The Fertility Doc | IVF & Infertility Specialist Dr. David Kreiner

Avoiding IVF Disasters: Are Your Embryos in Safe Hands?

2011-03-21T22:25:47-07:00

Practicing medicine for the past 30 years, I have developed an enormous respect for those things that happen to people that are beyond our control. Sometimes, the issue of preventability is a gray one and defies definitive blame assignment. Yet, when the dust settles there remain victims who are harmed for whom we are all sympathetic. It is for this reason that we are compelled to do everything within our power to ensure that tragic errors do not occur.

Elsewhere in society there are potentially devastating outcomes to human error and, like in medicine, it may be difficult to unravel how much fault is from natural calamity and how much we could have avoided with more rigorous human controls.

Just over a week ago, the world was exposed to perhaps the worst of Mother Nature’s natural disasters: a severe earthquake with multiple aftershocks, followed by a massive Tsunami. Aside from the horrendous devastation that took place in Japan, ongoing danger persists from damage to several nuclear power plants.

These unintentional, uncontrollable catastrophes occur naturally and are arguably nobody’s fault. And although some claim that nuclear power is dangerous because of the history of accidents like at Chernobyl and Three Mile Island, nuclear power plants continue to be constructed throughout the world because many perceive that the benefits of this alternate source of energy outweigh the risks. We are assured by those responsible that these plants are safe even in the face of the worst disasters… until we learn they are not.

It is our human condition to speculate how to prevent these complications from occurring. In IVF, perhaps the greatest potential disaster we face is the mixing up of embryos.

In February, 2009, a case of a mix-up of frozen embryos in a Michigan IVF program occurred to a couple who already had a set of twins as a result of a successful IVF. Their embryos were mistakenly transferred into the wrong woman, who then carried the pregnancy and after delivery handed the baby back to his biological parents. Reports of the mix-up have triggered calls from some to make IVF illegal. This sounds like the recent calls to decommission nuclear power plants and stop production of new facilities.

Mixing up gametes and embryos is tragic and society must do everything humanly possible to prevent it… except disallow the practice of IVF. As with other societal advances, accidents are rare but have unfortunately happened in the field of IVF. But, weighed against the benefit of all the babies who otherwise would never have been born, we should strive to improve the safety of IVF, not eliminate it.

Many of the greatest advances have had tragic results, unintended accidents that could sometimes been avoided. Sometimes, like the post-earthquake nuclear disasters in Japan, they are spawned by natural causes. But other times, there is an element of human error often preventable with the institution of carefully designed safeguards with a system of checks and balances.

Significant risk, including that of injury or death, is part of nearly everything we do in life today. The construction industry has always been plagued with accidental deaths. Not a bridge or a great high rise has been completed without misfortune. Do we stop construction? No, we ensure that all possible regulations that could protect those involved are in place and followed as strictly as possible to prevent further accidents.

Cardiac bypass surgery and other surgeries save lives and relieve suffering but, occasionally, patients intended to benefit are hurt or even killed accidentally. Rules and regulations are instituted to avoid problems such as performing the wrong operation on the wrong patient, using the wrong medication, operating on the wrong limb. Yet situations do occur rarely, usually because of a human slip. Rules are broken and mistakes result. When they do, hospitals review the procedures and protocols to better insure a sufficient system is in place to catch future errors before they effect patient care.

Just as we have safeguards in the operating room, we have them in place for identifying gametes and embryos with checks and balances that should prevent a mix-up such as the one in Michigan.

In our operating room, patients are identified while they are awake by the embryologist, nurse, physician and anesthesiologist by full name and birth date. As soon as the ovaries are aspirated, the eggs are identified and put in dishes with the patient’s full name and birth date on them. When the dishes are changed to replace the media, again matching names are put on the new dishes with a unique case number. A partner’s sperm specimen is labeled by him and processed in tubes labeled to match the partner’s name and the corresponding patient’s name and the case number. This is double-checked with the patient’s record which will also reflect the unique case number. It is reviewed by two embryologists for accuracy prior to fertilization. Finally, when the embryo is loaded in a catheter for transfer, the identity of the dish from the embryo is checked by the physician, embryologist, nurse and the patient herself prior to the transfer being performed.

Every attempt is made to confirm the identity of the gametes and embryos repeatedly throughout the IVF process from retrieval through transfer. A similar system of double checks of patient and embryo identity exists for frozen embryo transfers as well.

In over 25 years of practicing IVF, my program has not mixed up gametes or embryos.

There are approximately 3 million babies born through IVF and only a few rare mix ups reported. Perhaps we don’t hear …or know…about every mix up. I’d estimate that less than 1/100,000 pregnancies from IVF have occurred with some mix up in the embryo or gamete. When it occurs, it is tragic and requires the attention of our field and a refocus on those checks and balances we have in place to prevent such mishaps.

When it comes to institutions whose impact on society is of such great magnitude, it is essential that governing regulatory agencies ensure that all possible checks and balances are in place to ensure the greatest degree of safety. All involved must work hard to maintain the highest standards and then we can only pray that we have done everything possible so that such disasters never have such devastating consequences.

Embryo Rejection

2011-01-09T22:15:14-08:00

Dear Fertility Doc:

Two months ago I had my first IVF cycle & it did not work. I was wondering what common reasons there are a body would reject the 2 embryos that seemed to look good on the 3rd day?
A few years ago I had a healthy child that came naturally with out even trying. In the past 2 years I’ve had an ectopic pregnancy resulting in removing a tube as well as a miscarriage. It’s hard to understand why it was so easy to get pregnant naturally a few years back & why everything we have done since that time has not worked. Also, if a fresh embryo transfer didn’t work on day 3, would you recommend trying a frozen transfer or a fresh transfer again.

Still Not Pregnant

Dear Still Not Pregnant,

I often hear patients refer to a failed embryo transfer as an embryo rejection. I suppose it appears to make sense as the embryos that are being transferred appear completely normal. The disconnect between what appears to make sense and the reality of the procedure of IVF is that the creation of life is an enormously complex process truly beyond the level of human understanding.

Great strides have been made in the process resulting in pregnancy rates exceeding 60% for some groups. However, the apparent quality and grade of an embryo predicts the likelihood of a resulting pregnancy. It is far from guaranteeing a pregnancy. New tests for the viability of an embryo are being developed such as metabolomics and proteinomics. These assess an embryo by analyzing products of an embryo in culture. They will further the likelihood of achieving a pregnancy from a transferred embryo.

Remember, that though an embryo may be otherwise viable it may still be abnormal genetically which will diminish pregnancy rates and usually result in miscarriage when implantation does occur. The likelihood of a genetically abnormal embryo developing increases especially as the age of the woman increases as well as with severely decreased sperm counts in the male.

The decision to go forward after a failed fresh transfer with a frozen transfer of sister embryos or a new fresh transfer should be individualized based on the quality and grade of the frozen embryos, the age of the woman, her

insurance coverage and her tolerance for the stimulation and retrieval as well as her motivation and patience. I recommend you have this conversation with your physician who can advise you better about your specific situation.

I wish you the best of luck!

Study Suggests Stress Reduction May Increase Pregnancy Rate

2010-12-28T10:48:45-08:00

The old fertility legend about a couple who had failed fertility treatments and adopts a baby and then all of a sudden gets pregnant is one we have all heard. In fact, as a practicing reproductive endocrinologist over the past 25 years, I have experienced this with some of my own patients. Those stories have led us to believe that it takes longer for women with high stress levels to conceive. Unfortunately, there has not been much research on this. Until now, the best evidence for the benefit of stress reduction comes from the wellness center at Boston IVF where they had shown higher IVF success rates for women who were involved in their Mind Body program.

A new study in the current issue of the ASRM journal Fertility and Sterility (the primary research outlet for our national fertility society) lends credence to a link between stress and fertility. In the study, 274 British women ages 18 to 40 years old were examined to determine if using fertility-monitoring devices would improve their chances of conception. They were followed for six menstrual cycles or until they got pregnant, whichever came first. On Day 6 of each cycle, saliva samples were collected. Researchers measured their levels of alpha amylase and cortisol, two substances that reflect how the body reacts to stress.

Pregnancy rates were compared in women with the highest concentrations of alpha amylase in their first cycle to women with the lowest levels of the stress hormone marker. It was found that over the six month period, the group of women with the highest alpha amylase and hence stress, were 12% less likely to conceive than women with the lowest.
Cortisol levels were not associated with the women’s chances of conceiving. The alpha amylase and cortisol reflect two different components of the stress response and don’t necessarily correlate well. Alpha amylase reflects the “fight-or-flight” response to immediate stressors.

To confirm these findings, the research team conducted a larger and longer study of women trying to conceive. Evidence from these trials suggests that stress-reduction techniques can improve pregnancy rates in couples who use in vitro fertilization and related methods. With such findings it would appear that patients would benefit if they were enrolled in various stress reducing programs when try to conceive. Mind body programs, support groups, acupuncture and massage appear to offer the greatest benefit.

As a practitioner in the field of infertility for 25 years, I endorse these adjunctive therapies for my patients undergoing treatment so we can reap the fertility enhancing benefit of stress reduction before we submit them to multiple treatment cycles.

Vitamin D Deficiency May Diminish Your Fertility By David Kreiner, MD and Brianna Rudick, MD

2010-12-06T06:20:00-08:00

Vitamin D is a fat soluble vitamin that is present in a variety of forms but has recently been recognized as playing a critical role in reproduction. It is essential in the production of sex hormones in the body. It is thought that a deficiency of Vitamin D may lead among other things to ovulation disorders.

It has been demonstrated that Vitamin D deficient rats had a 75% reduced fertility and a 50% smaller litter size that was corrected with Vitamin D treatment. In addition, sperm motility in males was reduced in the presence of a Vitamin D deficiency.

A recent study at the Yale University School of Medicine revealed that only 7% of 67 infertile women studied had normal Vitamin D levels and not a single woman with an ovulatory disorder had normal levels. Nearly 40% of women with ovulatory dysfunction had a clinical deficiency of Vitamin D.

At the American Society of Reproductive Medicine conference this year, a study presented by Dr. Briana Rudick from USC showed that a deficiency of Vitamin D can also have a detrimental effect on pregnancy rates after IVF, possibly through an effect on the[O1] endometrial lining of the uterus. In her study only 42% of the infertile women going through IVF had normal Vitamin D levels. Vitamin D levels did not impact the number of ampules of gonadotropin utilized nor the number of eggs stimulated, embryos created nor embro quality. However, Vitamin D levels did significantly effect pregnancy rates even when controlled for number of embryos transferred and embryo quality. In this study the pregnancy rate dropped from 51% in Caucasian women undergoing IVF who had normal Vitamin D levels to 44% in those with insufficient levels and 19% in those that were deficient.

Vitamin D deficiency has also been associated with poor pregnancy outcomes including preeclampsia and gestational diabetes

Vitamin D can be obtained for free by sitting out in the sun and getting sun exposure on the arms and legs for 15-20 minutes per day during peak sunlight hours. The sunlight helps the skin to create Vitamin D3 that is then transformed into the active form of Vitamin D by the kidneys and liver. An oral supplement is available also in the form of Vitamin D3, with a minimum recommended amount of 1000 IU a day for women planning on becoming pregnant. For those with clinical insufficiencies a higher dose may be administered by injection.

[O1] Our study and many others suggest that the effect is endometrial, but we don’t know for sure.

What I Learned At The 2010 Annual Meeting of ASRM

2010-11-10T20:27:29-08:00

It has been two weeks since my return from this year’s national fertility meeting, the ASRM (American Society for Reproductive Medicine) which was held in Denver this year. It is the time and place that breakthroughs in fertility care are announced, results of research studies are discussed, problems and issues of the day are hammered out.

A few national trends were evident throughout the meeting. Single embryo transfer is becoming common place and successful. In some studies, it was as reliable as double embryo transfer in obtaining a baby. Noteworthy, was a study out of the Cornell program which attempted to dispute the previously reported increase in pregnancy complications associated with IVF pregnancies. They showed in their study that when only one embryo was transferred there was no increase in preterm birth complications. They proposed that multiple embryo transfers perhaps with multiple implantations that spontaneously reduce to singletons are the cause for the reported increase in IVF pregnancy complications supposedly seen in singleton pregnancies. This was yet another argument in addition to reducing the risk to multiple pregnancies proposed for transferring a single embryo at a time.

Questions were raised as to how to motivate patients to transfer only one embryo at a time. In addition to education, the concept at East Coast Fertility that is to offer those who transfer one at time free cryopreservation, storage and frozen embryo transfers was being practiced currently by at least one other program. I believe we will be hearing next year that this became a nationwide practice.

There were several studies showing excellent success with minimal stimulation IVF. Program directors actively providing minimal stimulation IVF complained that no distinction was made in the SART reporting so that the lower pregnancy rates seen with minimal stimulation still hurt those programs’ pregnancy statistics. Hopefully, this much less expensive, less invasive, safer alternative will be evaluated separate from full stimulation IVF so programs that offer this service to patients are not discriminated against for doing so.

Perhaps the most exciting advance I heard about during the meeting was the improved pregnancy rates and diminished miscarriage rates seen with the 24 chromosome analysis preembryo genetic diagnosis. This was being offered at the Blastocyst stage to improve cost effectiveness and reduce error and injury to the embryo. If this holds up then the promise of improving pregnancy rates of a single embryo transfer known to be genetically normal will become the standard of care not just improving the efficiency of IVF but perhaps making it as safe as a naturally conceived pregnancy.

Corporate Denial of Right To Watch Favorite TV Show

2010-10-20T02:49:10-07:00

It’s now official. News Corp. has pulled the plug on Cablevision customers by turned off the signal of FOX and My Nine affecting 3 million viewers in the New York Metropolitan area. My wife and daughters are distraught. Their favorite television show; Glee, not to mention critical sports shows and others are no longer viewable on our TV sets. They like so many others are frustrated and depressed at the prospect that they will be denied those pleasures that we have grown accustomed to expect.
My wife and I never truly experienced infertility. We had a workup for recurrent miscarriages and it took us over a year to conceive a healthy pregnancy in between our two boys and two girls. We were quite fortunate that we were not denied the joy of building our family that we had learned to expect while growing up, observing our own as well as our friends’ and neighbors’ families. It is a way of life that we understand as well as anything else that we experience throughout our lives.
When a couple experiences infertility, this expected right to the pursuit of happiness by creating one’s own family is denied. It is not deserved; the affected are innocent bystanders of a tragedy not of their own making. Someone afflicted with infertility might have just as randomly caught a cold or some other disease or condition. The difference is that if you unfortunately have any other condition or disease requiring medical treatment, the odds are excellent that you have insurance coverage for it. Infertility is not covered by most providers not because of ethical or religious reasons or even lack of sympathy, but instead because it costs money to the providers.
Cablevision and Fox TV are battling over millions of dollars. How I wish they would use the argument that they have increased costs to cover safe, cost effective fertility care like IVF; that they wish to provide for the right for their employees to have a family like they grew up seeing on Fox and My Nine movies and on Cablevision. Senator Kerry, former presidential candidate interceded in the past to try to negotiate a settlement between Disney and Cablevision so that my wife and others would not be denied their TV shows. Why can’t we get a similar hero to negotiate a settlement for coverage so that the infertile couple can get the treatment they need so they are not denied their families?
IVF is now cost effective and safe when used conservatively especially with our single embryo transfer program. We have a greater than 60% live birth rate per retrieval in women under 35. We can avoid multiple pregnancies by transferring one embryo at a time rather than expose a woman to a 35% multiple rate with ovulation induction and intercourse or insemination. Minimal stimulation IVF is a low cost alternative, $3900 at ECF that avoids hyperstimulation and allows for single embryo transfer. Why do politicians ignore the millions of infertile individuals and couples in this country and deny them the right to have their family that they grew up expecting as naturally as tuning into Fox and My Nine and watching a favorite TV show?

Should You Disclose The Identity of An Egg Donor?

2010-10-18T04:22:46-07:00

It has been my experience as well as that of others in the field that many individuals conceived through gamete donation are curious about their donor and the donor’s other offspring. They may fantasize about their genetic parent and siblings. They are curious if they look like them and have similar behavioral traits. They want to know why their donor donated. They almost ubiquitously are curious to meet their donor whether they may want to have ongoing contact or not. The degree of interest is variable where some may simply be satisfied with a picture and information, others may feel comfortable with maintaining anonymity whereas still others feel a strong desire to physically meet their donor. These feelings typically change over time and may become more significant during certain stages of life, such as at the prospect of an individual starting their own family.

Donor conceived individuals may be looking to fill in the blanks in their identity. Rebecca Hamilton, conceived through donation, wrote in Behind Closed Doors: Moving Beyond Secrecy and Shame, edited by Mikki Morrissette, “It’s not a ‘Dad’ I’m after. I had a wonderful Dad who raised me. I’m not looking for a replacement. Nor, incidentally, is any other donor-conceived person I have ever met….Wanting to understand one’s genetic roots is a unique longing that remains no matter how great life is going on other levels.”

Universally, it appears that those individuals who were conceived through donation do not look at the donor as a parent. The donor does not replace the role of the parent. Instead having an open relationship with a donor can provide answers to questions many donor conceived individuals have about their own identity.

So how do I answer the question, “should I help my child find her donor?”

Professionals in the field tell us that based on research, developmental theory, and my own clinical experience, that it is best for parents to be honest with their children about their origins. In some cases I may recommend providing them with options for obtaining information about their donor. Although many sperm banks and egg donor agencies only facilitate anonymous donations. Some sperm banks offer the possibility of working with a donor who is willing to be identified to your child any time after your child turns eighteen. The sperm bank stores data and provides it upon request. Your adult child is the only one in control of this information. If she wants identity information, it is available for her. If she does not desire to know her donor’s identity, the information is never revealed.

However, it is most common at least in the Northeast that a definitive plan is not established at the outset for how a donor’s identity would be released. Most programs maintain strict anonymity. There is no guarantee that this information will be available for their child. A third party, which could be an agency, medical office, or attorney must obtain the information, and a formal contract, signed by the donor, must state when and how identity information will be released to the donor conceived individual.

Ultimately, as future parents it is vital to examine your feelings and concerns regarding disclosure of the donor’s identity. Disclosure of the donor’s identity may affect the donor conceived individual and his sense of self. Though the donor does not replace the parent there is potential for creating friction in the relationship. There is also the donor’s family to consider which will also be impacted by revealing one’s identity to the donor conceived individual. One must weigh the potential benefit of satisfying curiosities with the risk of causing harm to the relationship with the individual’s parents as well the risk of causing harm to the donor’s family.

Is Disclosure To My Child About Her Donor Parentage Wise?

2010-10-13T06:06:04-07:00

I received this letter from a former donor egg recipient. It made me think about what it might be like, years after the actual procedure for a child who grows up wondering about his/her donor parent.

Dear Dr. Kreiner,

I want to thank you and your wonderfully caring staff for all you did to help me have my daughter, Jessica. There was not a moment that I did not feel supported during the process and for this I sing your praises constantly.

My daughter is truly a blessing and I will always cherish that you helped bring her into this world for me.

We informed Jessica about her genetic parentage a few years ago with the help of a psychologist who saw my husband and I first and then with Jessica for two or three more visits. I thought it went well. Jess seemed to understand that we loved her and that Russ and I were truly her father and mother and I cannot say that our relationship had changed in any significant way since then.

However, Jessica is now 14 years old and has recently been asking me about what I know about her genetic mom which is how she referred to her. I, took offense to her use of the term ”mom” and immediately corrected her, saying “you mean donor, honey”. This started a huge argument and has created a tense rift that still exists. I know that she has been doing research to identify her donor including calling your program. I don’t know what to do. Did we make a mistake by telling her? Should we seek out the donor and ask if she is willing to reveal herself to my daughter? Is it even legal or moral for us to ask? Should we tell my daughter that it is not possible to identify her and just leave it like that? I am afraid not to try as it seems to be so important to her and if I appear to be resisting she will get angry with me again.

What should we do Dr. Kreiner?

Still thankful but with some remorse,

Former donor egg recipient

I have been involved in these donor egg cases since 1985 and this type of question is rare for me to receive but now I wonder if that is because patients do not feel close enough to me to discuss these problems years after my services have been performed.

It is not uncommon for potential donor egg recipients to say to me ”I’m not going to tell my child about the donor. I’m going to carry him. I’m the mom”. We have always recommended that parents disclose that they had utilized donation to their child since it is thought that honesty is better than trying to shoulder “the big lie” which ultimately would be found out and lead to much larger problems.
If you are planning to build a family with a sperm or egg donor, you may be thinking about these very issues. Many patients believe that by disclosing their child’s donor origins will damage the parent-child bond that is so precious to them. They fear that a genetic connection to a donor could trump their relationship with their child. Most commonly, my patients plan to tell their child about the donor but want the donor’s identity to remain anonymous. They worry that an identified donor could disrupt the integrity of their family by inserting herself or himself into it.

Professionals in the field of infertility tell us that patients who need help to have a child often feel vulnerable and may view donors as threatening.

To Disclose or Not to Disclose That is The First Question

Unlike heterosexual couples, same sex couples and single individuals understand that from the moment they decide to build their family that they require assisted reproduction. These families openly disclose their children’s donor origins because it is the only way to explain their conception and birth. Inevitably, the children look at other families around them and wonder if they have a mommy or a daddy. It does not appear that disclosure in these cases has a negative impact on the families.

However, the heterosexual couples seek assistance only after failed attempts to have a child on their own and sometimes even after multiple IVF attempts using the woman’s own eggs. These couples typically experience incredible loss, frequently feel inadequate, and often become clinically depressed. Assisted reproduction with outside help with their family building was not something they ever imagined. Many feel a sense of shame that may add additional motivation to keep the donor parentage a secret from their child. We are told by those professionals in the field who study this that many former donor recipients turned parents fear their child will see the donor as the “real” mom or dad and believe they are preventing potential problems by keeping the secret from their child.

Interestingly, many individuals who are the result of gamete donation report feeling like they don’t fit in with their families. I have heard that when they ultimately are informed of their donor origin that it often makes sense to them and not infrequently is received by the child with a degree of relief to explain their uniqueness from their family. Sometimes donor conceived individuals inadvertently learn about their origins under less than ideal circumstances such as from a family friend or relative. Nondisclosure, in these cases, usually undermines trust and honesty within a family and may lead to psychological harm.

Professionals studying donation tell us that when children have been told about their donor origins, they are typically accepting of the recipient moms and dads. In fact, it appears that when children learn of their donor origins at a young age, they are more likely to have a more positive experience. Their donor conception is integrated from the beginning into their life story. It becomes who they are at an early stage when they develop their own identity and sense of self. Individuals told later in life are more likely to have more negative feelings about their donor conception than those told earlier. They may become angry about being deceived and often feel betrayed by the very people they thought were the most trustworthy in their lives, their moms and dads. Hence, disclosure at an early age is recommended by professionals studying this issue.

I will address the question of disclosing the identity of the donor in my next blog.

Reflecting on The Nobel Prize Being Awarded to Dr. Robert Edwards, IVF Pioneer

2010-10-12T05:25:27-07:00

Dr. Robert Edwards, the IVF pioneer responsible for the first successful IVF in the world, was announced as the recipient of the 2010 Nobel Prize for physiology. Dr. Edwards’ successful development of IVF technology was originally received by the public media as more science fiction than science. As a first year medical student in 1977, interested in women’s health, I became motivated by writings on his work to become an IVF physician. In 1980, I spent a month with Zev Rosenwaks at StonyBrook and started my reproductive endocrinology training. By that time Howard and Georgeanna Jones had successfully started the IVF program in Norfolk, Virginia, duplicating Dr. Edwards work.

The Joneses had just moved to Norfolk after a forced retirement at Johns Hopkins and hadn’t finished unpacking when the greatest fertility event of all time hit the news. Patrick Steptoe and Robert Edwards had succeeded in Great Britain with creating a new life through a process they called In Vitro Fertilization that the media had termed “test tube babies”.

I had the great fortune to study REI (reproductive endocrinology, infertility) with the Joneses and Zev Rosenwaks in Norfolk from 1985-1988. In 1988, I started IVF on Long Island which was successful then in about 25% of cases. In 1990, I met Dr. Robert Edwards who impressed me with his wit, his charm as well as his great intellect. I told him about my softball team named East Coast IVF that Dr. Edwards found particularly amusing. After all the scientific and political challenges he overcame to successfully achieve a live birth through IVF, he was struck by the irony that IVF had become routine as a commonplace alternative for those with difficulty building their own families.

Today, IVF is now successful 50% of the time. Four million babies have been born who if not for the technology of IVF would not be here today. What a remarkable testimony to his scientific accomplishments. Dr. Edwards truly deserved the Nobel Prize for developing this technology that led to the creation of so many lives.

As someone who owes his career to the man I am forever grateful and to those who have been touched through the birth of one of the 4 million we owe him much more than we can ever give.

Stress and Infertility – The Link is There….

2010-08-31T05:52:37-07:00

The old fertility legend about a couple who had failed fertility treatments, adopts a baby and then all of a sudden gets pregnant is one we have all heard.

In fact, as a practicing reproductive endocrinologist over the past 25 years, I have experienced this with some of my own patients.

Those stories have led us to believe that it takes longer for women with high stress levels to conceive. Unfortunately, there has not been much research on this. Until now, the best evidence for the benefit of stress reduction comes from the wellness center at Boston IVF where they had shown higher IVF success rates for women who were involved in their Mind Body program.

Latest Research on Stress and Fertility

A new study in the current issue of the ASRM journal Fertility and Sterility (the primary research outlet for our national fertility society) lends credence to a link between stress and fertility. In the study, 274 British women, ages 18 to 40 years old, were examined to determine if using fertility-monitoring devices would improve their chances of conception.

They were followed for six menstrual cycles or until they got pregnant, whichever came first. On Day Six of each cycle, saliva samples were collected. Researchers measured their levels of alpha amylase and cortisol, two substances that reflect how the body reacts to stress.

Cortisol levels were not associated with the women’s chances of conceiving. The alpha amylase and cortisol reflect two different components of the stress response and don’t necessarily correlate well. Alpha amylase reflects the “fight-or-flight” response to immediate stressors.

Applying the Findings

With such findings it appears that patients would benefit if they enroll in various stress reducing programs when trying to conceive. Mind-body programs, support groups, acupuncture and massage apparently offer the greatest benefit.

As a practitioner in the field of infertility for 25 years, I endorse these adjunctive therapies for my patients undergoing treatment, with the goal of reaping the fertility enhancing benefit of stress reduction before we submit them to multiple treatment cycles.