Psychological distress and in vitro fertilization outcome.

Objective: To examine whether psychological distress predicts IVF treatment outcome as well as whether IVF treatment outcome predicts subsequent psychological distress.

Design: Prospective cohort study over an 18-month period.

Setting: Five community and academic fertility practices.

Patient(s): Two hundred two women who initiated their first IVF cycle.

Intervention(s): Women completed interviews and questionnaires at baseline and at 4, 10, and 18 months' follow-up.

Main Outcome Measure(s): IVF cycle outcome and psychological distress.

Result(s): In a binary logistic model including covariates (woman's age, ethnicity, income, education, parity, duration of infertility, and time interval), pretreatment depression and anxiety were not significant predictors of the outcome of the first IVF cycle. In linear regression models including covariates (woman's age, income, education, parity, duration of infertility, assessment point, time since last treatment cycle, and pre-IVF depression or anxiety), experiencing failed IVF was associated with higher post-IVF depression and anxiety.

Conclusion(s): IVF failure predicts subsequent psychological distress, but pre-IVF psychological distress does not predict IVF failure. Instead of focusing efforts on psychological interventions specifically aimed at improving the chance of pregnancy, these findings suggest that attention be paid to helping patients prepare for and cope with treatment and treatment failure.