title: Relationship between psychological stress and reproductive outcome in women undergoing in vitro fertilization treatment: psychological and neurohormonal assessment.
abstract: OBJECTIVE
  To evaluate whether psychological stress, as well as changes in hypothalamus-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) at different time points during a first in vitro fertilization (IVF) cycle, correlates with the reproductive outcome.
  
  
  METHODS
  A prospective study was conducted in 264 women undergoing IVF or intracytoplasmic sperm injection (ICSI) treatment between January 2009 and March 2010. Standardized psychological questionnaires were used to assess anxiety and depression. Norepinephrine and cortisol in serum were measured with specific assays.
  
  
  RESULTS
  The non-pregnant women reported higher anxiety and depression scores at the pregnancy detection day compared with the pregnant group. Lower levels of norepinephrine and cortisol at the time of oocyte retrieval and lower levels of cortisol at the time of pregnancy test were found in women with successful treatment. Significant increases in serum norepinephrine and cortisol values were observed during ovarian stimulation. State Anxiety scores were negatively correlated with live birth rate, and positively associated with serum norepinephrine and cortisol values.
  
  
  CONCLUSIONS
  State anxiety is associated with both pregnancy rate and live birth rate in IVF patients, an effect that is partly mediated by activities in the HPA and SNS.
authors.affiliation: Department of Reproductive Medicine, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, Heilongjiang, 150001, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: An
authors.forename: Zhuangzhuang
authors.initials: Z
authors.lastname: Sun
authors.forename: Linan
authors.initials: L
authors.lastname: Li
authors.forename: Yajuan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Hongping
authors.initials: H
authors.lastname: Ji
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000523:psychology; D005260:Female; D005307:Fertilization in Vitro / Q000523:psychology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology; D050498:Live Birth; D015999:Multivariate Analysis; D009638:Norepinephrine / Q000097:blood; D054315:Oocyte Retrieval; D010062:Ovulation Induction / Q000009:adverse effects; D010913:Pituitary-Adrenal System / Q000502:physiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000523:psychology*; D018873:Pregnancy Rate; D011446:Prospective Studies; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013564:Sympathetic Nervous System / Q000502:physiology; D013997:Time Factors
chemical_list: D006854:Hydrocortisone; D009638:Norepinephrine