Stress and stress-related hormones during in-vitro fertilization treatment

Abstract

Whether stress and infertility are linked as cause or consequence is unclear, and there is no consensus on the most appropriate methods for measuring stress in infertile women. To address this question, we measured changes in biochemical and questionnaire-based assessments of stress in infertile women. Median baseline, follicular phase and pre-operative serum prolactin (229, 311 and 457 mIU/l) cortisol (278, 369 and 496 nmol/l) and state anxiety score (38, 40 and 49) respectively all increased during stimulated in-vitro fertilization (IVF) treatment. There was no such increase in a control group having similar laparoscopic surgery unrelated to infertility, or in women having unstimulated IVF without laparoscopy, suggesting that anxiety levels are greatest in stimulated IVF, increase as a result of the treatment, and are adequately reflected by state anxiety scores. Baseline serum prolactin in unstimulated IVF (384 mIU/l) was significantly higher than control (177 mIU/l), although this was not reflected in serum cortisol or state anxiety score. Trait anxiety was constant within and between groups, suggesting that stress is not contributing greatly to the infertility. Women who achieved a pregnancy had similar state anxiety scores to those who failed, suggesting that the degree of anxiety observed during IVF treatment is unlikely to influence the chance of pregnancy. There was a trend towards lower trait anxiety in women who became pregnant, but the numbers were small.

Regulation of the sperm calcium channel CatSper by endogenous steroids and plant triterpenoids

“…Stress and elevated hydrocortisone levels can also affect female fertility. One study shows that in women who underwent in vitro fertilization, baseline urine cortisol levels increased from ∼230 nM to ∼500 nM (32). According to our results, hydrocortisone blocked CatSper activation by P4 with an IC 50 of 153 nM.…”

Urine cortisol concentration as a biomarker of stress is unrelated to IVF outcomes in women and men

“…Infertility, as well as its treatment, can be considered significant chronic stressors, but the neuroendocrine components of this response and the extent to which environmental contaminants modulate this are unclear. Our results are similar to prior studies that reported no difference in IVF outcomes by cortisol levels, using urine, saliva, or serum levels in addition to self-reported stress questionnaires [13,25,26]. Yet, few prior studies employed urine cortisol as a psychological stress biomarker for IVF couples.…”

“…Previous studies employing psychometric measures, biological stress measures, or both have reported varied, and often conflicting, results for associations between psychological stress and IVF outcomes [5,13,14,[23][24][25][26]. Infertility, as well as its treatment, can be considered significant chronic stressors, but the neuroendocrine components of this response and the extent to which environmental contaminants modulate this are unclear.…”

Stress relief to augment fertility: the pressure mounts

“…The studies on the association between an aberrant stress response and poor fertility outcomes are mixed, with studies supporting an association (1,6,8,11,12,15,17,22,(24)(25)(26), studies refuting an association (13,18,(27)(28)(29), and even a study suggesting a positive impact of stress on reproduction (14). In addition, there are studies demonstrating a negative impact of stress on male reproduction (19,30,31).…”