment [1,2]. 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 .
In addition, preconception stress may increase the risk of infertility. In a 12 month, prospective observational study of women starting to attempt pregnancy naturally, salivary alpha-amylase (an index of stress) was measured at baseline . After adjusting for potential confounding factors (eg, age of the woman, consuming alcohol, and smoking cigarettes), the baseline level of alpha-amylase predicted subsequent infertility, such that infertility was more than twice as likely to occur in women with the highest tertile levels of alpha-amylase, compared with women in the lowest tertile.
PREVALENCE OF STRESS
Psychological stress appears to be more common in the partner with the fertility problem . The prevalence of psychological stress in infertility patients was illustrated in a study that used a psychiatrist to conduct structured personal interviews with 112 infertile women who were being seen for their first infertility clinic visit prior to medical evaluation . The Mini-International Neuropsychiatric Interview (MINI) was used to establish diagnoses. Forty percent of the patients met the criteria for a psychiatric disorder; the most common diagnosis was an anxiety disorder (23 percent), followed by major depressive disorder (17 percent). These findings reflect a much higher prevalence of psychiatric disorders in this sample of infertility patients than the 10 to 12 percent average prevalence of such symptoms in the primary care setting.
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 .
ASSESSMENT OF STRESS
Stress is defined as a stimulus which produces mental tension or physiological reaction, for the purposes of this review, the experience of infertility is the stimulus. Distress is the experience of anxiety or suffering, for the purposes of this review, the experience of infertility leads to the suffering
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