There is little doubt that stress and emotional lability plays a role in the normal physiological/hormonal regulation of the menstrual cycle. After all, Eskimos often stop ovulating and menstruating during long dark winters, young women confronted by a major emotional trauma such as a broken love affair can develop irregular ovulation, menstruation and even amenorrhea and chickens kept exposed to constant light will ovulate more frequently and yield more eggs. Against this background, women trying to achieve spontaneous pregnancies need to be made aware that one of their biggest enemies is stress.
On the other hand, when it comes to ovulation induction the woman’s central regulatory mechanism is so to say put on “automatic pilot” such that stress plays much less of a role if any at all. There is no such thing as a completely stress-free IVF experience and, when a question arises as to how this might effect outcome, I reassure my patients that this should not be of major concern.
This having been said, unquestionably the financial and physical investment in IVF will inevitably lead to stress and it is accordingly in everyone’s best interest to place proper emotional preparation for IVF high on the “to-do list”. Since most infertile patients feel disempowered it is advisable to have them fully informed and empowered to make decisions. In this regard, there is no greater advantage than to have an empathetic, sensitive and seasoned medical team at the helm. Undoubtedly the nurse coordinator plays a pivotal role in this regard. There are cases where the IVF journey becomes overwhelming for patients. In such situations, a referral to a counselor is essential. Rarely, does the degree of emotional lability relate to an underlying psychosis. In such cases, it is vital to refer the patients to a psychiatrist and to be ready to cancel the cycle of treatment should this become indicated.
Quite frankly, many patients undergoing IVF become duly stressed because of being confronted with so many do’s and don’ts by the treating medical team. Issues such as “avoid caffeine”, “avoid hot tubs”, “get 10 hours of rest a night”, “don’t dare have a single glass of wine”, “beware of taking your medications even a few minutes outside of schedule”. These and many other such didactic rules tend to scare patients and lead them to the erroneous belief that even a single deviation could spell failure. In my opinion, this is totally unnecessary as no single infraction is fatal.