Cortisol dysregulation in anxiety infertile women and the influence on IVF treatment outcome

Yujuan Chai; Qihang Li; Yang Wang; Ben Niu; Huijia Chen; Tingxuan Fan; Xiatong Ke; Heng Zou

doi:10.3389/fendo.2023.1107765

Cortisol dysregulation in anxiety infertile women and the influence on IVF treatment outcome

Front Endocrinol (Lausanne). 2023 Jun 13:14:1107765. doi: 10.3389/fendo.2023.1107765. eCollection 2023.

Authors

Yujuan Chai¹, Qihang Li¹, Yang Wang², Ben Niu², Huijia Chen³, Tingxuan Fan⁴, Xiatong Ke⁵, Heng Zou³

Affiliations

¹ Department of Biomedical Engineering, School of Medicine, Shenzhen University, Shenzhen, Guangdong, China.
² Department of Management, Shenzhen University, Shenzhen, Guangdong, China.
³ Reproductive Medicine Center, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁴ Greater Bay Area International Institute for Innovation, Shenzhen University, Shenzhen, Guangdong, China.
⁵ Research Department III, Shenzhen Health Development Research and Data Management Center, Shenzhen, Guangdong, China.

Abstract

Introduction: Dysregulation of the stress-regulatory hormone cortisol is associated with anxiety, but its potential impact on infertile women and in vitro fertilization (IVF) treatment remains unclear. This prospective cross-sectional study aimed at evaluating the dysregulation of cortisol and its correlation to anxiety in infertile women. The influence of stress on IVF outcomes was also investigated.

Methods: A point-of-care test was used for the measurement of morning serum cortisol in 110 infertile women and 112 age-matching healthy individuals. A Self-Rating Anxiety Scale (SAS) was used for the anxiety assessment of infertile women, and 109 of them underwent IVF treatment starting with the GnRH-antagonist protocol. If clinical pregnancy was not achieved, more IVF cycles were conducted with adjusted protocols until the patients got pregnant or gave up.

Results: Higher morning serum cortisol level was identified for infertile patients, especially for the elder. Women with no anxiety showed significant differences in cortisol levels, monthly income, and BMI compared with those with severe anxiety. A strong correlation was found between the morning cortisol level and the SAS score. When the cutoff value is 22.25 μg/dL, cortisol concentration could predict the onset of anxiety with high accuracy (95.45%) among infertile women. After IVF treatments, women with high SAS scores (>50) or cortisol levels (>22.25 μg/dL) demonstrated a lower rate of pregnancy (8.0%-10.3%) and more IVF cycles, although the impact of anxiety was not affirmative.

Conclusion: Hypersecretion of cortisol related to anxiety was prevalent among infertile women, but the influence of anxiety on multi-cycle IVF treatment was not affirmative due to the complicated treatment procedures. This study suggested that the assessment of psychological disorders and stress hormone dysregulation should not be overlooked. An anxiety questionnaire and rapid cortisol test might be included in the treatment protocol to provide better medical care.

Keywords: IVF outcome; anxiety; cortisol; infertility; point-of-care testing.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Female
Fertilization in Vitro
Humans
Hydrocortisone*
Infertility, Female* / therapy
Pregnancy
Prospective Studies
Treatment Outcome

Substances

Hydrocortisone

Grants and funding

This study was supported by Shenzhen Overseas Talent Program (827–000511); SZU Top Ranking Project (86000000210); SZU Start-up Grant (860-000002110806); Guangdong province Young Innovative Talents Project (2022KQNCX067); Innovation and Entrepreneurship Training Program for College Students (202210590017X); Traditional Chinese Medicine research joint project of Chongqing Health Commission and Chongqing Science and Technology Bureau (2019ZY3152) and Guangdong Province Innovation Team “Intelligent Management and Interdisciplinary Innovation” (2021WCXTD002).