Thursday, February 25, 2010

Does stress affect the outcome of an IVF cycle ?

When an IVF cycle fails, often the patient's world falls apart. Everyone does a post-mortem including the couple, the doctor and the rest of the world ! Why did it fail ? Why did the uterus reject the embryo ? Did we do anything wrong to cause the embryo to fall out ? What can we do differently the next time ? Are we destined to fail every time ?

In the desperate search for answers, many doctors will play the game of blaming the victim. Rather than be honest and tell the patient the plain truth that we really have no way of determining why an IVF cycle fails, they will tell the patient that the cycle failed because she did not rest enough, or because she was too stressed out !

This is very unfair - and blatantly false ! Stress has very little to do with the outcome of an IVF cycle. Implantation is a biological process which is not influenced by the state of mind . After all, even rape victims do get pregnant !

I agree that it's best for IVF patients to have a positive approach. It's much better for the doctor, for example , because I'd much rather treat patients who are smiling ! However, by telling the patient to "relax" or "not take stress", I think we sometimes do them a disservice. If the message is that a positive attitude increases IVF success rates, the hidden sub-text is - the IVF cycle failed because you were too negative or too stressed out ! This is adding insult to injury !

Programs like the Mind-Body program and books like The Secret are useful - but only upto a limit. We all need a more balanced approach. Many smart patients prefer being pessimistic and keeping their expectations low, because they find it easier to handle failure using this tactic. If we blame their failure on their " negative " state of mind, they just end up feeling even worse and thinking of themselves as losers.

I know this is a chicken and egg problem. Optimistic patients who success will broadcast their success to the entire world - and many will attribute their success to their positive attitude. They will then advise other patients to adopt the same attitude as well, if they want to succeed ! However, the truth is that pessimistic and negative patients have successful IVF cycles too - they just don't talk about them as much !

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  1. Anonymous5:41 PM

    Hi Doctor,

    I've been following your blog for quite sometime. It is very informative.

    I do know from all that you've written so far that you strongly advocate IVF and ICSI, bypassing IUI and other smaller techniques if possible, depending on the individual case, of course. However, what about patients who have some genetic condition that could possibly be the reason for infertility in the first place? And what about patients who have metabolic or other conditions that run in the family such as diabetes for example?

    I came across this article recently regarding ICSI:


    I have to say, after a long stint with infertility treatments, and being in the healthcare profession myself, in my gut I do agree with this article. While IVF seems acceptable (since all sperms are given the opportunity to do their bit, creating an embryo in the natural way even though it is outside the body), ICSI seems aggressively invasive, and chances of choosing a genetically weak sperm is pretty high, since you too admit that even at the microscopic level it is often hard to detect anything wrong and in this case the doctor seems to play God.

    Your opinion would be invaluable. Do post something on this.

  2. I agree this used to be a major concern when ICSI was first introduced. Historically, the same argument was proposed against IVF as well ! However, ICSI has stood the test of time - and the risk of birth defects is not increased with ICSI.

    I think we can reassure infertile patients that ICSI is safe and effective - they have enough to worry about as it is , so I don't think it's responsible to create more theoretical bogeys in their minds.


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