Date of Award

January 2011

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Beth Rackow

Subject Area(s)

Obstetrics and gynecology, Psychology

Abstract

The role of stress in reproduction and the treatment for infertility has been of considerable interest. This study aims to assess self-report measures of stress and anxiety over the course of the in vitro fertilization (IVF) cycle and compare the experience of first-time and repeat-cycle subjects. It is hypothesized that stress will be higher in first-time participants and that stress and anxiety scores will negatively predict pregnancy success. The study consecutively recruited 86 women who were accepted for IVF at a university-based clinic, 44 of whom elected to enroll in the study and complete the State-Trait Anxiety Inventory (STAI), Perceived Stress Scale (PSS) and Infertility Self-Efficacy Scale (ISES) at three time points: prior to ovarian stimulation (T1), one day prior to oocyte retrieval (T2), and 5-7 days post embryo transfer (T3). Mean STAI-State scores were significantly elevated compared to normative data for women at all three time points (p< 0.01). STAI-State and PSS mean values did not change over time and did not differ in first-time compared to repeat subjects. Self-efficacy (ISES) scores declined over time, with a greater decline for repeat subjects. Of the 36 women who completed a cycle, 15 achieved clinical pregnancy. Using logistic regression modeling, all scores at T2 were correlated with pregnancy outcome, with lower scores on the STAI-State and PSS and higher scores on the ISES associated with higher pregnancy rates measured at 6-7 weeks gestation. Stress and anxiety levels remained elevated across all cycles but did not differ between first-time and repeat subjects. Women with lower stress and anxiety levels on the day prior to oocyte retrieval had a higher pregnancy rate. However, significant limitations include the small sample size, possible selection bias in those who decided to participate, and the omission of significant potential confounders such as previous parity and infertility cause (e.g. maternal versus paternal factors). Therefore, these results reflect the need for further well-powered studies to confirm the potential predictive capacity of stress and anxiety scores and emphasize the need for further randomized, controlled stress-reduction intervention studies.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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