I stumbled across this article the other day, which can be found here, describing a new research study by Alice Domar, Ph.D., et al. It will be published in the next issue of Fertility and Sterility. They authors found participation in a mind/body treatment program during IVF cycles significantly improved success rates (52% in the treatment group vs. 20% in the control group). Mind/body treatment is usually offered once weekly for several weeks in a group setting. It combines cognitive behavior therapy, mindfulness and relaxation therapy techniques, and yoga.
At first, I was excited by this news, as I've been a fan of Dr. Domar's work for some time. I think that she has created a very helpful, cost-effective clinical program to help individuals deal with the stress surrounding infertility treatment. However, I was also curious to see the details of the study, because prior research has not consistently demonstrated that participation in a mind/body treatment program is correlated with an increase in treatment success. Further, it often seems that when study results are reported in the mainstream media, they results are often misunderstood or presented as conclusive facts.
The study, which can be found here, was done with 143 women beginning their first IVF cycle at Boston IVF. The women were randomly split into two groups. In the treatment group, the women were offered 10 weekly mind/body sessions. In the control group, the women received spa gift certificates every three months. The two groups of women were not significantly different except for two variables. The women in the treatment group were more likely to work full-time. Also, the embryos of the women in the control group were much more likely to be fertilized using ICSI. This was probably because the women in the control group had a much higher rate of male factor involvement in their infertility treatment (20 percent versus 8 percent in the mind/body treatment group).
The study followed the women over two IVF cycles. In the first IVF cycle, pregnancy rates were the same--43 percent of the women in the treatment and control groups had confirmed clinical pregnancies. However, in the second IVF cycle, the women in the treatment group had a significantly higher pregnancy rate--52 percent--versus the control group, who had a pregnancy rate of 20 percent.
The authors theorized that the reason there was no significant difference in the pregnancy rates during the first IVF cycle was because most of the women in the treatment group had not actually received the mind/body treatment yet. They had predicted it would take longer for the women to start cycling, and the mind/body program is not continuously offered at all times. They argued that the pregnancy rates were higher for the treatment group in the second IVF cycle because by then, almost all of the women had actually attended at least six to ten treatment sessions.
On the face of it, all of this sound pretty good, right? However, when I started really looking at the numbers, I became less convinced. To me, the first troubling issue with this study is that the treatment and control groups were not really diagnostically similar. In the control group, male factor infertility was a much more prevalent cause. Indeed, when the authors reran the statistical analyses to control for male factor infertility, the difference between the second IVF cycle success rates were no longer statistically significant.
Further, the study had difficulty recruiting, and in some cases retaining, participants. This meant that for the second IVF cycle, in which they found their significant results, there were only 21 women in the treatment group left, and 20 in the control group. With such a small sample size, it is difficult to make generalizations to the general IVF population. As the authors point out in the article, it may be that women who are willing and able to participate in a research study, especially those who can attend weekly treatment sessions, may be different than women, who for whatever reasons, cannot. These differences, not the mind/body treatment itself, may be the cause of their higher pregnancy rates.
Thus, I think it is premature to conclude that mind/body programs can significantly improve pregnancy rates for IVF. Further study in this area clearly needs to be done to provide us with more information.
I realize touches on a controversial issue, because there are so many strong and conflicting opinions about whether stress plays a role in causing infertility. For many, the last thing they want to hear is that their own emotions are causing their infertility woes. In contrast, others would love to believe that if they could just change their feelings or mindset, they could transcend the physical difficulties they may have. To make matters worse, the research in this area is all over the map, with some studies showing that stress or depression impairs fertility, others showing it has no effect, and some showing that moderate stress increases fertility rates.
Regardless of the research on pregnancy rates, I still believe that mind/body programs can be very useful during infertility treatment (and probably during a lot of other life difficulties, too). Anything that helps us deal with stress, reconnect with our bodies, and provides support is beneficial. But I wouldn't go into mind/body treatment expecting it to significantly increase your chances of achieving a pregnancy. The way I see it, it might help some people with certain diagnoses to conceive. However, there are also probably some people for whom decreasing stress levels won't change their physical situation, and their chances for pregnancy would remain the same.