Hum. Reprod. Advance Access originally published online on November 5, 2007
Human Reproduction 2008 23(1):112-116; doi:10.1093/humrep/dem357
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Low negative affect prior to treatment is associated with a decreased chance of live birth from a first IVF cycle
1 Department of Medical Psychology and Psychotherapy, Erasmus MC, 3015 GD Rotterdam, The Netherlands 2 Department of Obstetrics and Gynaecology, Erasmus MC, 3015 GD Rotterdam, The Netherlands 3 Department of Public Health, Erasmus MC, 3015 GD Rotterdam, The Netherlands 4 Department of Reproductive Medicine and Gynaecology, University Medical Centre, 3584 CX Utrecht, The Netherlands
5 Correspondence address. Tel: +31 10 408 78 05; Fax: +31 10 408 94 20; E-mail: c.deklerk{at}erasmusmc.nl
BACKGROUND: Psychological variables, such as anxiety and depression, may have a negative impact on IVF outcomes, but the evidence remains inconclusive. Previous studies have usually measured a single psychological parameter with clinical pregnancy as the outcome. The objective of the current study was to determine whether pretreatment or procedural psychological variables in women undergoing a first IVF cycle affect the chance of achieving a live birth from that cycle.
METHODS: Between February 2002 and February 2004, 391 women with an indication for IVF were recruited at two University Medical Centres in The Netherlands. Pretreatment anxiety and depression were measured with the Hospital Anxiety and Depression Scale. The Daily Record Keeping Chart was used to measure negative and positive affect before treatment and daily during ovarian stimulation. Multiple stepwise forward logistic regression analysis was performed with term live birth as the dependent variable.
RESULTS: Regression analysis showed that women who expressed less negative affect at baseline were less likely to achieve live birth (P = 0.03). After one IVF cycle, women who received a standard IVF strategy were more likely to reach live birth delivery than those who received a mild IVF strategy (P = 0.002). A male/female indication for IVF was associated with a higher chance of achieving term live birth than a female only indication (P = 0.03). Age, duration of infertility or type of infertility were not independent predictors of live birth.
CONCLUSIONS: The relationship between psychological parameters and IVF success rates is more complex than commonly believed. The expression of negative emotions before starting IVF might not be always detrimental for outcomes.
Key words: assisted reproduction/IVF outcome/live birth delivery/psychology/stress
Submitted on May 11, 2007; resubmitted on September 24, 2007; accepted on October 2, 2007.
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