Relationship between psychological stress and reproductive outcome in women undergoing in vitro fertilization treatment: Psychological and neurohormonal assessment

Purpose

To evaluate whether psychological stress, as well as changes in hypothalamus-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) at different time points during a first in vitro fertilization (IVF) cycle, correlates with the reproductive outcome.

Methods

A prospective study was conducted in 264 women undergoing IVF or intracytoplasmic sperm injection (ICSI) treatment between January 2009 and March 2010. Standardized psychological questionnaires were used to assess anxiety and depression. Norepinephrine and cortisol in serum were measured with specific assays.

Results

The non-pregnant women reported higher anxiety and depression scores at the pregnancy detection day compared with the pregnant group. Lower levels of norepinephrine and cortisol at the time of oocyte retrieval and lower levels of cortisol at the time of pregnancy test were found in women with successful treatment. Significant increases in serum norepinephrine and cortisol values were observed during ovarian stimulation. State Anxiety scores were negatively correlated with live birth rate, and positively associated with serum norepinephrine and cortisol values.

Conclusions

State anxiety is associated with both pregnancy rate and live birth rate in IVF patients, an effect that is partly mediated by activities in the HPA and SNS.     

The influence of maternal psychological stress on the fetus.

The effects of maternal agitation, induced by exposure to bright light, upon fetal well-being were studied in pregnant rhesus monkeys at 139 to 148 days of gestation. Fetuses were classified as "healthy" or "asphyxiated" according to their initial acid-base state. Following variable periods of maternal excitement, a decrease in heart rate and arterial oxygenation was seen in all fetuses. Recovery occurred more rapidly in the healthy group, after maternal sedation was achieved, either by removing the stimulus or by additional administration of pentobarbital, 5 to 20 mg. intravenously. The beneficial effects of meternal sedation on the fetus have thus been demonstrated.     

Dimensions of prenatal anxiety and their influence on pregnancy outcome.

Wtih the use of perinatal data from a prospective study of 73 primigravid women and their newborn infants, we determined that prenatal anxiety is not a unitary construct, but that it is useful to consider the distinct concerns of pregnancy. From interviews with the pregnant women, three dimensions of anxiety were identified: (1) anxiety about the pregnancy and approaching birth, (2) anxiety about anticipated care of the child, and (3) psychiatric symptomatology. Correlations of the three anxiety dimensions with background and perinatal outcome variables reveal the strongest associations between anxiety about pregnancy and birth with maternal age, education, and preparation for childbirth. Anxieties about pregnancy and birth and about parenting are related to administration of anesthesia during childbirth and the motor maturity of the neonate. The findings thus give evidence that even in a medically uncomplicated population, emotional states of pregnancy are rooted in the woman's background and may have an impact on perinatal events and infant functioning.     

The influence of increasing BMI in nulliparous women on pregnancy outcome

Objective

The aim of the study was to demonstrate the influence of BMI in pregnancy on rates of adverse pregnancy outcome in overweight nulliparous women.

Study design

The study was a retrospective review of data from the local hospital database held at the Jessop Wing of the Royal Hallamshire Hospital in Sheffield. We reviewed all nulliparous women with recorded BMI at booking between January 2001 and November 2008 who delivered singleton babies. All the women were stratified into five groups (underweight, normal, overweight, obese, and morbidly obese). The different BMI range groups were compared with the group of women with a normal BMI (20-25). SPSS v15 was used for statistical analysis.

Results

The caesarean section rate rose from 18.2% in women of normal BMI to 40.6% in the morbidly obese women (RR 2.2 - CI 1.7-2.8). Morbidly obese women had three times that risk of macrosomia compared with normal BMI women (RR 3.1 - CI 2.1-4.8). The stillbirth rate was associated with increasing obesity with RR 16.7 (CI 4.9-56) for the morbidly obese women.

Conclusions

Increasing degrees of obesity are associated with increases in the incidence of caesarean section, fetal birth weight and adverse pregnancy outcomes. The increased risk shows an increment in a stepwise fashion among the different BMI groups.     

The influence of gestational age on depressive reactions, stress and anxiety of pregnant women and their partners in relation to prenatal diagnosis

Prenatal diagnosis is usually performed in the early weeks of gestation in order to avoid medical and emotional maternal risks in the event of fetal malformation. This study examines emotions such as depression, stress and anxiety in pregnant women and their partners with regard to the week of gestation in which the prenatal diagnosis was made. In total, 452 pregnant women (between 7 and 40 weeks' gestation) and 274 partners participated in this study. The pregnant women were divided into four groups of 113 subjects each according to length of pregnancy (group 1 = 7-15 weeks' gestation, group 2 = 16-18 weeks' gestation, group 3 = 19-23 weeks' gestation and group 4 = 24-40 weeks' of gestation). Depression, stress and Spielberger state-trait anxiety levels were measured before the prenatal examination, and stress and state anxiety were assessed after prenatal examination. Statistical analysis was performed using analysis of variance (ANOVA). After the prenatal examination, the mean values of state anxiety (p = 0.032) and stress (p = 0.030) showed statistically significant differences in the pregnant women. Their partners only showed statistically significant differences in the stress values (p = 0.048) after examination. In conclusion, emotional stress related to the prenatal diagnosis seems to be largely independent of gestational age. Ultrasound scans give the parents-to-be a clearer image of their unborn child, as their perception of the fetus is transformed from that of an anonymous object into an individual.     

The endocrinological evaluation of bilateral and unilateral oophorectomy in premenopausal women

The sequence of changes in serum follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2), testosterone (T), and progesterone (P) levels immediately following unilateral and bilateral oophorectomy with hysterectomy and hysterectomy alone has been measured in 65 premenopausal women by radioimmunoassay (RIA). In addition, relationship of vasomotor symptoms and serum hormone levels were studied and no correlation was found. We show mathematically the change of the relationship of the pituitary and gonadal hormones after castration. We believe that castration causes change in the activity of the hypothalamo-pituitary and gonadal axis. In view of our results, we recommend leaving at least one ovary to prevent postcastration symptoms and to maintain a good physiological condition.     

孕产妇的心理状况与分娩方式的关系

目的研究孕产妇的心理状况随孕周进展的动态变化及其分娩结局,寻求降低剖宫产率的有效对策。方法采用自制问卷、症状自评量表(scL-90)、总体幸福感量表,对89例孕产妇分别于孕35周、38周、产后72小时进行心理状况的评定分析。结果89例孕产妇中自然分娩48例,占53.93％;剖宫产41例,占46.07％(其中无产科指征12例,占29.27％)。无指征剖宫产组分娩前后焦虑、恐怖、抑郁因子分均高于自然分娩及有指征剖宫产组,抑郁因子分均高于自然分娩组及有指征剖宫产组,差异显著(P＜0.01);无指征剖宫产组总体幸福感值低于自然分娩组,差异极显著(P＜0.001)。相关分析表明幸福感、对生育的期望、文化程度与孕产妇的症状水平呈显著负相关(P＜0.01),分娩方式与孕产妇心理状况呈显著正相关(P＜0.01)。结论无产科指征的剖宫产主要是与随孕周进展乃至分娩而渐进的焦虑、恐怖、抑郁有关。故有针对性的进行心理干预可望降低剖宫产率。     

Prevalence and outcome of pregnancies in Norwegian and Swedish women with cystic fibrosis

BACKGROUND: As patients with cystic fibrosis now live longer, more women with cystic fibrosis wish to become mothers. We looked at the prevalence and outcome of pregnancies in women with cystic fibrosis who were alive in Norway and Sweden in the year 2000. METHODS: Women with cystic fibrosis aged 18 years and older attending cystic fibrosis centers in Norway and Sweden were included in the study. Information was obtained from medical records, interviews and questionnaires. RESULTS: One hundred and thirty-two women with cystic fibrosis were included. Sixty-one (46%) had considered or were now considering pregnancy. Forty-six (75%) of these 61 women had already conceived. Eighty pregnancies were reported, including 12 (15%) conceived by assisted reproductive techniques. There were eight (10%) induced abortions, 11 (14%) miscarriages, and one extrauterine pregnancy. The remaining 60 (75%) pregnancies resulted in live born infants. CONCLUSIONS: Today women with cystic fibrosis have a better chance of getting pregnant than previously reported. In this study, 75% of those who wanted to get pregnant had succeeded. Fifteen percent of pregnancies were conceived by artificial reproductive techniques. The possibility of motherhood must be considered in these patients. It is important to plan pregnancies with optimal follow up by a cystic fibrosis team.     

The influence of maternal age on pregnancy outcome in nulliparous women with twin gestation

We sought to determine if outcomes of nulliparous twin pregnancies differ based on maternal age. Nulliparous women with current twin pregnancies were identified from a database of women enrolled for outpatient nursing surveillance. Data were stratified into four groups by maternal age: less than 20, 20 to 34, 35 to 39, and greater than or equal to 40 years. Maternal and neonatal outcomes for women less than 20, 35 to 39, and 40 or more were compared with 20- to 34-year-old controls using Kruskal-Wallis, Mann-Whitney, and Pearson chi-square analyses. We analyzed 2144 nulliparous twin pregnancies. Patients ≥35 years (34 to 39, 78.5% or ≥40, 85.9%) were more likely to have cesarean deliveries compared with controls 20 to 34 years old (71.2%). Women aged 35 to 39 were less likely to deliver at <37 weeks, and women in the ≥40 group were less likely to deliver at <35 weeks due to spontaneous preterm labor compared with the controls. Neonates born to women aged 35 to 39 had a greater gestational age at delivery and larger average birth weight than controls. Maternal and neonatal outcomes were not adversely influenced by advanced maternal age in nulliparous women carrying twin gestations.     

Pregnancies in women with hyperprolactinaemia: obstetric and endocrinological management of 50 pregnancies in 37 women

Summary. Fifty pregnancies occurred in 37 women with hyperprolactinaemia. Thirty women (81%) initially attended with infertility and 24 (65%) had secondary amenorrhoea. Twelve women (31%) had pituitary macroadenomas, of whom seven (19%) were treated with neurosurgery and/or external radiotherapy before conception. Fortyone conceptions (82%) followed treatment with bromocriptine. There were no unusual obstetric or endocrinological complications. Scrum prolactin measured at least 6 months post partum when under basal conditions, without bromocriptine and not breast feeding, showed no significant trends compared with initial values. Tumour growth was not stimulated by the high oestrogen levels of pregnancy.     

The prevalence of urinary incontinence and its influence on the quality of life in women from an urban Swedish population.

OBJECTIVES: To assess the prevalence of urinary incontinence and its influence on the quality of life. MATERIAL AND METHODS: A random sample of every fourth woman aged > or =20 years resident in a primary health care district of the city of G?teborg was obtained from the population register (n=2911). The women were invited by letter to complete a questionnaire concerning urinary incontinence. The women were also requested to assess their quality of life using a visual analogue scale. RESULTS: The overall response rate was 77%. The prevalence of urinary incontinence increased (p<0.001) in a linear fashion from 3% in the cohort 20-29 years to 32 % in the cohort of women aged > or =80 years. The proportion of women suffering from stress incontinence decreased (p<0.001) with increasing age, while the proportion of women suffering from urge and mixed incontinence increased (p<0.01) with increasing age. Women with stress incontinence had a greater body weight and had given birth to a greater number of children compared to continent women. There was, however, in this respect no difference between women with urge incontinence and continent women. Women with urinary incontinence reported a poorer quality of life compared to continent women (p<0.01). Women with urge incontinence and women with mixed incontinence reported a poorer quality of life compared to women with stress incontinence (p<0.05). Only 6% of the women from this population had sought medical attention for urinary incontinence. CONCLUSIONS: Although urinary incontinence was a prevalent condition, particularly among the elderly and had a negative influence on the quality of life, only a small number of women had sought medical care.     

孕妇沙眼衣原体、解脲支原体感染对围产结局的影响

目的研究孕妇沙眼衣原体(CT)和解脲支原体(UU)的感染对围产结局的影响。方法选取门诊行产前检查及住院待产的正常孕妇149例,采用ELISA方法检测母体血清中的抗UUIgG和抗CTIgG抗体,二者均未检出者作为对照组,对所有对象随访至妊娠结束,并详细记录分娩过程及新生儿情况。结果与对照组相比,UUIgG阳性组及复合阳性组[UUIgG( )且CTIgG( )]其早产、胎膜早破及死胎、畸胎的发生率具有显著性差异(P<0.05,P<0.05,P<0.05;P<0.01,P<0.05,P<0.01)。结论UU、CT感染可以引起不良妊娠结局,如早产、胎膜早破、畸胎、死胎,应积极预防和治疗。     

The influence of pad test loss on management of women with urodynamic stress incontinence

Members of the International Continence Society (UK section) were randomised to receive a scenario comprising clinical and urodynamic data of a woman with urodynamic stress incontinence, including a one-hour pad loss of either 42 g (large loss) or 7 g (small loss). Members were asked to indicate their initial management choice from a list of four options. Three hundred and fifteen of 440 (72%) members responded. Gynaecologists and urologists were significantly more likely to choose surgical treatment for patients with a large pad loss (24% vs 8%; difference 15.8%, 95% CI 2.9–28.7), despite published data demonstrating the poor reproducibility and reliability of the pad test.     

The influence of infant birth weight on post partum stress incontinence in obese women

One hundred ninety four women with a Body Mass Index (BMI) of at least 30 kg/m² who were delivered vaginally between 01 10 93 and 30 09 95 at the obstetric department, Herning Central Hospital, were sent a postal questionnaire about stress incontinence. The response rate was 89.2%. In the heavy birth weight group (n=4000 g or more) stress incontinence increased from 10.6% before pregnancy to 34.0% post partum. In the low birth weight group 6.9% suffered from stressincontinence before pregnancy increasing to 30.6% post partum. There was no difference in the reporting of mixed or urge incontinence between the two groups. Received: 4 November 1996 / Accepted: 12 November 1996     

The course and outcome of pregnancy after ovarian electrocautery in women with polycystic ovarian syndrome: the influence of body-weight

Summary. In 89 women with polycystic ovary syndrome (PCOS) who conceived after ovarian electrocautery, the pregnancy continued beyond 31 weeks in 62. In this group the frequency of pre-eclampsia and diabetes was 12·9 and 8·1% respectively. The increased frequencies were confined to overweight women. The frequency of major and minor malformations was 1% and 3·8% respectively. The rate of early miscarriage of the first pregnancy after ovarian electrocautery was 15%, and when later pregnancies were included the rate reduced to 10·3%. These data do not indicate any impact upon the course or outcome of pregnancy from the state of PCOS per se or the ovarian electrocautery that induced ovulation in this series.     

A comparison of psychological stress among women with and without reproductive failure

Objective

To determine whether women with recurrent implantation failure (RIF) after in vitro fertilization (IVF), similar to women with recurrent pregnancy loss, have significantly higher stress levels than women without reproductive failure, and to compare stress levels between women with RIF and women with recurrent pregnancy loss.

Methods

In a questionnaire-based study between September 2009 and January 2011, psychological stress was measured among patients attending recurrent pregnancy loss and RIF clinics at the Royal Hallamshire Hospital, Sheffield, UK. Participants completed the Fertility Problem Inventory (FPI), the Perceived Stress Scale (PSS), and the Positive and Negative Affect Schedule (PANAS) on their first visit to their respective clinic. Thirty fertile control women also completed the 3 validated questionnaires.

Results

Compared with the control group, women with RIF and recurrent pregnancy loss had significantly higher scores in the FPI (RIF, P < 0.001; recurrent pregnancy loss, P = 0.003) and the PANAS negative affect domain (RIF, P = 0.004; recurrent pregnancy loss, P = 0.001), and lower scores in the PANAS positive affect domain (RIF, P < 0.001; recurrent pregnancy loss, P < 0.001). Whereas the perceived stress score (PSS) of the recurrent pregnancy loss group was significantly higher than that of the control group (P = 0.006), the score of the RIF group was not, although the difference tended toward statistical significance (P = 0.058).

Conclusion

The study findings confirm the stressful nature of RIF and recurrent pregnancy loss.     

The course and outcome of pregnancy after ovarian electrocautery in women with polycystic ovarian syndrome: the influence of body-weight

In 89 women with polycystic ovary syndrome (PCOS) who conceived after ovarian electrocautery, the pregnancy continued beyond 31 weeks in 62. In this group the frequency of pre-eclampsia and diabetes was 12.9 and 8.1% respectively. The increased frequencies were confined to overweight women. The frequency of major and minor malformations was 1% and 3.8% respectively. The rate of early miscarriage of the first pregnancy after ovarian electrocautery was 15%, and when later pregnancies were included the rate reduced to 10.3%. These data do not indicate any impact upon the course or outcome of pregnancy from the state of PCOS per se or the ovarian electrocautery that induced ovulation in this series.     

The influence of race on fetal outcome

The purpose of this study was to examine racial differences in fetal death by gestational age among South Carolinians during 1999 to 2000 in an attempt to identify sociodemographic risk factors that may contribute to the refinement of care protocols. This historical cohort design appended the 1999 to 2000 South Carolina Vital Records fetal death file (N = 944) to the birth file (N = 99, 726) to perform secondary data analysis. Inclusion criteria were maternal South Carolina residency, delivery of a singleton in South Carolina, and racial identification as white or black. Independent associations between race (black or white), gestational age categories of deliveries (fetal death or live birth), and maternal sociodemographic characteristics (maternal age and prenatal care) were examined using chi2 analysis. Black and white fetal mortality rates (FMRs) were examined. Logistic regression was used to control for confounding variables. The study sample consisted of 63.4% white and 36.6% black for all deliveries; 40.89% white and 59.11% black for fetal deaths. There was a significant racial difference in gestational age categories, initiation of prenatal care, maternal age, and fetal death rates (p = 0.0001). The black FMR was nearly 2.5 times greater than the white rate (p < 0.0001; 95% confidence interval, 2.2 to 2.9). There was an independent association between race and gestational age at fetal death (p = 0.0001) as well as race and maternal age. Results did not remain statistically significant after controlling for confounding variables. In this study, we identified several factors associated with an increased risk of fetal death. However, after controlling for gestational age, the odds of fetal death among blacks were no longer significantly elevated in comparison to those of whites. Future studies that examine racial disparities should consider gestational age in analytic models. Identifying racial demographics and behavioral risks may contribute to refinements in care protocols for high-risk mothers in an effort to reduce fetal mortality.     

Coasting疗法对体外受精-胚胎移植治疗结局的影响

目的 探讨在控制性超促排卵（COH）中coasting疗法与体外受精-胚胎移植（IVF-ET）治疗结局的关系。方法 对南方医科大学南方医院生殖医学中心2005年1月至2005年12月222例不孕症患者的临床资料进行回顾性分析。根据是否行coasting疗法分为两组,比较两组的卵泡数、卵子数、临床妊娠率、种植率和分娩率。结果coasting组的coasting天数为（1.3±0.5）d,coasting组与非coasting组的卵泡数、卵子数分别为（33.0±7.6）个、（17.1±7.1）个和（17.4±7.7）个、（11.9±4.8）个,coasting组显著高于非coasting组,差异有显著性意义（P〈0.05）,而临床妊娠率、种植率和分娩率分别为51.4%、34.6%、48.6%和47.8%、28.8%、44.0%,差异无显著性意义（P〉0.05）。结论 coasting是预防重度卵巢过度刺激综合征（OHSS）的一种有效方法,不影响IVF-ET的妊娠结局。