Psychological Aspects of Infertility & IVF

….Gaudium’s Module

By-Dr. Manika KhannaDirector Gaudium IVF Janakpuri, New Delhi

THE PSYCHOLOGIC IMPACT OF INFERTILITY

• Research has shown that the prevalence of depressive symptoms in the infertile population is twice that of the general population.

• Infertile women have comparable levels of anxiety and depression to women with heart disease,HIV+ status, or metastatic cancer.

• A total of 40.2% of the women met the criteria for a psychiatric disorder ;the most common was anxiety disorder (23.2%),followed by depressive disorder (17%).This compares with a community sample prevalence of 3%.

THE IMPACT OF STRESS ON TREATMENT OUTCOME

• There have been 21 studies which include adequate data on the relationship between stress prior to or during an IVF cycle, and subsequent pregnancy rates. Fifteen of these studies show a significant relationship between distress and pregnancy.

• The baseline level of stress was significantly related to outcome.

• The subjects who expressed the least baseline level of distress were 93% more likely to give birth than the patients who reported the most baseline level of distress.

THE IMPACT OF PSYCHOLOGIC DISTRESS ON DROPOUT RATES.

• The most recent research shows that the primary reason why patients drop out of IVF treatment is psychological stress.

• This study also revealed that the couples who dropped out of treatment were as satisfied with their care as couple who remained in treatment, so the quality of care does not seem to a contributing factor in patients‘ stress levels.

• Obviously, couples who drop out of treatment are likely to sacrifice their chance of pregnancy. A retrospective German study on 2130 IVF patients analyzed the cumulative pregnancy rate and found a 31.4% rate per couple, the rate would have increased to 41%, if they had undergone one more cycle. If a couple had undergone the six insurance-covered cycles, the rate would have climbed to 60%.

THE IMPACT OF PSYCHOLOGIC INTERVENTION ON INFERTILE

WOMEN

• In a recent meta-analysis of the literature, the author concluded that group as well as individual and couple’ psychotherapy is associated with the alleviation of anxiety and depressive symptoms.

• The couple who received the intervention reported lower anxiety and depression scores as well as a 43% pregnancy rate, compared to a 17% rate in the control group who received routine nursing care.

• This is the most recent of several studies which have not shown any definitive benefit of brief counseling.

• The Mind/Body intervention included instruction in relaxation techniques, stress

management strategies, and lifestyle modifications.

• During the one year follow-up study period,55% of the mind/body

and patients 54% of the support group patients experienced a

live birth, compared to only 20% of the control subjects.

• The data thus far on the effectiveness of psycho logic intervention point to a

stress-management kind of approach, rather than more traditional use of

individual or couples’ counseling.

• In addition ,patients report significant reduction in physical symptoms such as

insomnia,headaches,abdominal pain, and gastrointestinal symptoms.

Sessions of the Gaudium Module for infertility

1. Group leader and peer counselor introduction, research on the stress/infertility connection, participant and partner introduction.

2. Physiology of mini relaxation exercises and effective communication.

3. The art of self-nurturance, how to reintroduce joy into one’s life.

4. The impact of lifestyle behaviors on fertility : weight, smoking, alcohol, exercise, the safety and efficacy of alternative medicine approaches.

5. Yoga.

6. Catering to individual stress related problems.

7. Sunday session – couples’ yoga, the use of humor to reduce stress.

8. Helping them deal with social pressures.

9. Guest lectures from prior participants.

10. Summary and goodbyes.

Gaudium Module For Synergizing

the Mind & Body.

Conclusion

• Infertile Couples suffer depressive symptoms twice that of the general population.

• Stress level negatively impact IVF Success rates and increase Drop-out rates.

• A holistic approach including relaxation of Mind and Body increases treatment success rates by as much as 20-30%

Reference

• Anderheim L,Holter H,Bergh C,Moller A. Does psychological stress affect the outcome of in vitro fertilization? Hum Repored 2005;20:2969-75.

• Domar AD. Infertility and the mind/body connection. The Female patient 2005;30:24-8.

• Land JA,Courtar DA,Evers JL.Paitent dropout in an assisted reproductive technology program:implication for pregency rates.Fertil Steril 1997;68:278-81.

• Shroder AK,Katalinic A,Diedrich K,Lugwig M.Cumulative pregency rates and drop out rates in German IVF programme:4102 cycles in 2130 patients.Repo Biomed Online 2004;5:600-6.

• De Liz TM, Strauss B.Differential efficacy of group and individual/couple psychotherapy with infertile patients. Hum Repord 2005;20:1324-32.

• Domar AD, Capp D,Slawsby EA et al.impact of group psychological intervention on pregency rates in infertile women.Fertil Steril 2000;73:805-11.

• Domar AD,Clapp D,Orav J,Kessel B,Freizinger M.The impact of group psychological interventions on distress in infertile women. Health Psychol 2000;19:568-75.

Thank You