The study assessed allostatic load, which refers to the cumulative “wear and tear” of chronic stress and life events, in 444 women who were trying to become pregnant.
Women with higher allostatic load scores – based on nine indicators such as blood pressure, blood sugar, cortisol, noradrenaline, and cholesterol – were less likely to become pregnant within a year.
Allostatic load (AL) is a practical index that reflects multi-system physiological changes which occur in response to chronic psychosocial stress. This study investigated the association between female pre-pregnancy allostatic load and time to pregnancy.
For example, the women with an allostatic load score of 5-6 would have a 59% reduction of fecundability compared with those with scores of 0.
“What we found provides a new idea for preconception counseling. But obviously, how to objectively assess the stress is a complex scientific question, and how to intervene and reduce the impact of chronic stress is a burning problem, which are all things we need to study further,” said senior author Bei Wang, PhD, of Southeast University in Jiangsu, China.
Infertility affects around one in every six couples of reproductive age globally and more than 25 million inhabitants of the European Union (EU) . The World Health Organization (WHO) acknowledges that despite the high frequency of infertility, the majority of infertile women remain silent about their experience, increasing their psychological fragility. Natural infertility may result in emotions of shame, remorse, and poor self-esteem.
These negative emotions might manifest as despair, worry, discomfort, and a low quality of life in varied degrees [2,3]. Other studies report infertility as causing depression comparable to cancer and other life-threatening diseases . On top of the negative psychological ef- fects, infertility still causes stigmatization in couples that are unable to conceive, including the pressuring families and social pressure of peers, disturbing the quality of life, social position, and causing serious relationship tension [5,6].
Existing research indicates that infertility has a greater impact on women than on males, with some women becoming victims of spousal abuse, economic distress, and social isolation . It was observed in Europe that couples seeking assisted reproductive therapy (ART) are more likely to have a higher socioeconomic status than the general population , since couples from this category often elect to have children later in life, after achieving career goals .
Options regarding infertility treatment vary nowadays by complexity, success rates, and, consequently, their costs. Assisted reproductive therapy (ART) in Romania has evolved extensively during the past two decades, offering a range of procedures, including in-vitro fertilization (IFV) and embryo transfer, intracytoplasmic sperm injection (ICSI), gamete intrafallopian transfer, zygote intrafallopian transfer, tubal embryo transfer, gamete and embryo cryopreservation, oocyte and embryo donation, and gestational surrogacy [10,11]. It is estimated that at least 8 million babies have been born through these assisted techniques since the first successful attempt , although the numbers in Romania remain unclear since most of them are performed in private practices.
Even though modern and expensive reproductive methods offer a statistically higher rate of success, several modifiable and unmodifiable factors are known to influence or might influence these numbers. While some lifestyle factors, such as cigarette smoking, illicit drug use, and alcohol and caffeine consumption, can be detrimental to female fertility, others, such as preventative care, can be favorable. Among the strongest impact factors on fertility as described by the scientific literature are the patient BMI, stress exposure, abnormal reproductive organ anatomy, and delayed childbearing age of starting a family, the latter two being unmodifiable [13,14].
Women experiencing infertility overwhelmingly believe that stress plays a role in their failure to conceive , and those who seek ART are particularly worried that stress may lower their chances of getting pregnant [16,17]. Multiple mechanisms by which the stress exposure and depression may influence female fertility were suggested; however, populational studies on fertility with this main goal are scarce .
This has resulted in imprecise conclusions about the effect of depression on infertility [4,19], although several published studies have indicated that infertile women receiving fertility treatment experience higher levels of stress and a higher prevalence of depression and anxiety than the general population [20,21]. Additionally, these symptoms are more prevalent in individuals who have had many IVF rounds after unsuccessful efforts [22,23].
In light of the aforementioned information, we sought to address the stress and financial factors that are most prevalent in Romania, and represent a susceptible reason for impeding access of infertile couples to assisted reproductive treatment in our country.
Original Research: Open access.
“Female fecundability is associated with pre-pregnancy allostatic load” by Bei Wang et al. Acta Obstetricia Et Gynecologica Scandinavica