Cognitive-behavioral treatment decreases cardiovascular and neuroendocrine reaction to stress in women waiting for assisted reproduction

A higher cardiovascular vulnerability to stress is associated with a lower pregnancy rate during in vitro fertilization and embryo transfer (IVF-ET) program. The present study was carried out to assess whether cognitive-behavioral treatment (CBT) program attenuates autonomic and neuroendocrine response to a stressful task in infertile women waiting for IVF-ET. Forty-five consecutive couples referred to our Department for assisted reproduction were enrolled. Mean duration of infertility was 3.1 years. Two-thirds of them already failed an IVF-ET attempt. Once included in the waiting list women were administered the Stroop colorword (CW). Systolic BP, heart rate (HR) and plasma cortisol were serially measured. Subjects showing a positive HR reaction were selected to receive CBT (12 group sessions over 16 weeks) while the remnants just waited, for the same period of time (observation group). After 17-19 weeks subjects were re-submitted to the Stroop CW. The HR response to Stroop CW was significantly reduced by CBT while it remained unchanged in the observation group. Similarly, systolic BP response was reduced after CBT whereas an increase occurred in the observation group. After CBT, a significant decrease in the reaction of plasma cortisol to Stroop CW took place whereas no changes were observed in the other subjects. The present findings indicate that CBT is useful for decreasing the level of distress in patients submitted to IVF-ET treatment. (C) 2003 Elsevier Ltd. All rights reserved.