- Psychological and physiological stress during IVF treatment leads to an increase in cortisol concentration, which is a key mechanism of stress-induced impairment of IVF outcome.
- The most relevant negative effects are the following: altered follicle development and decreased uterine receptivity; development of insulin resistance and follicular cortisol-mediated effects on egg quality.
- Several prospective study and a systematic review with meta-analysis demonstrate that psychological and social aspects and follicular cortisol levels inversely correlate to clinical pregnancy rate.
- There is a negative association between salivary cortisol levels, anxiety, and depression on the day of embryo transfer and implantation success, even if embryo quality is similar between groups.
- At Zemya IVF & Fertility Clinics, we view the integration of mental health assessment and support as an inseparable feature of our IVF Treatment in Green Park, IUI Treatment in Green Park, ICSI Treatment in Green Park, and Egg Freezing in Green Park therapy programs.
During the IVF Treatment in Green Park, most of the medical attention is given to ovarian stimulation, embryo quality, and lab protocols. However, one of the main and often overlooked factors of IVF failure is not even inside the lab. It is in the mind and body of the patient who is going through the process.
The role of mental health and cortisol in IVF failure has been extensively validated with a plethora of evidence to support that psychological and physiological stress during IVF directly and measurably impacts IVF success rates. At Zemya IVF & Fertility Clinics, a trusted IVF Centre in Green Park, mental health and wellbeing are integrated within every patient’s care pathway as a priority – not an afterthought.
Psychological and Physiological Stress During IVF
Infertility causes not only physical pain but psychological suffering as well. Often, the extent of this stress is hardly recognized by patients themselves or doctors. Women on IVF treatment are subject to a very challenging mix of mental and physical changes. For one thing, fertility drugs impact one’s mood and ability to control emotions. Then, going for the staring appointments causes anxiety due to anticipation. Finally, the emotion of one day each embryo transfer is very high, whether one is hopeful or fearful. The level of emotion in both possibilities is rarely matched in other medical experiences.
Psychological distress is a common theme in future psychosocial studies of infertile women, which is supported by all the evidence. For instance, these women tend to be more anxious and depressed than those who are fertile, and that emotional distress before treatment does not subside after the treatment begins; instead, it increases as the stress scale score goes up with each step of the IVF cycle.
Significant differences have been noted in the symptoms of depression, state anxiety, and perceived stress levels between women who achieve clinical pregnancy and those undergoing failed IVF treatment, with the latter showing significantly increased levels of psychological distress before and during treatment compared with the former.
Cortisol: The Hormonal Link between Stress and Infertility Treatment Failure
The physiological mechanism by which stress impacts infertility treatment failure involves cortisol, the principal stress hormone of the human body. When the body is placed under acute or chronic stress, requiring activation of its sympathetic response or hormonal changes, the hypothalamic-pituitary-adrenal axis elevates cortisol levels as part of the physiological response to stress.
A prospective cohort study was conducted to measure levels of salivary cortisol in women who underwent IVF. It was found that there was an inverse relationship between high levels of cortisol in the follicles during ovarian stimulation and clinical pregnancy rate. Specifically, women who had significantly elevated measurements of salivary cortisol produced fewer mature follicles, had lower fertilization rates, and overall, achieved significantly lower clinical pregnancy rates.
In particular, the analysis of cortisol levels on the day of embryo transfer has been very enlightening. Salivary cortisol levels on the day of embryo transfer have been seen to negatively impact implantation rates, even when the embryo quality was comparable between the two groups. This, in fact, establishes the fact that the uterine environment, not the embryo, is impacted by high levels of cortisol. A study has shown that when the stress scale score increased significantly during the ART treatment cycle, the pregnancy outcome was adversely affected, and the women in the highest tertile of stress had a significantly lower percentage of successful clinical pregnancies.
The way cortisol analysis can explain these results is complex. Persistently high cortisol levels can block the reproductive hormone signals (sympathetic and hormonal changes) at the brain level and the hormone factory in the pituitary gland, make the uterus less ready for the embryo around the time of implantation, cause insulin resistance, which messes up hormones even more, and lead to an inflammatory state in the uterus that is not good for the embryo. Cortisol in the follicular fluid around the egg has also been seen in cohort studies to harm the quality of the oocyte directly, which is another reason why chronic stress is associated with worse lab outcomes.
The Cycle of Chronic Distress and Failed IVF Treatment
One of the significant clinically relevant foresights from prospective psychosocial research is the highlight of the self-reinforcing nature of psychological distress and IVF failure. In brief, failed IVF treatment elevates the level of depression, increases the level of state anxiety, and raises the level of perceived stress – all of which are proven to rise salivary cortisol levels for the following cycle, thus creating a negative environment for IVF outcomes once again. Patients who have had multiple failed IVF interventions and who have not been given psychological and social support alongside their medical care enter subsequent cycles with much higher levels of treatment-emotional distress than first-timers, which further exacerbates the effects of cortisol on each successive ART treatment cycle.
A psychological and endocrinological assessment undertaken through a series of prospective cohort studies revealed a significant correlation between baseline levels of distress and subsequent IVF treatment failure. This further reinforces the need to consider psychological stress levels both before and during IVF treatment, rather than focusing on psychological interventions only after the event of a failed cycle. Women with mental disorders and psychiatric disorders showed particularly significant differences in IVF outcomes compared to women without these disorders. Depression symptoms and state anxiety need to be screened for in women undergoing IVF.
How Zemya IVF & Fertility Clinics Treats Mental Health in IVF Care
In Zemya IVF & Fertility Clinics, the mental health and social aspects of the patients receiving fertility treatments are taken with the same level of clinical importance as any other laboratory or medical protocol. Stress scale score, depression scores, and pretreatment emotional distress evaluation are part of the initial assessment for patients receiving IVF Treatment (IVF process) in Green Park, IUI Treatment in Green Park, and ICSI Treatment in Green Park, which helps the fertility experts assess patients with increased levels of mental health problems that may affect the treatment process even before the start of the ART treatment cycle.
Mindfulness-based stress reduction, cognitive behavioural techniques, and dedicated fertility counselling are available to every patient for women undergoing IVF treatment. These strategies have reduced perceived stress and lowered salivary cortisol in prospective psychosocial studies. They also improve treatment outcomes for infertile women. Patients choosing Egg Freezing in Green Park get the same support. Thing is. Making fertility decisions can be emotionally heavy. Support helps them cope with that weight and offer successful outcomes.
For individuals with known mental disorders, psychiatric disorders, and/or highly elevated levels of depression and state anxiety, proper referrals to mental health specialists are included with fertility treatment and not in lieu of it. The mental health specialists at Zemya IVF & Fertility Clinics realize that to achieve a successful IVF cycle, one must consider the whole person and that the role of mental health and cortisol in IVF (in vitro fertilization) failure is well evidenced and not secondary.
