Doctors in Sweden claim women who are feeling stressed won't have to add an additional worry—will my IVF cycle fail because I'm emotionally upset? Their study, published in the August 25 issue of the journal Human Reproduction,¹ suggests that a woman's psychological stress has no influence on the outcome of her pending in vitro fertilization cycle.

"This means that we can use these findings to reassure women, and this information should, in itself, help to reduce their stress and worry levels," explained the study's chief author, Lisbeth Anderheim, a midwife and PhD student in the department of Obstetrics and Gynecology at Sahlgrenska University Hospital in Goteburg, Sweden.

Placing Blame on Yourself
Many women about to undergo treatment for infertility feel responsible for the outcome, explained Anders Moller, MD, in the department of Obstetrics and Gynecology at Sahlgrenska University Hospital in Goteburg, Sweden, who headed this study. "They have a tendency to blame themselves for a negative outcome: 'Had I not been so nervous...', 'I was too tense…', 'I was too sad…', 'I should have been more positive in my thinking…', 'I should rest more…', 'I should not work as much as I did…', etc.," Moller told Priority Healthcare. "We wanted to find out what influence psychological stress actually [has]."

No Consistent Studies
Other medical experts have never been able to agree on the influence of stress on a woman's ability to conceive using assisted reproduction. While some previous studies say it does increase the risk of failure,² other studies have found no such link.³

Even in studies where there may have been a relationship, it has generally been weak, Anderheim pointed out.

Assessing Emotional States
This new study was of a prospective nature, and thus, does not rely on answers given after the patients found out whether their treatment was successful or not, the Swedish investigators pointed out. For the analysis, 166 women answered extensive questionnaires about their well-being. These covered a wide range of emotions, their general health, and their relationship with their partner, lifestyle, outlook on life, and intensity of their desire to have children. A second questionnaire distributed just before egg retrieval was answered by 151 of the study participants.

A total of 139 women had embryos available for transfer. Of those, 58 conceived and 81 did not.

Emotions Did Not Play a Role
After comparing the responses to the questionnaires with each woman's assisted reproduction (ART) outcome, they found there were no differences psychologically between those who conceived and those who did not. "The only variable that was significantly associated with pregnancy was the number of good quality embryos transferred," Anderheim said.

It was determined that each woman was in good psychological health before treatment began, and there were no significant differences between the two groups (those who conceived and those who did not) on an additional test designed specifically to assess a range of emotions often expressed by people undergoing infertility treatment.

Anderheim said the healthy psychological well-being of the patients before the study began was a somewhat surprising finding, and did not relate to earlier clinical impressions. So, it's possible that the patients were keeping their worries to themselves because they had great expectations, and were giving answers that were more positive than they truly felt, Anderheim and her colleagues speculated.

The first questionnaire was used because the study team wanted to assess each woman's psychological status before ART treatment. The second was chosen because patients often express anxiety and stress during egg retrieval, they said. Anderheim also acknowledged it may have been valuable to analyze stress levels right before each patient's embryo transfer—another period of high stress in an IVF cycle.

Rest Assured
Nonetheless, the lack of a link between stress and IVF failure was encouraging, she said.

"We have no reason to 'put the blame on the victim' among infertile couples," added Moller. Meanwhile, he said more studies may be necessary in this area. "Maybe there are other aspects that play a role [on IVF outcome]," he said.

1. Anderheim L, Holter H, Bergh C, Moller A. Does psychological stress affect the outcome of in vitro fertilization? Hum Reprod Epub: 2005 Aug 25.
2. Klonoff-Cohen H, Chu E, Natarajan L, Sieber W. A prospective study of stress among women undergoing in vitro fertilization or gamete intrafallopian transfer. Fertil Steril 2001 Oct;76(4):675-87.
3. Milad MP, Klock SC, Moses S, Chatterton R. Stress and anxiety do not result in pregnancy wastage. Hum Reprod 1998 Aug;13(8):2296-300.

John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include overseeing health news coverage for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.