The association of physiological cortisol and IVF treatment outcomes: a systematic review

Abstract

Purpose A systematic review was conducted to (1) collate and synthesise the available evidence for the role of cortisol in relation to IVF treatment outcomes; (2) to establish the strength of an association between cortisol and IVF; and (3) to assess the overall quality of the studies and guide future research in this area. Methods Seven electronic databases, including the reference lists of published papers, were searched. Inclusion criteria qualified any prospective/observational cohort study that reported original data. Quality assessment of eligible studies was conducted using the STROBE statement, which was used to assess the risk of bias and the quality of observational studies included in this review. Result(s) A total of eight studies reported a significant association between cortisol and IVF outcomes. Three studies found that higher cortisol may be associated with more favourable IVF outcomes, whereas five studies found that lower cortisol levels may be conducive to IVF success. Eleven of all studies included in this review were regarded as low quality publications. Conclusion(s) Study findings were that the evidence for the role of cortisol in relation to IVF outcomes is currently mixed. Future researchers are encouraged to consider the methodological limitations highlighted in this review and to utilise more robust assessment methods when examining the influence that chronic, rather than acute, stress may have on IVF outcomes.

Relationship between hair and salivary cortisol and pregnancy in women undergoing IVF

“…Despite these potential limitations, the present study extends the available evidence for the role of cortisol on clinical pregnancy in IVF patients (Massey et al, 2014) and provides the first evidence that elevated chronic cortisol levels are associated with a reduced likelihood of pregnancy. The pathways by which cortisol may influence reproduction, however, remain unclear, .…”

“…These contrasting outcomes were evident in a recent systematic review which reported that both high and low cortisol levels were associated with an increased likelihood of pregnancy in women undergoing IVF treatment (Massey et al, 2014). Twelve studies were identified that explored associations between cortisol (measured in blood, urine, saliva and follicular fluid) and establishment of clinical pregnancy.…”

“…First, the majority of studies failed to control for extraneous variables known to influence cortisol including time of day, caffeine consumption and body mass index (BMI) (Massey et al, 2014). Second, studies measured cortisol at different stages of treatment.…”

A prospective investigation of perceived stress, infertility‐related stress, and cortisol levels in women undergoing in vitro fertilization: influence on embryo quality and clinical pregnancy rate

“…Similarly, efforts to measure the effect of physiological stress on IVF treatments have varied. A recent systematic review by Massey et al in 2014 demonstrated that both high and low cortisol levels have been associated with increased likelihood of pregnancy in women undergoing IVF . However, for the majority of included studies, the quality was rated as poor.…”

Intraoviductal concentrations of steroid hormones during in vitro culture changed phospholipid profiles and cryotolerance of bovine embryos

“…A recent meta-analysis of studies in women undergoing IVF treatment reported contradictory results regarding the potential role of cortisol on IVF outcomes (Massey, Campbell, Raine-Fenning, Aujla, & Vedhara, 2014). In studies, wherein a significant association between cortisol and IVF outcome was shown, both high and low cortisol levels in women were associated with an increased likelihood of pregnancy after embryo transfer (Massey et al, 2014). It is worth mentioning that, in cows, ovum pick-up, transrectal palpation of genital organs, and the catheterization of the uterine cervix for insemination, which are routine procedures for oocyte retrieval, in vitro embryo production and transfer, cause stress and an increase in cortisol circulating levels (Chastant-Maillard et al, 2003;Nakao et al, 1994;Petyim et al, 2007).…”