Supporting Research for Mind/Body Therapies

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Clinical application of the relaxation response in women's health
Deckro JP, Domar AD, Deckro RM.
Women are subject to multiple stressors often getting little recognition or support for their diverse roles. Although stress is a natural part of life, research indicates that prolonged or extreme stress can have a negative effect on a woman's health. Nurses, because of their holistic approach, are ideally suited to use interventions that empower women to deal effectively with stress. This article outlines the mind/body connection and describes the relaxation response as a counterbalance to the deleterious effects of stress. Instructions for several methods of using the relaxation response in a clinical setting are given. Return to Research Index

Psychological impact of infertility
Cousineau TM, Domar AD.
The inability to conceive children is experienced as a stressful situation by individuals and couples all around the world. The consequences of infertility are manifold and can include societal repercussions and personal suffering. Advances in assisted reproductive technologies, such as IVF, can offer hope to many couples where treatment is available, although barriers exist in terms of medical coverage and affordability. The medicalization of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatization, and a disruption in the developmental trajectory of adulthood. Evidence is emerging of an association between stress of fertility treatment and patient drop-out and pregnancy rates. Fortunately, psychological interventions, especially those emphasizing stress management and coping-skills training, have been shown to have beneficial effects for infertility patients. Further research is needed to understand the association between distress and fertility outcome, as well as effective psychosocial interventions.Return to Research Index

The psychological impact of infertility: a comparison with patients with other medical conditions
Domar AD, Zuttermeister PC, Friedman R.
To compare the psychological symptoms of infertile women with patients with other chronic medical conditions, subjects completed the Symptom Checklist-90 (Revised) (SCL-90R), a standardized, validated and widely used psychological questionnaire, prior to enrolling in a group behavioral treatment program. All subjects were female and the totals in each program were as follows: 149 with infertility, 136 with chronic pain, 22 undergoing cardiac rehabilitation, 93 with cancer, 77 with hypertension, and 11 with human immunodeficiency virus (HIV)-positive status. The infertile women had global symptom scores equivalent to the cancer, cardiac rehabilitation and hypertension patients, but lower scores than the chronic pain and HIV-positive patients (p < 0.0001 and p < 0.02 respectively). The anxiety and depression scores of the infertile women were significantly lower than chronic pain patients but not statistically different from the other groups. The results suggest that the psychological symptoms associated with infertility are similar to those associated with other serious medical conditions. Therefore, standard psychosocial interventions for serious medical illness should also be applied in infertility treatment. Return to Research Index

Impact of Group psychological interventions on pregnancy rates in infertile women
Domar A, Clapp D, Slawsby E, Dusek J, Kessel B, Freizinger M. Fertility and Sterility. 2000: 73; 4:805-11.
In a study of women with infertility, the pregnancy rate of a support group that met once a week for 10 weeks and included relaxation and imagery was 55%, vs. a regular support group with 52%, and a control group with only 20%.  Interestingly, 42% of the pregnancies achieved in the relaxation/imagery group were spontaneous, versus only 12% in the support group, the rest of whom required reproductive. Return to Research Index

The impact of group psychological interventions on distress in infertile women
Domar AD, Clapp D, Slawsby E, Kessel B, Orav J, Freizinger M.
Infertile women express higher levels of distress than fertile women, with distress peaking between the 2nd and 3rd year. The purpose of this study was to determine whether group psychological interventions could prevent this surge. One hundred eighty-four women who had been trying to conceive between 1 and 2 years were randomized into either a cognitive-behavioral group, a support group, or a control group. All experimental participants attended a 10-session group program. Participants completed psychological questionnaires at intake and again at 6 and 12 months. Substantial attrition occurred, particularly in the control group. The cognitive-behavioral and support participants experienced significant psychological improvement at 6 and 12 months compared with the control participants, with the cognitive-behavioral participants experiencing the greatest positive change. Return to Research Index

Body-mind-spirit intervention for IVF women
Chan CH, Chan CL, Ng SM, Ng EH, Ho PC.
BACKGROUND: Literature supports the efficacy of psychosocial intervention for infertile women. An eastern body-mind-spirit group intervention has been developed to help infertile women in the Chinese population cope with the distress arising from IVF treatment. Return to Research Index

METHODS: The eastern body-mind-spirit group intervention adopts a bio-psycho-social-spiritual health model, recognizing the strong association between mind, body, and spirit. Chinese philosophies and concepts of health will be integrated into the intervention, helping participants to regain balance and harmony both within themselves and between them and the environment. In this paper, a revisiting of assumptions, therapeutic goals, and the therapeutic process underlying this model are outlined. Program evaluation in terms of descriptive literary sketch done by the participants will be listed so as to illustrate the clinical process. Return to Research Index

CONCLUSIONS: It was shown and reflected that the eastern Body-Mind-Spirit approach could enhance the holistic health of IVF women. Further investigation on the program efficacy is then suggested. Return to Research Index

Psychological distress and infertility: forty years of research
1998 J Psychosom Obstet Gynaecol 19;4:218-28
Brkovich, A. M. and Fisher, W. A.
Theoretical mechanisms by how stress can influence fertility: stress effects the limbic system, which links to GnRH pulsatility; stress and depression are associated with lower serotonin levels, which leads to increased prolactin which can negatively impact ovulation; stress can cause immune function abnormalities, which may influence fertility-related antibody problems. Return to Research Index

Psychosocial experiences in women facing fertility problems—a comparative survey
1999 Hum Reprod 14;1:255-61
Oddens, B. J., den Tonkelaar, I., and Nieuwenhuyse, H.
Infertile Belgian women had more depressed mood, memory/concentration problems and anxiety than a control population. Both the infertile group and control group agreed that infertility was a severe life event. Return to Research Index

Psychosocial distress and infertility: men and women respond differently
1991 Fertil Steril 55;1:100-8
Wright, J., Duchesne, C., Sabourin, S., Bissonnette, F., Benoit, J., and Girard, Y.
Both male and female infertility patients were significantly more distressed than the average population, but women showed more anxiety, depression, hostility, cognitive disturbances, stress levels and decreased self-esteem than their partners. Return to Research Index

Coping with male infertility - gender differences
2001 Arch Gynecol Obstet 265;3:131-6
Kowalcek, I., Wihstutz, N., Buhrow, G., and Diedrich, K.
Women of infertile couples rated higher on "depressional coping" than their partners. Women with infertility rated lower on "religiousness and search for meaning" than women with other chronic medical problems.

Psychosocial, treatment, and demographic predictors of the stress associated with infertility
1992 Fertil Steril 57;1:122-8
Abbey, A., Halman, L. J., and Andrews, F. M.
For both men and women, stress was directly correlated with treatment costs and number of tests and treatments received, and did not relate to age, number of years married, or number of years of infertility. For women, attitudes about infertility treatments, importance of children, and level of social support significantly affected stress levels. Authors recommend increasing patients' sense of control, realistic optimism and social support to reduce stress.

Behaviorally induced reproductive compromise in women and men
1997 Semin Reprod Endocrinol 15;1:47-53
Berga, S. L.
Psychosocial problems can affect the central GnRH-LH/FSH drive, and cause ovarian compromise on a continuum of amenorrhea, oligomenorrhea, polymenorrhea, or luteal-phase deficiency. Although drug treatment can restore reproductive function, it is also masking the problem. "Attitudes, moods, and behaviors can have endocrine consequences and cause definable reproductive disorders...Misattributions, negative images of self and others, unrealistic expectations, and emotional disharmony can cause neuroendocrine havoc."

Psychological interactions with infertility among women
Cwikel J, Gidron Y, Sheiner E.
Center for Women's Health Studies and Promotion, Ben-Gurion University of the Negev, P.O. Box 151, Beer Sheva 84101, Israel.
Despite the fact that various studies have demonstrated the importance of the mind-body connection and fertility, the psychosocial aspects of infertility have not been adequately addressed. Fertility treatments, ranging from medical monitoring, to hormonal remedies and in vitro fertilization (IVF), are both a physical and emotional burden on women and their partners. Return to Research Index

Psychological factors such as depression, state-anxiety, and stress-induced changes in heart rate and cortisol are predictive of a decreased probability of achieving a viable pregnancy. A couple that is trying to conceive will undoubtedly experience feelings of frustration and disappointment if a pregnancy is not easily achieved. However, if the difficulties progress and the man and or woman are labeled as having fertility problems, then this may result in a severe insult to self-esteem, body image, and self-assessed masculinity or femininity. Return to Research Index

Three types of relationships have been hypothesized between psychological factors and infertility. These include: (1) psychological factors are risk factors of subsequent infertility; (2) the experience of the diagnosis and treatment of infertility causes subsequent psychological distress; (3) a reciprocal relationship exists between psychological factors and infertility. The evidence for these three relationships is reviewed and an alternative approach to the treatment of infertility including stress evaluation that precedes or is concurrent to fertility treatment is suggested.
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Yoga: an adjunct to infertility treatment
Khalsa HK.
West Medford, MA 02155, USA. hari@reachhari.com
Yoga and meditation can help women experiencing the challenges of infertility. The practice of meditation and relaxation can help increase the clarity of the mind, maintain healthy body chemistry, and give patients the patience to undergo the rigors of infertility treatments. When one understands and can attain physical relaxation, one tends to feel better about the body itself, and begins to treat the body with more respect. This understanding can lead to healthier lifestyle habits as well as increased sensitivity regarding symptoms and body processes. This is beneficial to both doctor and patient as the patient can report with more clarity and sense cycles and physical issues more readily. Return to Research Index

High levels of anxiety impact IUI success rates and miscarriage rates
Demyttenaere, Nijs, Steeno, & Koninckx, 1988
In a study with women undergoing donor sperm insemination, those with higher levels of anxiety prior to undergoing inseminations took significantly longer to conceive and were also significantly more likely to miscarry that those with lower levels of anxiety.
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Depression rates impact fertility
Thiering, Beaurepaire, Jones, & Saunders, 1993
Women who were not depressed before starting IVF treatment had a conceptions rate twice as high as women who were depressed before treatment. Women with a history of depression were nearly twice as likely to report infertility as women without such history. Return to Research Index

Infertility: the impact of stress, the benefit of counseling
1997 J Assist Reprod Genet 14;4:181-3
Seibel, M. M.
Infertility patients have been called the "most neglected silent minority" because they have a loss that often goes unnoticed. In addition, they face many other often unnoticed stresses, such as the difficulties of going to work while undergoing infertility testing and treatments, the fear caused by newspaper reports of possible increased risk of cancer with ovulation agents, or the ethical problems of facilities implanting the wrong embryos. Even if successful, they may continue to consider themselves "infertile", often not buying baby clothes or making preparations during their pregnancy. And if therapies do not work, they often drop out of treatment without closure or support. For all of these reasons, the author recommends a psychologist as part of an infertility team, for individual counseling as well as behavioral advice on relaxation training, stress management, and nutritional and exercise counseling. Return to Research Index

Anxiety impacts egg production and quality
Klonoff-cohen and Natarajan, 2004
Women undergoing IVF who were "worried" about the medical aspects of their treatments had 20% fewer eggs retrieved and 19% fewer eggs fertilized.
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Mind/Body interventions alleviate the physical and emotional symptoms of stress, depression and anxiety
Herbert Benson, M.D.
Participants report significant decreases in insomnia, headaches, back pain, abdominal pain, depressive symptoms, anxiety, anger, and fatigue.  Harvard Medical School's research reports the direct relationship between stress and neuroendocrine responses and describes the primitive reflexes of sympathetic and adrenal activation in response to perceived stress and distress on health. Return to Research Index

Reduction in stress and depression can improve conception rates
Rodriguez et al.,1983
Women with unexplained infertility who went through an 8-week program of relaxation training, cognitive restructuring, and self-instructional management were significantly more likely to conceive than a control group who receive no training.  Within the 2-month study period, 4 out of 7 experimental subjects conceived, whereas none of the 7 control subjects conceived. Return to Research Index
 
Relaxation training improves IVF conception rates
Farrar, Holbert, & Drabman, 1990
In a study of 63 women about to undergo an IVF treatment cycle, those who chose to attend 2-weeks worth of sessions on relaxation training were significantly more likely to conceive on their first IVF attempt. Return to Research Index

The relaxation response: Psychophysiologic aspects and clinical applications.
International Journal of Psychiatry in Medicine. 1975; 6:87-98. Benson H, Greenwood MM, Klemchuk H.
It is hypothesized that situations requiring continous behavioral adjustment activate an integrated, hypothalamic response, the emergency reaction. The frequent elicitation of the physiologic changes associated with the emergency reaction has been implicated in the development of diseases such as hypertension. Prevention and treatment of these diseases may be through the use of the relaxation response, an integrated hypothalamic response whose physiologic changes appear to be the counterpart of the emergency reaction. This article describes the basic elements of techniques which elicit the relaxation response and discusses the results of clinical investigations which employ the relaxation response as a therapeutic intervention. Return to Research Index

Yoga, Meditation May Help Increase Pregnancy Rates; Clinics Add Special Courses
By ANDREA PETERSEN
Staff Reporter of THE WALL STREET JOURNAL
November 23, 2004; Page D10 Return to Research Index

Supporting Research for Acupuncture

Acupuncture: A Cure for Infertility?
Tuesday, April 26, 2005, by Catherine Donaldson-Evans Return to Research Index

Influence of acupuncture on idiopathic male infertility in assisted reproductive technology.
Zhang M , Huang G , Lu F , Paulus WE , Sterzik K
J Huazhong Univ Sci Technolog Med Sci, 22(3): 228-30   2002
The clinical effects of acupuncture on idiopathic male infertility in sperm parameter and on therapeutic results in assisted reproductive technology were investigated. 22 patients failed in intracytoplasmic sperm injection (ICSI) with idiopathic male infertility were treated with acupuncture twice weekly for 8 weeks, followed by ICSI treatment again. The sperm concentration, motility, morphology, fertilization rates and embryo quality were observed. Quick sperm motility after acupuncture (18.3% +/- 9.6%) was significantly improved as compared with that before treatment (11.0% +/- 7.5%, P < 0.01). The normal sperm ratio was increased after acupuncture (21.1% +/- 10.4% vs 16.2% +/- 8.2%, P < 0.05). The fertilization rates after acupuncture (66.2%) were obviously higher than that before treatment (40.2%, P < 0.01). There was no significant difference in sperm concentration and general sperm motility between before and after acupuncture. The embryo quality after acupuncture was improved, but the difference between them was not significant (P > 0.05). Acupuncture can improve sperm quality and fertilization rates in assisted reproductive technology. Return to Research Index

Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality.
Arch Androl, 39(2):155-61 1997 Sep-Oct (ISSN: 0148-5016)
Siterman S; Eltes F; Wolfson V; Zabludovsky N; Bartoov B
Institute of Chinese Medicine, Tel Aviv, Israel.
The aim of this prospective controlled study was to assess the effect of acupuncture on the sperm quality of males suffering from subfertility related to sperm impairment. Semen samples of 16 acupuncture-treated subfertile patients were analyzed before and 1 month after treatment (twice a week for 5 weeks). In parallel, semen samples of 16 control untreated subfertile males were examined. Two specimens were taken from the control group at an interval of 2-8 months. The expanded semen analysis included routine and ultramorphological observations. The fertility index increased significantly (p < or = .05) following improvement in total functional sperm fraction, percentage of viability, total motile spermatozoa per ejaculate, and integrity of the axonema (p < or = .05), which occurred upon treatment. The intactness of axonema and sperm motility were highly correlated (corr. = .50, p < or = .05). Thus, patients exhibiting a low fertility potential due to reduced sperm activity may benefit from acupuncture treatment. Return to Research Index

Effects of acupuncture and moxa treatment in patients with semen abnormalities.
Gurfinkel E , Cedenho AP , Yamamura Y , Srougi M
Asian J Androl, 5(4): 345-8   2003

AIM: To evaluate the effect of Chinese Traditional Medicine, acupuncture and moxa treatment, on the semen quality in patients with semen abnormalities.

METHODS: In a prospective, controlled and blind study, nineteen patients, aged 24 years approximately 42 years and married for 3 years approximately 11 years without children with semen abnormalities in concentration, morphology and/or progressive motility without apparent cause, were randomized into two groups and submitted to acupuncture and moxa treatment at the therapeutic (Study Group) and the indifferent points (Control Group), respectively, for 10 weeks. Semen analyses were performed before and after the treatment course.

RESULTS: The patients of the Study Group presented a significant increase in the percentage of normal-form sperm compared to the Control Group (calculated U=16.0, critical U=17.0).

CONCLUSION: The Chinese Traditional Medicine acupuncture and moxa techniques significantly increase the percentage of normal-form sperm in infertile patients with oligoastenoteratozoospermia without apparent cause.

Acupuncture and good prognosis IVF patients
P. C. Magarelli, D. K. Cridennda, M. Cohen. Reproductive Medicine & Fertility Center, Colorado Springs, CO; East Winds Acupuncture, Inc., Colorado Springs, CO.
 
OBJECTIVE: To determine the role of electro stimulation acupuncture and traditional combined with auricular acupuncture on IVF outcomes in good prognosis patients.

RESULTS: Total IVF cases 114, 53 with Acupuncture (Ac) and 61 without Acupuncture (Non-Ac). Demographics, Infertility Diagnoses, and Treatment Protocols were statistically the same between both groups and by design, the following parameters were similar: Sperm Morphology; Peak Day 3 FSH; Average Pulsatility Index; Peak E2 at hCG; and Post hCG P4. These parameters earned the designation of Good Prognosis group. Preg- S80 Abstracts Vol. 82, Suppl. 2, September 2004 nancy rates (PR) and Miscarriage rates (SAB) were statistically improved at the p < 0.05 levels in those patients that received Acupuncture (51% v 36% PR and 8% v 20% SAB in the AC v Non-Ac groups). There were no ectopic pregnancies in the Ac group and 9% in the Non-Ac group, p < 0.008. Finally, Birth rates (BR) per cycle start and per pregnancy were significantly higher in the Ac group, with 23% more births/pregnancy significant at the p < 0.05 level.

CONCLUSION: The use of adjunctive therapies in IVF protocols is gaining popularity. In previously published data, Acupuncture was reserved for Poorer Prognosis patients and enhanced outcomes were observed. In this study, we demonstrated that Good Prognosis patients would also benefit from inclusion of published Acupuncture protocols. This is also the first publication of Birth outcome data in Acupuncture treated IVF patients. Acupuncture significantly increased birth outcomes; it significantly decreased ectopic pregnancies and miscarriage rates. These data uniquely support a definitive role of both Electrostimulation and Traditional combined with Auricular Acupuncture in IVF in Good Prognosis IVF patients. Return to Research Index

Nutrition Research

In a multicenter prospective study, Dr. Hillary Klonoff-Cohen and colleagues from the University of California, San Diego, examined the effect of male and female alcohol consumption during IVF and GIFT on reproductive endpoints in 221 couples with female infertility. Main outcome measures included egg retrieval, transfer, fertilization, pregnancy, miscarriage, live birth, and multiple gestations.

For every additional drink per day, women had a 13% decrease in the number of eggs aspirated (p = 0.02). The risk of not achieving pregnancy was increased 2.86 times with alcohol consumption in the month before the IVF or GIFT attempt (p = 0.05). Alcohol use 1 week before the attempt was associated with an odds ratio for miscarriage of 2.21 (p = 0.03).

Paternal alcohol consumption 1 month and 1 week before IVF or GIFT increased the risk of not achieving a live birth by 2.28 and 2.43 times, respectively (p = 0.04). The risk was increased by 3.14 (p = 0.02) and 8.32 times (p = 0.006) for those who drank one additional drink per day during the first visit and for the week prior to sperm collection.

If these findings are confirmed, "clinicians should recommend that couples abstain from alcohol consumption at least 1 month before the attempt to maximize the effectiveness and success of the IVF and GIFT procedure," Dr. Klonoff-Cohen and colleagues advise.
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Alcohol consumptions and miscarriage rates
American Journal of Epidemiology Vol 160 No 7 2004 661-67
Alcohol consumption in the week prior to conception was associated with an increased rate of miscarriage. For women ten or more drinks a week was associated with 2 to 3 times greater risk of miscarriage while for men it was 2 to 5 times greater risk.
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Impact of coffee consumption on conception rates
Yale University School of Medicine. Epidemiologic Reviews Vol 14, Pg 83, 1992
A study of 1,909 women in America found the risk of not conceiving for 12 months was 55% higher for women drinking 1 cup of coffee per day. It was 100% higher for women drinking 1 and one half to 3 cups and 176 % higher for women drinking more than three cups per day. Return to Research Index

Coffee consumption and miscarriage rates
Journal of American Medical Association December 22 1993
Coffee drinking before and during pregnancy was associated with over twice the risk of miscarriage when the mother consumed 2 to 3 cups of coffee per day.
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Smoking and infertility.
These finds came from the British Medical Association 2004 and Fertility and Sterility 2004
Men who smoke have a lower sperm count and a higher proportion of malformed sperm.

Women who smoke take longer to conceive. Women who smoke are twice as likely to be infertile as non smokers. Men and women who smoke have a poorer response to fertility treatment. Women who have stopped smoking take no longer to become pregnant than those who have never smoked. Stopping smoking improves sperm count and quality. Return to Research Index