Does Psychological Stress of In-vitro Fertilization Patients Affect Physiological Stress Markers and What is the Contribution of Cognitive Behavioral Therapy?

Iris Har-Vardi 1 Irit Szaingurten-Solodkin 1 Annaelle Berrebi 1 Johanna Czamanski-Cohen 2 Tamar Wainstock 3 Maram Azab 1 Orly Sarid 4 Julie Cwikel 4 Amos Douvdevani 5 Eliahu Levitas 1
1Department of Obstetrics and Gynecology, Soroka University Medical Center and Ben-Gurion University of the Negev, Israel
2School of Creative Arts Therapies, University of Haifa, Israel
3School of Public Health, Ben-Gurion University of the Negev, Israel
4Spitzer Department of Social Work, Ben-Gurion University of the Negev, Israel
5Department of Clinical Biochemistry and Pharmacology, Soroka University Medical Center and Ben-Gurion University of the Negev, Israel

Introduction:
Failure to achieve pregnancy often results in chronic stress caused by the threat of infertility. IVF patients were reported to experience high levels of psychological distress.

Aim:
To study the effect of psychological perceived-stress (PS) in IVF patients on IVF treatment parameters and molecular markers of stress and inflammation.

Materials and Methods:
A PS questionnaire was used to distinguish between normal-PS and high-PS. Women experiencing high-PS were randomly assigned to cognitive behavioral therapy (CBT) and control groups. Blood samples were collected at three time-points: T1- at the recruitment day; T2- at the beginning of the IVF treatment; T3- at the day of beta-HCG test. IVF treatment parameters were collected. Cell free DNA (CFD) concentrations, telomere length and cytokines concentrations were measured in the serum and whole blood.

Results:
Eighty-eight women were recruited to the study. Women with normal-PS levels were not significantly different from women with high-PS in-terms of: age, BMI, cause of infertility, estrogen levels and primary or secondary infertility. Women under high-PS had significantly elevated IL-4 concentrations at T1 and T3 compared to women with normal stress levels. The stress levels in the CBT group were significantly reduced at T2 (PS T2-PS T1= -2.94±4.30, p=0.010) while the decrease in the control group wasn`t statistically significant (PS T2-PS T1= -1.70±4.07, p=0.104). cfDNA concentrations at T2, were significantly lower in the CBT compared to the control group (215.62±272.35 ng/ml versus 540.27±427.67 ng/ml respectively, p=0.016).

Conclusions:
CBT is effective in lowering high-PS and CFD levels. This intervention may be considered as a supportive treatment for IVF patients.