Infertility: Altered responses to stress in women undergoing in-vitro fertilization and recipients of oocyte donation

Clinical impressions suggest the presence of considerable anxietyand depression in infertile couples. We utilized a psychologicalstress test to assess adaptations to provoked stress to improvethe psychological profile of infertile women. A psychologicalstress test was administered to four groups: normal menstruatingfemales (controls, n = 13); oocyte donors (n = 13); recipientsof oocyte donation (n = 7); and women undergoing standard in-vitrofertilization (IVF; mean age 38.0 years; n = 8). The psychologicalstress test consisted of three active coping tasks: (i) serialsubtraction, (ii) Stroop colour test, (iii) speech task and(iv) one passive coping task, the cold-pressor test. Haemo-dynamicresponses (HD) were monitored before, during and after the psychologicalstress test, and serum samples were drawn for catecholaminesand cortisol. Baseline blood pressures were similar among groups.The psychological stress test elicited different biophysicalresponses in controls compared with the other groups (P <0.001). Oocyte donors had different speech task responses frombaseline, although these and the other parameters of the psychologicalstress test were not different from either the recipient orIVF groups. Blood pressure responses from baseline were bluntedin both recipients and standard IVF patients following provokedstress. Baseline cortisol and norepi-nephrine were similar amongall groups, yet provoked stress elicited a significant increasein controls (142.0 ± 25.2%, P < 0.001) compared withoocyte donors (17.1 ± 19.7%), recipients and standardIVF patients (mean –15.5 ± 17.3% respectively).Norepinephrine responses were apparently greater in controls(60.1 ± 13.1%) compared with oocyte donors (41.8 ±27%) and recipient and IVF groups combined (21.7 ± 12.4%)but this result was not significant. These data suggest thatinfertile women have blunted biophysical and biochemical reactionsto provoked behavioural stressors. Oocyte donors demonstrateblunted passive coping responses similar to those of infertilewomen, yet still respond to active coping stressors in a mannersimilar to that of normal controls. Our data suggest that infertilitytherapy combined with the anticipation of success or failureresults in blunted patterns of response to passive coping stressors.However, blunted active coping responses are unique to infertilewomen.