Does stress affect IVF outcomes? A prospective study of physiological and psychological stress in women undergoing IVF

Abstract Research Question To evaluate the effects of physiological and psychological stress on fertility outcomes for women undergoing IVF. Design A Prospective cohort study of 72 patients undergoing IVF in 2017 and 2018. Physiological stress was assessed by salivary cortisol measurements: (i) pretreatment, when the patient received the IVF protocol, (ii) prior to ovum pick-up (follicular cortisol was also measured) and (iii) prior to embryo transfer (ET). Emotional stress was evaluated at each assessment with the State-Trait Anxiety Inventory (STAI) and 1-10 visual analogue Stress Scale. Pattern of cortisol and stress questionaires, oocytes number retrieved, subsequent embryo transfer, fertilization rate and pregnancy rate. Results Salivary cortisol levels increased by 28% from pretreatment phase (0.46 ± 0.28 mcg/dl) to maximum level on OPU day (0.59 ± 0.29 mcg/dl, p=0,029) and then decreased by 29% on ET day (0.42 ± 0.23 mcg/dl, p=0.0162). On ET day, cortisol among women in their first cycle was higher compared to women who underwent more than one treatment (p=0.024). Stress Scale score increased by 39% from pretreatment to a maximum level on OPU day and then decreased by 12% on ET day. Salivary cortisol and stress scale were not related to subsequent ET, fertilization rate, embryo quality or clinical pregnancy rate. Follicular cortisol level was positively correlated with fertilization rate (p=0.004). Conclusion It can be cautiously concluded that physiological and psychological stress do not negatively affect IVF outcomes. Moreover, high follicular cortisol levels might have positive effects on pregnancy rates.