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Self-reported stress, anxiety and depression not associated with fecundity

Self-reported psychological stress, anxiety and depression were not associated with a woman’s ability to conceive, according to study results.

“My other work has shown that a stress biomarker, alpha-amylase, is associated with a longer time to pregnancy,” study researcher Courtney D. Lynch, PhD, MPH, told Healio.com. “Unfortunately, this study showed little to no correlation between the stress biomarkers alpha-amylase and cortisol and the self-reported information from the psychosocial questionnaires. So, it seems that the commonly used psychosocial instruments that we evaluated would not be helpful to clinicians in identifying physiologically stressed women.”

Lynch, director of reproductive epidemiology at The Ohio State University College of Medicine, and colleagues conducted a prospective cohort study of 339 women aged 18 to 40 years who were attempting to conceive.

Women completed a baseline questionnaire and daily diaries in which they recorded bleeding, sexual intercourse, smoking and alcohol consumption for up to six cycles during the period in which they were trying to conceive. From day 6 to day 26 of each cycle, the women tested their urine to identify the day they were most likely to ovulate. On day 6 of each cycle, women collected a saliva specimen for the measurement of physiologic markers of stress. The women also completed a series of self-administered psychosocial questionnaires. The researchers used discrete-time Cox proportional hazards and a Bayesian Fecundity model to examine the association between the women’s self-reported stress, anxiety, depression and social support and time to pregnancy— a measure of fecundity — and the day-specific probabilities of pregnancy.

Results showed that 61% of women became pregnant during the study, 20% did not become pregnant and 19% withdrew. Controlling for maternal age, months trying to conceive before enrollment, parity, caffeine use, smoking and frequency of intercourse, the researchers found no association between most psychosocial measures and fecundity or day-specific probabilities of pregnancies, with the exception of some evidence indicating that women with greater social support had a shorter time to pregnancy, compared with women with lesser social support. This finding was only statistically significant for women in the second highest quartile (AOR=1.79; 95% CI, 1.14-2.82).

That the scores reflected on the various psychosocial questionnaires were not overall associated with a decrease in time to pregnancy was contrary to what the researchers had first hypothesized. In addition, the results differed from those reported by other researchers. One reason for the difference, according Lynch and colleagues, could be that other studies measured stress during the luteal, rather than the follicular, phase of the menstrual cycle. Another explanation may be that women in the present study did not report particularly high levels of perceived stress, anxiety or depression.

“We have demonstrated that any role that stress may play does not appear to be detectable via self-administered questionnaires completed during the follicular phase of the menstrual cycle,” the researchers wrote. “Our findings highlight the need to study women reporting high levels of stress and psychological disturbance; as well, it is a call to collect information on stress and mood throughout the menstrual cycle to permit a more accurate picture of the relation between stress and fecundity.”

Disclosure: Study researcher Cecilia Pyper, MBBS, is an advisor to Swiss Precision Diagnostics, the company that acquired Unipath. Unipath supplied the modified fertility monitors that were used in the study. Pyper owns no shares in the company. The other researchers report no relevant financial disclosures.