Pituitary-adrenal and sympathetic nervous system responses to psychiatric disorders in women undergoing in vitro fertilization treatment
Pituitary-adrenal and sympathetic nervous system responses to psychiatric disorders in women undergoing in vitro fertilization treatment
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DOI：
10.1016/j.fertnstert.2011.05.092
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发表时间：
2011-08-01
影响因子：
6.7
通讯作者：
Wu, Kun
中科院分区：
文献类型：
--
作者：
An, Yuan;Wang, Zhuoran;Wu, Kun
目标：评估心理变量以及下丘脑-垂体-肾上腺（HPA）轴和交感神经系统（SNS）在基线时和对心理社会应激的反应是否会影响接受首次体外受精（IVF）周期的女性的妊娠机会。设计：前瞻性研究。设置：私人IVF中心。患者：264名接受IVF或卵胞浆内单精子注射（ICSI）治疗的妇女。干预措施：卵巢刺激后取卵。主要结果测量：标准化的心理问卷来评估焦虑和抑郁，结果：治疗期间，心理评分仅呈上升趋势，但不影响妊娠率。在取卵当天，去甲肾上腺素和皮质醇浓度在统计学上显著增加，在治疗成功的女性中，血清和卵泡液中去甲肾上腺素和皮质醇浓度较低。治疗前血清和卵泡液中类固醇浓度与状态焦虑评分呈正相关。结论：去甲肾上腺素和皮质醇浓度可能对IVF治疗的临床妊娠率产生负面影响。这些生物应激标志物可能是IVF-ICSI后心理社会应激与结局之间复杂关系的联系之一。（Fertil Steril（R）2011;96：404-8. (C)美国生殖医学会（American Society for Reproductive Medicine）
Objective: To evaluate whether psychological variables as well as changes in hypothalamus-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) at baseline and in response to a psychosocial stressor affect the chance of achieving pregnancy in women undergoing a first in vitro fertilization (IVF) cycle.Design: Prospective study.Setting: Private IVF center.Patient(s): 264 women undergoing IVF or intracytoplasmic sperm injection (ICSI) treatment.Intervention(s): Oocyte retrieval after ovarian stimulation.Main Outcome Measure(s): Standardized psychological questionnaires to assess anxiety and depression, and norepinephrine and cortisol in serum or follicular fluid measured by specific assays.Result(s): Only a trend increase was found in psychological scores during treatment, which did not affect the ongoing pregnancy rates. On the oocyte retrieval day, a statistically significant increase in norepinephrine and cortisol concentrations was found. Lower concentrations of norepinephrine and cortisol, both in serum and follicular fluid, were found in women whose treatments were successful. Concentrations of steroid in serum before treatment and in follicular fluid were positively associated with the State Anxiety scores.Conclusion(s): Norepinephrine and cortisol concentrations may negatively influence the clinical pregnancy rate in IVF treatment. These biological stress markers could be one of the links in the complex relationship between psychosocial stress and outcome after IVF-ICSI. (Fertil Steril (R) 2011;96:404-8. (C) 2011 by American Society for Reproductive Medicine.)