Impact of different controlled ovarian stimulation protocols on the physical and psychological burdens in women undergoing in vitro fertilization/intra cytoplasmic sperm injection

Abstract

CONTEXT:Infertility treatment involves a considerable amount of physical and psychological burden which may impact the outcome.AIM:The objective was to understand the amount of physical and psychological burden in women undergoing their first in vitro fertilization (IVF)/intra cytoplasmic sperm injection (ICSI) cycles.SETTING AND DESIGN:Multi-center, prospective, parallel, observational study.MATERIALS AND METHODS:The study was conducted across 12 IVF centers in India. A total of 692 women undergoing controlled ovarian stimulation as a part of the first cycle IVF/ICSI completed the trial. Women were recruited in 2 groups based on type of treatment (Group A - gonadotropin-releasing hormone [GnRH] antagonist; Group B - GnRH agonist) and were asked to fill questionnaires during the 2 treatment visits.RESULTS:The mean changes between Visit 1 (baseline) and Visit 2 in anxiety and depression (Hospital Anxiety and Depression Scale) scores in Group A for anxiety and depression were −0.5 (3.67), −0.1 (3.57) respectively and for Group B were −0.4 (3.68), 0.1 (3.67) respectively, which was not statistically significant. In Group A, the mean (±standard deviation [SD]) Hopkins Symptom Check List (HSCL) score was 17.9 (±5.17) in visit 1 and 19.1 (±5.45) Visit 2. The change between visits was 1.1 (P < 0.0001) with higher score reflecting higher somatic distress symptoms. In Group B, the mean (±SD) HSCL score was 18.2 (±5.19) in Visit 1 and 18.8 (±5.23) in visit 2. The change between visits was 0.6 (P < 0.0014). The difference of the mean change in physical burden between Group A and Group B was not statistically significant.CONCLUSION:A significant impact in both treatment protocols with respect to the physical burden was found between Visit 1 and Visit 2 but no difference in physical or psychological burden between the two treatment groups was observed.

Women Undergoing Hormonal Treatments for Infertility: A Systematic Review on Psychopathology and Newly Diagnosed Mood and Psychotic Disorders

“…Finally, nine trials were included, all of them in non-clinical populations. Four trials compared GnRH agonists and GnRH antagonists (3,(34)(35)(36), showing a better mood profile (less depressive symptoms) for those hormonal protocols including antagonists in one trial. Two trials compared protocols using either GnRH agonists or GnRH antagonists versus natural cycle protocols that did not use gonadotropin stimulation, reporting a better mood profile in those protocols without gonadotropin stimulation (32,33).…”

“…One study suggested that treatment with one GnRH agonist, buserelin, had a poorer mood profile than other GnRH agonist (goserelin) 1 week later but showed similar mood changes at the end of the trial (37). However, GnRH agonists did not seem to differ from GnRH antagonists in their associated occurrence of depressive symptoms, suggesting that neither protocol has a psychopathological effect on women undergoing fertility treatments (3,(34)(35)(36).…”

“…Eight trials investigated the effects of hormones used in women undergoing fertility treatments (2,3,(32)(33)(34)(35)(36)(37). All of them evaluated the effect of GnRH antagonists or GnRH agonists on the occurrence of newly diagnosed depressive symptoms in women (Tables 1, 2 and 3).…”

“…Similarly, Mamata et al (34) carried out a trial across 12 IVF centres in India (34). The authors divided participants into two groups according to the type of treatment they received: a) GnRH antagonists and b) GnRH agonists.…”

“…The assessment of the risk of bias has been presented in detail in Table S2. Of all nine clinical trials included in our systematic review, four were considered to be good (2,3,36,39), four fair (33)(34)(35)37), and only one (32) had poor quality.…”