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Archive for August, 2010

This is a topic that has surfaced in the support group in Oakland recently and I thought I would share some information regarding stress and infertility.

There are women who get pregnant easily even if they smoke like a chimney, drink a six-pack after dinner, and think of exercise as a waste of good texting time. Then there are the women who do all the right things but months and years pass and the strip in the home pregnancy kit refuses to change color. Relax, say well-meaning friends. Chill out. Let it happen. Gee, thanks, thinks the beneficiary of their insight, gritting her teeth.

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But as unwelcome as the advice may be, it may be right. New evidence suggests that stress does affect fertility. A recent study found that women with high levels of alpha-amylase, an enzyme that correlates with stress, have a harder time getting pregnant. Saliva samples taken from 274 women over six menstrual cycles (or until they got pregnant) revealed that those with the highest enzyme concentrations during the first cycle were 12 percent less likely to conceive than were women with the lowest levels.

What’s more, women involved in the study, published earlier this month in the journal Fertility and Sterility, had no prior record of infertility. Participants were either planning to get pregnant or had been trying for less than three months.

Researchers do not yet understand the role stress plays, since women can and often do get pregnant even under the intense stress, for example, that follows the death of a spouse. “I suspect that some women are more reproductively sensitive to stress than other women,” says Alice Domar, who directs the Domar Center for Mind/Body Health in Boston. And the effect can feed on itself. “If you are stressed and you don’t get pregnant quickly, then you get more stressed,” says Domar, citing evidence from a study in Taiwan in which 40 percent of participants seeking infertility treatment were diagnosed with depression or anxiety. The treatment itself can be stressful, she adds, adding even more uncertainty.

[Alternative Treatments May Boost IVF Success]

If stress can influence the chance of conception, managing it may improve the odds. Researchers like Sarah Berga, who heads the department of gynecology and obstetrics at Emory University School of Medicine, have been trying to prove just that. Berga and her colleagues studied women who had stopped ovulating for more than six months and found that they had high levels of cortisol, a stress hormone. In stressful situations, cortisol, like adrenaline, pushes metabolism into high gear; sustained high levels can raise blood pressure, cause weight gain, or lead to other health problems. In a small study by Berga published in 2003, seven out of eight participants who received stress management therapy began ovulating again versus two out of eight who got no intervention.

What are some practical ways women trying to get pregnant can reduce stress? Experts make these recommendations:

Enlist your partner. Research shows that women handle infertility-related stress differently from men. Women more often seek social support, for example; men lean towards problem-solving. That disconnect can strain the relationship. Constant attention on procreation, according to psychologist Julia Woodward of the Duke Fertility Center in Durham, N.C., also contributes, siphoning the fun and joy from sex. She advises couples to act as if they were dating again. Set aside time during the week to go to a movie. Take a dance class together. And put a time limit of 20 minutes or so on pregnancy discussions. Fertility talk that goes on and on can make matters worse, she says.

Rethink your attitude. Thinking “everybody else gets pregnant so easily” only causes distress. Woodward helps women counter their negativity with positive coping statements: “If getting pregnant was so easy, there wouldn’t be fertility clinics.” Recognize pessimistic thinking and practice forming a response that is more realistic.

Try journaling. Setting down on paper how you feel can take some of the pressure off, says Tracy Gaudet, executive director of Duke Integrative Medicine. It’s a way to off-load concerns you feel uncomfortable sharing, she says. And you can shred the pages or throw them out, a physical act that contributes to the effect.

Stay active. Continuing activities you enjoy is critical, says Woodward; otherwise the pregnancy project becomes the sole focus. Take pictures, plan special meals—whatever your passion, indulge it. Doing something enjoyable also boosts serotonin, a mood-enhancing brain chemical. That’s an added bonus.

Work on relaxation. One easy way, Gaudet suggests, is to spend time once or twice a day coaxing the body into a state of deep relaxation. Take five minutes or so to close your eyes and transport yourself to a far-off destination, a mini-mental vacation. Allow yourself to experience all the senses of your surroundings, says Gaudet, and your body will respond as if you are actually there. The benefits of the “relaxation response” include a slower heart rate and lower blood pressure. If a specific kind of technique is preferred, there’s no shortage of choices. Meditation, yoga, and progressive muscle relaxation are just a few.

[Relax! Stress, if Managed, Can Be Good For You]

Exercise. Walking, swimming, yoga, or other moderate exercise may take the edge off stress, and it has additional advantages. Overweight women who trim pounds through physical activity benefit, for example; extra body fat produces excess estrogen, which interferes with ovulation. Higher-energy workouts like running or jogging stimulate the release of feel-good endorphins. Berga warns that too much exercise for women who are already stressed, however, can make matters worse, since exertion triggers the release of cortisol. Relying exclusively on exercise to relieve stress, moreover, won’t do anything about what is causing it—a hostile boss, for example.

[5 Mind-Blowing Benefits of Exercise]

Get individual counseling or group support. A woman struggling to get pregnant needs someone who can empathize, says Woodward. Counseling can be an outlet for feelings of confusion, sadness, and frustration. Group support, says Woodward, is particularly helpful for women who feel isolated as a result of infertility. Resolve.org, a website of the National Infertility Association, has links to local support groups across the nation.

Source: By Megan Johnson U.S. News & World Report

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Women who fail to become pregnant after undergoing in vitro fertilization treatment often grapple with the decision of whether to try IVF again. It’s a difficult one to make: The procedure carries hefty financial, physical and emotional costs, and there are no guarantees it will work.

Now a team of Stanford University School of Medicine researchers has developed a model to predict the outcomes of a subsequent round of IVF for those women who have already gone through a cycle. The researchers found that their test, which relies on taking clinical data from prior, failed treatments to provide more personalized predictions, is 1,000 times more accurate than the age-based guidelines currently used to counsel patients.

“Our findings show that the first IVF cycle can provide quantitative, customized prediction of the live birth probability in a subsequent cycle,” the researchers wrote in their paper. “This concept is radically different from the current paradigm, in which age is a major predictor.”

The paper, published online July 19 in the Proceedings of the National Academy of Sciences, was led by Mylene Yao, MD, assistant professor of obstetrics and gynecology. It follows previous work from Yao about another method she and her colleagues had devised that provides more accurate predictions about whether a woman undergoing IVF treatment will become pregnant. The newer test not only integrates more data into its methodology, but also its success was measured with a different outcome: live birth instead of pregnancy.

Yao said she’d like to see the new test widely available for clinical use, and she and co-author Wing Wong, PhD, professor of statistics and of health research and policy, have founded a company, Univfy, to develop and market prognostic tests to support clinical decision-making in infertility. Stanford holds the patent on this test.

Each year, close to 100,000 IVF cycles are performed using a woman’s fresh eggs, and around 29 percent of the treatments result in live births. Physicians typically use age-based data, with adjustments based on other clinical factors, to counsel patients on the probability of success. But given all the factors at play — including the number and quality of eggs and the total number of embryos implanted — age may be misleading as a prognostic factor.

Consider this scenario: A 38-year-old patient is told that women in her age bracket have a 33 percent chance of becoming pregnant from IVF. But because she has a lower-than-usual number of eggs, her physician says her chances are actually less than 33 percent. “The problem is that the patient will ask, ‘How much less?’” said Yao. And currently, the answer is at best an educated guess from the doctor.

Co-author Lynn Westphal, MD, an associate professor of obstetrics and gynecology who treats patients in Stanford’s Reproductive Endocrinology and Infertility Center, said a woman’s decision to repeat IVF is influenced by several factors, including financial considerations and her chances of becoming pregnant. “Many patients, even if they have insurance coverage, will drop out — either because they don’t understand what their odds are or they find it’s a very emotionally challenging experience to go through,” she said.

Westphal said improvements in the ability to predict a patient’s chances of IVF success would make counseling more meaningful. “The more information, the better,” she said.

It was the goal of Yao, Westphal and their colleagues to develop a way to provide patients with more personalized predictions. They took data from 1,676 IVF cycles performed at Stanford Hospital & Clinics between 2003 and 2006 and identified 52 factors — such as patient age, levels of certain hormones, number and quality of eggs and individual characteristics of each embryo — that influence a woman’s chance of having a baby. They then developed a computer model that sorted patients into subsets defined by similar clinical characteristics (so-called “deep phenotyping”) to predict live-birth probabilities in a subsequent round of IVF.

When testing their model with data from a separate set of more than 600 IVF treatments performed in 2007-08, the researchers determined that the model’s predictions were significantly different than the age-based predictions in 60 percent of patients. Interestingly, out of this group, more than half were assigned greater odds of having a baby than what age-related data indicated.

What’s more, in further verifying the accuracy of their new method, Yao and her colleagues determined that their model predicted outcomes with 1,000 times more accuracy than the age-based guidelines widely used in clinics.

Their findings, the researchers said in the paper, indicated that “the current age-based paradigm may provide misleading live birth outcome probabilities for a large portion of patients.”

Yao noted that because it’s critical to have data from previous treatment, this model wouldn’t be able to predict chances of success for those embarking upon their first IVF. But she said having personalized, accurate prognostic information would be invaluable in assisting women’s decisions to keep going or not. “For some of the patients, we may be able to reassure them and help them move forward and do another cycle if they have good odds,” agreed Westphal. “For other patients, if they’re in a poor category, we’ll help them move on to consider better options.”

Source: The first author of the paper is Prajna Banerjee, PhD, a postdoctoral scholar in obstetrics and gynecology. Other Stanford co-authors include Bokyung Choi; Lora Shahine, MD; Sunny Jun, MD; Kathleen O’Leary; and Ruth Lathi, MD. Funding came from the National Institutes of Health and the Coulter Foundation Translational Research Program at Stanford University.

More information about Stanford’s Department of Obstetrics and Gynecology, which also supported the work, is available at http://obgyn.stanford.edu/.

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