Kristin L. Rooney

Impact of a group mind/body intervention on pregnancy rates in IVF patients

OBJECTIVE To determine if women who were randomized to a mind/body program before starting their first IVF cycle would have higher pregnancy rates than control subjects. DESIGN Randomized, controlled, prospective study. SETTING Private academically affiliated infertility center. PATIENT(S) A total of 143 women aged≤40 years who were about to begin their first IVF cycle. INTERVENTION(S) Subjects were randomized to a ten-session mind/body program (MB) or a control group and followed for two IVF cycles. MAIN OUTCOME MEASURE(S) Clinical pregnancy rate. RESULT(S) Only 9% of the MB participants had attended at least one-half of their sessions at cycle 1 start. Pregnancy rates for cycle 1 were 43% for all subjects; 76% of the MB subjects had attended at least one-half of their sessions at cycle 2 start. Pregnancy rates for cycle 2 were 52% for MB and 20% for control. CONCLUSION(S) MB participation was associated with increased pregnancy rates for cycle 2, prior to which most subjects had attended at least half of their sessions.

Lifestyle behaviors in women undergoing in vitro fertilization: a prospective study.

OBJECTIVE To determine the lifestyle behaviors of women before and during an IVF cycle. DESIGN Prospective survey. SETTING Private academically affiliated infertility center. PATIENT(S) One hundred eighteen women, ages 18-44, scheduled to undergo an assisted reproductive technology (ART) cycle using their own eggs. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Lifestyle history and daily habit survey. RESULT(S) In the month before their IVF cycle, 92% exercised, 3% smoked, 73% drank alcohol, 76% drank caffeinated beverages, 14% took herbs, and 30% underwent acupuncture. During their ART cycle, 100% exercised, 2% smoked, 49% drank alcohol, 77% drank caffeine, 12% took herbs, and 47% underwent acupuncture. CONCLUSION(S) This is the first prospective assessment of numerous lifestyle habits during an ART cycle. A number of surprising observations were made. Despite physician recommendation against it, some ART patients took herbs while cycling. Patients continue to exercise regularly and drink caffeine daily, and almost half continued to drink alcohol. Lifestyle behavior counseling should be considered for patients pursuing ART. CLINICAL TRIAL REGISTRATION NUMBER NCT01119391.

Exploratory randomized trial on the effect of a brief psychological intervention on emotions, quality of life, discontinuation, and pregnancy rates in in vitro fertilization patients

OBJECTIVE To determine whether a brief self-administered cognitive coping and relaxation intervention (CCRI) would lead to decreased treatment termination in in vitro fertilization (IVF) patients compared with routine care (RC). DESIGN Randomized, controlled, prospective study. SETTING Private academically affiliated infertility center. PATIENT(S) One hundred sixty-six women about to begin their first IVF cycle. INTERVENTION(S) Randomization to the self-administered CCRI or RC control group and then observation for 12 months. MAIN OUTCOME MEASURE(S) Treatment discontinuation within 12 months (primary outcome), clinical pregnancy rate and psychological well-being (secondary outcomes). RESULT(S) The 12-month pregnancy rate was similar for the RC and CCRI groups (odds ratio [OR] 1.02; 95% CI, 0.53-1.98). Of the patients who were not pregnant on the first cycle, 15 of 46 (15.2%) patients assigned to RC discontinued compared with 5 of 55 (5.5%) patients assigned to the CCRI (OR 3.11; 95% CI, 0.756-12.80). The CCRI group engaged in statistically significantly more positive reappraisal coping (OR 0.275; 95% CI, 0.16, 0.39) than the RC control group (OR 0.097; 95% CI, -0.03, .23). The CCRI group had an improved Fertility Quality of Life (FertiQoL CORE: OR 4.07; 95% CI, 2.07, 6.06; FertiQoL Emotional: OR 5.95; 95% CI, 2.89, 9.00) compared with the control group (Core OR: 0.67; 95% CI, -1.55, 2.89; Emotional: OR -0.02, 95% CI, -3.36, 3.32). The CCRI group reported less global anxiety (OR 0.275; 95% CI, 0.16, 0.39) than the control group (OR 0.471; 95% CI, -2.40, 3.34). The CCRI reported positive evaluations for the intervention (e.g., ease of use, helpfulness, perceived stress reduction). CONCLUSION(S) Use of the CCRI tool led to improved psychological status but not statistically significantly more treatment cycles or a higher pregnancy rate. CLINICAL TRIAL REGISTRATION NUMBER NCT01318291.

The impact of lifestyle behaviors on infertility treatment outcome.

Purpose of review The impact of lifestyle behaviors on fertility is poorly understood, as is the impact of specific behaviors on the advanced reproductive technologies. It is vital for healthcare professionals to understand which lifestyle behaviors can have the greatest negative impact in an effort to improve patient recommendations. The purpose of this article is to review the recent research on this topic. Recent findings The majority of research in this area is epidemiological; there are a few randomized controlled trials (RCTs) regarding weight loss in infertility patients, but no RCTs on other lifestyle behaviors. High or low BMI, alcohol, vigorous exercise, nicotine, and antidepressant medications may have an adverse impact on fertility. It is unclear whether dietary supplements can have a positive impact on fertility. Patients do not appear to follow recommendations for lifestyle behavior modifications during infertility treatment. Summary Healthcare professionals need to be more effective in making lifestyle behavior recommendations for infertility patients, including those receiving treatment. Video abstract http://links.lww.com/COOG/A13.

The impact of stress on fertility treatment.

Purpose of review The goal of this review was to summarize the recent research on the relationship between stress and assisted reproductive technology treatment. Recent findings Women and men with infertility report high levels of distress that can impact their quality of life. There are numerous psychosocial interventions, including cognitive behavior therapy and/or self-help ones, which may decrease distress, increase patient retention and improve pregnancy rates. Summary Patient distress is an important factor to consider. Decreasing burden of care may lead to significant improvements in assisted reproductive technology outcome.

Lifestyle habits of 12,800 IVF patients: Prevalence of negative lifestyle behaviors, and impact of region and insurance coverage

Lifestyle habits of women undergoing in vitro fertilization (IVF) treatment are largely unknown. Therefore, this prospective study aimed to determine the prevalence of negative lifestyle habits in women undergoing IVF and determine if habits are related to the region in the United States and/or by mandated insurance coverage. A total of 12,811 ART patients were surveyed in infertility clinics throughout the US. They took an online questionnaire added to the patient portal of electronic medical record eIVF, a fertility-specific electronic health record. Of the women surveyed, 17–23% of patients drank alcohol, 2–7% smoked, 62–68% drank caffeine, < 1% used recreational drugs, and 47–62% exercised during their IVF treatment. There were a few statistically significant regional differences in health habits (p < 0.001) but there were no differences in health habits between women who resided in a state with mandated insurance coverage versus those without insurance coverage. This is the first prospective assessment of lifestyle habits across regions in the USA and by insurance coverage. The study concluded that women undergoing IVF engage in behaviors which may negatively impact their cycle. Women in certain parts of the US had significantly worse habits than other regions, but the availability of mandated insurance coverage did not impact health habits.

The Role of the Mental Health Professional in the ART Clinic Setting

Many mental health professionals (MHPs) in the ART clinic setting spend most or all of their time on third party evaluations. However, there is a far larger role for the MHP. The MHP can work with patients to treat and limit their distress, making the experience easier for patients, while potentially increasing pregnancy rates and decreasing dropouts. The MHP can also support nurses, to limit burnout. Finally, the MHP can work with the health care team to teach them empathic communication, which leads to increased patient-centered care.