Infertility and Psychological Stress
The belief that infertility is a psychologically mediated condition is long-standing. As an example, the Bible (1 Sam 1:1-28) describes Hannah, wife of Elkanah, as despondent and anorexic; she conceives only after she prays and is promised by a high priest that her wish will be granted.
As health care professionals developed the ability to diagnose and treat most cases of infertility, they began to view it as an organic condition. Some infertility patients were told that their stress level had nothing to do with their ability to become pregnant and some health professionals did not assess the psychological status of their patients. However, there is evidence that stress levels influence the outcome of infertility treatment, as well as contribute to patients' decisions to continue treatment. Stress also affects patients' reactions to pregnancy loss during infertility treatment and pregnancy complications. Moreover, psychological distress is associated with treatment failure and interventions to relieve stress are associated with increased pregnancy rates.
Stress is defined as a stimulus which produces mental tension or physiological reaction, for the purposes of this review, the experience of infertility is the stimulus. Distress is the experience of anxiety or suffering, for the purposes of this review, the experience of infertility leads to the suffering.
Clinically, the provider can assess stress by observation of the patient and inquiring about the patient's emotional state. Research shows that the main sources of stress for infertility patients are the impact of infertility on their social life, their sexual health, and their relationships with their partner. Thus, questions which ask about each of these areas are recommended.
Psychological stress appears to be more common in the partner with the fertility problem. The prevalence of psychological stress in infertility patients was illustrated in a study that used a psychiatrist to conduct structured personal interviews with 112 infertile women who were being seen for their first infertility clinic visit prior to medical evaluation. Forty percent of the patients met the criteria for a psychiatric disorder; the most common diagnosis was an anxiety disorder (23 percent), followed by major depressive disorder (17 percent).
The level of stress in infertility patients tends to increase as treatment intensifies and as duration of treatment continues. Therefore, a population of in vitro fertilization (IVF) patients would be expected to experience more stress than women early in their infertility evaluation.
Many IVF patients report depressive symptoms prior to beginning their cycle, which likely reflects the impact of repeated, unsuccessful, less invasive forms of treatment, but may reflect a prior history of mood/anxiety disorders independent of infertility.
Since IVF is highly invasive and intensive, patient distress is not unanticipated. In fact, most IVF patients state that treatment is more of a psychological than a physical stressor. Nearly half of female IVF patients reported that infertility was the most upsetting experience of their lives. Most IVF patients report symptoms of depression, anxiety, anger, and isolation after unsuccessful treatment.
Since IVF is by far the most expensive and invasive form of infertility treatment, it is important to understand the impact of psychological distress on its outcome. It is concerning that the majority of patients report symptoms of anxiety and/or depression prior to commencing IVF treatment. If psychological distress can interfere with the success of treatment, and most patients report elevated levels of distress, then the impact of distress may be important.
As discussed above, distress is one reason that couples drop out of IVF programs before achieving a pregnancy.
Psychological interventions lead to a decrease in psychological symptoms and appear to increase pregnancy rates. The optimal approach to psychological intervention has not been determined. We suggest relaxation techniques, stress-management, coping skills training, and group support. Evaluation by a psychiatrist for consideration of pharmacotherapy is indicated in women with significant symptoms of anxiety or depression.
As health care professionals developed the ability to diagnose and treat most cases of infertility, they began to view it as an organic condition. Some infertility patients were told that their stress level had nothing to do with their ability to become pregnant and some health professionals did not assess the psychological status of their patients. However, there is evidence that stress levels influence the outcome of infertility treatment, as well as contribute to patients' decisions to continue treatment. Stress also affects patients' reactions to pregnancy loss during infertility treatment and pregnancy complications. Moreover, psychological distress is associated with treatment failure and interventions to relieve stress are associated with increased pregnancy rates.
Stress is defined as a stimulus which produces mental tension or physiological reaction, for the purposes of this review, the experience of infertility is the stimulus. Distress is the experience of anxiety or suffering, for the purposes of this review, the experience of infertility leads to the suffering.
Clinically, the provider can assess stress by observation of the patient and inquiring about the patient's emotional state. Research shows that the main sources of stress for infertility patients are the impact of infertility on their social life, their sexual health, and their relationships with their partner. Thus, questions which ask about each of these areas are recommended.
Psychological stress appears to be more common in the partner with the fertility problem. The prevalence of psychological stress in infertility patients was illustrated in a study that used a psychiatrist to conduct structured personal interviews with 112 infertile women who were being seen for their first infertility clinic visit prior to medical evaluation. Forty percent of the patients met the criteria for a psychiatric disorder; the most common diagnosis was an anxiety disorder (23 percent), followed by major depressive disorder (17 percent).
The level of stress in infertility patients tends to increase as treatment intensifies and as duration of treatment continues. Therefore, a population of in vitro fertilization (IVF) patients would be expected to experience more stress than women early in their infertility evaluation.
Many IVF patients report depressive symptoms prior to beginning their cycle, which likely reflects the impact of repeated, unsuccessful, less invasive forms of treatment, but may reflect a prior history of mood/anxiety disorders independent of infertility.
Since IVF is highly invasive and intensive, patient distress is not unanticipated. In fact, most IVF patients state that treatment is more of a psychological than a physical stressor. Nearly half of female IVF patients reported that infertility was the most upsetting experience of their lives. Most IVF patients report symptoms of depression, anxiety, anger, and isolation after unsuccessful treatment.
Since IVF is by far the most expensive and invasive form of infertility treatment, it is important to understand the impact of psychological distress on its outcome. It is concerning that the majority of patients report symptoms of anxiety and/or depression prior to commencing IVF treatment. If psychological distress can interfere with the success of treatment, and most patients report elevated levels of distress, then the impact of distress may be important.
As discussed above, distress is one reason that couples drop out of IVF programs before achieving a pregnancy.
Psychological interventions lead to a decrease in psychological symptoms and appear to increase pregnancy rates. The optimal approach to psychological intervention has not been determined. We suggest relaxation techniques, stress-management, coping skills training, and group support. Evaluation by a psychiatrist for consideration of pharmacotherapy is indicated in women with significant symptoms of anxiety or depression.
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