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BackgroundStress exposure has been proved to be linked to reproductive failure. The reproductive potential of women depends on the ovarian reserve. Anti-müllerian hormone (AMH) has been proved a reliable clinical marker of ovarian reserve. However, the correlation between psychological stress and AMH level is not clear.MethodsA cross-sectional study including 576 women was conducted. AMH concentration was tested to reflect the ovarian reserve. Salivary alpha-amylase (SAA) level was measured to assess the stress of patients objectively.ResultsThe SAA level was significantly, and negatively correlated with AMH levels in infertile women (r = −0.315, P = 0.000; adjusted for age, r = −0.336, P = 0.000).ConclusionHigher psychological stress was related to a decreased AMH level in infertile women and psychological stress may affect ovarian reserve.

IFU) accompanying the demonstration pen device, after which, participants were asked to demonstrate their learning by injecting into a pad. They were then asked to complete a questionnaire assessing their experience and comparing this to either known (nurses) or previously used (women) fertility injection devices, if applicable. Nurses received initial training and then trained an average of 2.9 patients (range 2-5). Descriptive data are summarized.RESULTS: Following training and use, all 30 (100%) nurses agreed or strongly agreed that the iGFP was easy to learn and 28 (93%) felt it would be easy to teach. After training patients, all 30 nurses evaluated the overall process of teaching patients how to self-administer as easy or very easy; 27 (90%) nurses felt that teaching the overall process of self-administering was easier or much easier than their expectations. Of the 13 nurses with experience training patients on Bemfola Ò in the previous 6 months, 11 (85%) felt that the iGFP was easier or much easier to teach. Of the 28 nurses with Puregon Ò training experience in the previous 6 months, 22 (79%) felt that the iGFP was easier or much easier to teach. All of these nurses felt that the iGFP would minimize dosing errors compared with Bemfola (n¼12; one nurse did not correctly complete this question) or Puregon (n¼28). Almost all, 83 out of 86 (97%) patients, found the iGFP easy or very easy to learn to use. In particular, setting the iGFP dose was considered easy or very easy by 84 (98%) patients. Following training and use, 75 (90%) patients agreed or strongly agreed that they would recommend the iGFP to friends and family if they needed IVF treatment. Of the 30 nurses, 29 agreed or strongly agreed that they would recommend the iGFP to fellow fertility nurses.CONCLUSIONS: The improved version of the prefilled, ready-to-use follitropin alfa multi-dose pen injector (Gonal-f Ò Pen) is easy to learn and easy to teach for fertility nurses and easy to use for women recently/currently receiving or requiring ART. Over 90% of nurses and patients in this study would recommend the improved pen.