Evaluating stress in couples using IVF

This study looked at stress and cortisol levels in couples using in vitro fertilization (IVF) and other reproductive technologies. It found that women who became pregnant had higher cortisol levels, while the stress and cortisol levels of male partners were not related to pregnancy.

Infertility can be a long and stressful process. Adding technological treatments such as IVF, or the related procedure intracytoplasmic sperm injection (ISCI), can also be stressful. IVF can be a long process, and the hormone injections used to stimulate the ovaries can also have emotional side effects. Studies have increasingly found that women using IVF have higher rates of stress, anxiety, and depression. In addition, stress may reduce fertility and pregnancy rates.

Cortisol is a hormone produced by the adrenal glands. Cortisol is connected to alertness and is important in the body’s internal clock. Cortisol levels are highest in the morning and decrease throughout the day. Additionally, cortisol spikes during times of stress, leading to the ‘flight-or-fight’ response. Cortisol awakening response (CAR) is a spike in cortisol that occurs in the 30 minutes to an hour after waking. CAR occurs in over 70% of healthy people of all ages. However, CAR is blunted in patients with stress, anxiety, and depression. Measurements of cortisol after awakening can be used as an objective measure of stress.

Some studies have found that stress and anxiety of the female partner reduce IVF success, and some have not found an effect. Few studies have looked at stress and anxiety of both partners in heterosexual couples. It is also unclear how morning cortisol levels relate to IVF.

This study included 75 couples with infertility undergoing their first cycle of IVF or ISCI. Both partners were of normal weight or overweight (body mass index between 20 and 29.9 kg/m²).

Both partners took questionnaires of anxiety and depression prior to IVF. 54% did not have anxiety. 33% had moderate anxiety, and 11% had moderate/severe anxiety. There was no relationship between mental health and pregnancy rates. However, women in couples with male-factor infertility had higher stress levels than women in couples with unexplained infertility.

Both partners took saliva tests of cortisol levels on a morning prior to beginning IVF treatment. They were taken immediately upon waking, and at 15, 30, and 60 minutes after waking. Women who conceived had significantly higher average cortisol levels (24.7 vs. 20.7). Men of couples who conceived also had higher average cortisol levels (36.8 vs. 22.1), but this difference was not statistically significant.

This study found that women who became pregnant through IVF had significantly higher levels of cortisol. There was a trend toward higher cortisol in men of couples who conceived.

Cortisol levels vary throughout the day. More studies are needed.