April 23, 2004 -- Even though she knew it was her only chance of having a baby, Nashville reporter Karin Miller says it still took her more than half a year to get over her fears and decide to have in vitro fertilization (IVF) last spring.
"After going to the doctor and hearing what was involved, I completely freaked out," Miller tells WebMD. "It was a really scary time. It took me six or seven months to decide to go through with it."
Research suggests that for many women, the stress associated with infertility treatment rivals that of being treated for cancer. Fears and concerns associated with in vitro fertilization have long been suspected of influencing the success of IVF. Now a new study sheds light on which fears affect IVF success the most.
Cost Tops the List
Researchers at the University of California in San Diego found that concerns about the cost of treatment most directly affected its success or failure. Women who reported being extremely stressed about paying for IVF were 11 times less likely to have a baby as women who were unconcerned. And stress associated with missing work also appeared to influence outcome in a big way.
"This is a very expensive procedure, and people often end up paying for it without the help of insurance," lead researcher Hillary Klonoff-Cohen, PhD, tells WebMD. "Nevertheless, we were surprised that financial concerns had such a huge impact on outcome."
The study involved 151 infertile women undergoing either IVF or a similar assisted reproduction procedure known as GIFT. The UCSD researchers developed a questionnaire to measure stress prior to treatment. They also recorded treatment endpoints like the number of eggs retrieved and fertilized, the number of pregnancies achieved, and the number of babies born.
Although financial concerns had the most impact on outcome, women who worried about the medical aspects of treatment had 20% fewer eggs retrieved and 19% fewer eggs fertilized than those who expressed few concerns. The findings are reported in the April issue of the journal Fertility and Sterility.
'Chicken or Egg'
"Fifty or 60 years ago, infertility was considered a psychological problem because we didn't have medical ways to treat it," assisted reproduction counselor Sharon Covington, MWS, tells WebMD. "Now it is very much a medical issue, but there is still something of a 'chicken or egg' question with regard to stress. Infertility is inherently stressful, but it is not clear to what extent stress causes infertility."
No one is suggesting that adopting the 'don't worry, be happy' approach would take care of all women's infertility issues. But Covington says studies like this one underscore the importance of taking a holistic approach to infertility treatment. She is the director of psychological support services at Rockville, Maryland's Shady Grove Fertility Center.
"If we are better able to address the stresses associated with treatment, such as improving insurance coverage or offering creative financing, we may end up with better outcomes," she says.
Reproductive specialist Mark Perloe, MD, says it is clear that stress plays an important role in the success or failure of assisted reproduction procedures, but the UCSD study was too small to answer many questions about this. Perloe is medical director of the Atlanta infertility clinic Georgia Reproductive Specialists.
"These findings certainly need to be reproduced in a larger study," he tells WebMD. "And we don't really know if stress per se is the problem or if stress is keeping patients from doing the things that their medical team needs them to do."
Miller says her stress level dropped once she made the decision to have IVF. She started doing more yoga to improve her relaxation skills and trained for triathlons to get her body in the best shape possible. She also did a lot of research.
"I was determined to know as much as I could," she says. "And I had already made the decision that I would do IVF twice, but no more. That took some of the pressure off. I didn't feel like it had to work the first time."
But it did. Now 27 weeks pregnant, Miller is due to give birth at the end of July.