Overcoming the IVF Baby Blues: Hormones and Stress Are Major Contributors to Depression, Research Finds

Between 20 and 30 percent of women who undergo in vitro fertilization (IVF) procedures suffer from significant symptoms of depression. Many practitioners believe that the hormone therapy involved in IVF procedures is primarily responsible for this. But new research from Tel Aviv University shows that, while this is true, other factors are even more influential.
According to Dr. Miki Bloch of Tel Aviv University's Sackler Faculty of Medicine and the Sourasky Medical Center in Tel Aviv, stress, pre-existing depression, and anxiety are more likely than hormone therapy to impact a woman's depression levels when undergoing IVF. Combined, these factors may also affect IVF success rates -- so diagnosis and treatment of this depression is very important.
Recently reported in the journal Fertility and Sterility, Dr. Bloch's research clarifies the involvement of different hormonal states as triggers for depression during IVF, both for long- and short-term protocols.
The long and short stories
In the long-term IVF protocol, explains Dr. Bloch, women receive injections which block ovulation, resulting in a sharp decline in estrogen and progesterone levels. This state continues for a two-week period before the patient is injected with hormones to stimulate ovulation, at which point the eggs are harvested and fertilized before being replanted into the womb. The short-term IVF protocol, on the other hand, does not include the initial two-week period of induction of a low hormonal state.
Some gynaecologists believe that depression is more likely when a woman undergoes long-term IVF therapy because of those first two weeks of hormonal repression. But Dr. Bloch's research has demonstrated that the difference between the two different procedures is negligible -- depression and anxiety rates for women who undergo the long protocol and those who undergo the short are exactly the same.
Dr. Bloch and his fellow researchers conducted a random assignment study, in which 108 women who came to the Sourasky Medical Center for IVF were randomly assigned to either the long- or short-term protocol. They were given questionnaires and interviews at the start of the therapy and at four other points during the IVF treatment.
The results, says Dr. Bloch, show consistently increasing depression rates among patients in both groups, irrespective of which protocol they underwent. The first two weeks of hormonal repression, he explains, thus have no impact on whether a woman experiences depression during IVF. "Once the patient begins ovulating, her estrogen rises to high levels. Then, after the ovum is replanted in her uterus, there is a precipitous drop in these hormonal levels," he explains. It's the severity of the estrogen drop, a feature of both protocols, that was found to affect the patient's emotional state.
Preventing stress in susceptible women
Whatever the specific effect of hormones, during their study Dr. Bloch and his fellow researchers discovered that the stress and anxiety experienced during the treatment has a significant impact on patient depression rates. When compared to a "normal" population, women undergoing IVF experience very high levels of anxiety and depression even before the treatment begins. As the protocol advances, explains Dr. Bloch, women experience increased anxiety about the success of the implantation.
Women who have a previous history of anxiety or depression disorders before the IVF treatment are even more susceptible, he says. This is likely due to the fact that these women are more emotionally vulnerable to the toll of the IVF process rather then increased reactivity to changing hormonal levels, Dr. Bloch says.
Choosing the right protocol
When it comes to depression rates, the type of protocol a patient undergoes, whether short-term or long-term, has no impact, Dr. Bloch concluded. The combination of the stress surrounding the treatment, a personal history of psychiatric disorders, and a sharp decline in estrogen levels are the main contributing factors towards depression during IVF therapy. While doctors should look at their patient's individual needs when deciding on an IVF protocol, the current report suggests the type of protocol per se is not an important factor in the induction of depression.

Little Sipho

Young Sipho goes into the kitchen where his mother is baking.
He puts his hands in the flour and covers his head with it.
He says: "Look mamma, I am a white boy!"
His mother slaps him hard on the face and says: "Sipho, go show your dad what you've done!!"
So he does, and his dad slaps him too.
His granny happens to be right next to his dad and she slaps him vehemently in disgust.
Then Sipho's mom says: "Did you learn something from all this?
The poor little Sipho shakes his head, crying and says:
"I did. I've only been a white boy for 5 minutes and I'm already scared of you blacks!"

Take Care While Driving!

The Honda rider was traveling at such a high speed, his reaction time was not sufficient enough to avoid this accident. Swedish Police estimate a speed of ~250 KM/h (155mph) before the bike hit the slow moving car side-on at an intersection. At that speed, they predicted that the rider's reaction time (once the vehicle came into view) wasn't sufficient enough for him to even apply the brakes.

The car had two passengers and the bike rider was found INSIDE the car with them. The Volkswagen actually flipped over from the force of impact and landed 10 feet from where the collision took place. All three involved (two in car and rider) were killed instantly. This graphic demonstration was placed at the Stockholm Motorcycle Fair by the Swedish Police and Road Safety Department. The sign above the display also noted that the rider had only recently obtained his license.

At 250 KM (155 mph) the rider is traveling at 227 feet per second. With normal reaction time to SEE-DECIDE-REACT of 1.6 seconds the above rider would have traveled over 363 feet while making a decision on what actions to take. In this incident the Swedish police indicate that no actions were taken.

Beach Sand Art

Women using IVF more likely to conceive when stressed

Women who are stressed out when undergoing IVF may have a higher chance of falling pregnant, research suggests.
Those reporting higher stress levels had up to double the chance of a positive pregnancy test when compared with those who were more relaxed, according to a study on 217 women.
They were asked on their first appointment how much fertility-related stress they were experiencing on a scale from 1 to 10.
Those who scored 1 to 3 on the scale had a pregnancy rate of 30 per cent while those who scored 7 to 10 had a rate of 50 to 60 per cent.
Dr Robert Hunter, from Staten Island University Hospital in New York, which carried out the study, said previous research had found a similar finding. However, other studies have discovered that stress can negatively affect IVF.
'We were a little surprised by the outcome of the study - we were expecting the opposite result,' Dr Hunter said.
'It highlights the complexity of stress. There's a very complex relationship between stress pathways and the reproductive pathways.
'This is something that we're still struggling to understand and more work needs to be done.'
Dr Hunter said there was good evidence, however, that stress could actually improve how the body functions, such as the 'fight or flight' response.
Levels of key hormones rise when a person is under stress, including the adrenal hormones adrenaline and cortisol.
The team are now planning further studies, including looking at these markers of stress in the body.
Co-researcher Dr Eric Knochenhauer said questions also need to be asked about sources of stress, such as coming from a partner, worries about the costs of IVF and pressure from parents, in-laws or friends.
'Fertility-related discussions used to be something that nobody had with friends but now it's much more common,' he said.
'I think that causes stress for some patients.'
Another one of the researchers, Dr Michael Traub, said one interesting finding from the study related to older women, who reported being less stressed.
'If they are older and they think their chances of becoming a parent are very low, they might have less stress because their expectations are lower.'
All the findings held true even when factors such as depression, smoking status, age and alcohol intake were taken into account.
Tony Rutherford, chair of the British Fertility Society, said: 'This study used a questionnaire to assess stress rather than looking for biochemical markers.
'There is some evidence that increasing stress might be of benefit to patients undergoing IVF.
'In the UK we are pushing for a national trial on whether steroids improve IVF.
'It's an interesting relationship.'

IVF success usually peaks early

More tries aren't necessarily better when it comes to in vitro fertilization. New research found that about 1 in 3 women had a baby the first time they tried a test tube embryo, and that improved to nearly 1 in 2 with a second try.
However, undergoing a third cycle boosted success rates very little and leveled off with subsequent attempts.
"Don't quit if the first cycle isn't successful. Your chances go up with the second cycle," said lead researcher Barbara Luke of Michigan State University. But "if you haven't gotten pregnant by the third, the chances are slim to continue."
In vitro fertilization involves mixing egg and sperm in a laboratory dish. The resulting embryo is then transferred into the womb to grow into a baby. Earlier last month, British researcher Robert Edwards won the medicine Nobel Prize for pioneering the technique that has led to 4 million test tube babies.
Infertility treatment is expensive. The average cost for an IVF cycle is about $12,400, according to the American Society of Reproductive Medicine. Some insurance companies cover it.
Desperate couples often try over and over to conceive, and there are no ethics standards on when doctors should stop helping them try. Fertility clinics report success rates based on the number of cycles attempted, but that doesn't indicate how likely an individual woman is to get pregnant with each IVF cycle she undergoes.
The new study is the first to examine that nationally. It looked at in vitro procedures around the country between 2004 and 2008.
Over the five-year period, some 300,000 women had more than half a million IVF cycles that resulted in 171,327 first-time deliveries. The live birth rate was 36% on the first IVF try, 48% with a second cycle and 53% with a third attempt.
Among those who tried seven or more times, the chance of success was 56% -- hardly any better than the 53% after three tries.
The findings show "diminishing returns" after three IVF cycles, said lead researcher Luke. "The results are not going to be much better."

Quintuplets revisited!

Sarah Pavlenko made history 21 years ago as one of the world's first IVF quintuplets. This week Ms Pavlenko has returned to the same Perth hospital where she was delivered to begin a career caring for miracle babies just like her. "I always wanted to be a nurse," she said. "I grew up hearing stories about my time in the neonatal ward being cared for alongside my brother and sisters."Those stories inspired me to get into the health system."

The Pavlenko quintuplets Sarah, Jessica, Joshua, Aimee and Breeanna were born at King Edward Memorial Hospital on January 18, 1989.The births made headlines around the world and the Pavlenkos are still the only quins on record to be born at WA's maternity hospital.

"People always ask me what it was like to grow up as a quin," Ms Pavlenko said. "The best part was that there was always someone around to talk to or hang out with. The older we've got, the closer we've become."

Ms Pavlenko returned to KEMH on Monday to start her nursing career after graduating from Edith Cowan University.She will be working in the neonatal intensive-care unit where the state's sickest babies are kept alive.The hallways to the neonatal unit are still covered in newspaper clippings and photos of the Pavlenko quins as babies.

"I've had hospital staff come up to me and tell me that they were working the day that I was born," Ms Pavlenko said. "It's amazing. They're so happy to see me again it's like I'm family. "It shows that the hospital must be a good place to work if the staff are still there 21 years later." Ms Pavlenko said it was surreal to look at the babies in the neonatal ward and imagine that once it was her. "They're so tiny," she said. "Holding them you can't help but think that it was once you. But, each baby is an individual with its own special needs."

One of her sisters, Breeanna, will also become a nurse within months at Princess Margaret Hospital for Children.Amazingly, the same day the Pavlenko quintuplets were born, quadruplets were also delivered at KEMH.