Infertility: Altered responses to stress in women undergoing in-vitro fertilization and recipients of oocyte donation

Clinical impressions suggest the presence of considerable anxiety and depression in infertile couples. We utilized a psychological stress test to assess adaptations to provoked stress to improve the psychological profile of infertile women. A psychological stress test was administered to four groups: normal menstruating females (controls, n = 13); oocyte donors (n = 13); recipients of oocyte donation (n = 7); and women undergoing standard in-vitro fertilization (IVF; mean age 38.0 years; n = 8). The psychological stress test consisted of three active coping tasks: (i) serial subtraction, (ii) Stroop colour test, (iii) speech task and (iv) one passive coping task, the cold-pressor test. Haemo-dynamic responses (HD) were monitored before, during and after the psychological stress test, and serum samples were drawn for catecholamines and cortisol. Baseline blood pressures were similar among groups. The psychological stress test elicited different biophysical responses in controls compared with the other groups (P < 0.001). Oocyte donors had different speech task responses from baseline, although these and the other parameters of the psychological stress test were not different from either the recipient or IVF groups. Blood pressure responses from baseline were blunted in both recipients and standard IVF patients following provoked stress. Baseline cortisol and norepi-nephrine were similar among all groups, yet provoked stress elicited a significant increase in controls (142.0 ± 25.2%, P < 0.001) compared with oocyte donors (17.1 ± 19.7%), recipients and standard IVF patients (mean -15.5 ± 17.3% respectively). Norepinephrine responses were apparently greater in controls (60.1 ± 13.1%) compared with oocyte donors (41.8 ± 27%) and recipient and IVF groups combined (21.7 ± 12.4%) but this result was not significant. These data suggest that infertile women have blunted biophysical and biochemical reactions to provoked behavioural stressors. Oocyte donors demonstrate blunted passive coping responses similar to those of infertile women, yet still respond to active coping stressors in a manner similar to that of normal controls. Our data suggest that infertility therapy combined with the anticipation of success or failure results in blunted patterns of response to passive coping stressors. However, blunted active coping responses are unique to infertile women.