A study of women's moods during IVF has found a strong relationship between negative mood and multiple embryo transfer.Dr Christopher Newton of the University Hospital at London Health Sciences Centre, London, Canada, said that his work could lead to better understanding of the importance of couples' emotional health during IVF treatment, and the effect this has on their decision-making.
A reduction in the incidence of multiple pregnancies with IVF requires the transfer of fewer, and ideally only one, embryo (single embryo transfer, or SET). However, many women resist SET because they either favour a multiple pregnancy, or prefer to accept the risk rather than take the chance of not getting pregnant.
"Research quite unrelated to infertility - for example, in gambling or playing the lottery - had shown that decision-making could be influenced by particular mood states and by the individual tendencies of some people to engage in greater risk taking behaviour", said Dr Newton. "We decided to see whether this was equally applicable in assisted reproduction."
The team asked 129 female infertility patients to undertake a standardised questionnaire, the Profile of Mood States (POMS), one month before hospital UVF treatment.
POMS measures such transient moods as anxiety, depression, anger and fatigue, and provides a total score of overall distress. The women also completed a Fertility Problem Inventory (FPI), that assesses and measures infertility-specific social, sexual, and relationship stress.
Finally, the women were asked to rate the desirability of having a twin or triplet versus a singleton pregnancy; the perceived likelihood or a twin or singleton pregnancy; and the desirability of SET.
"Risk taking behaviour was measured by asking women to make a graded endorsement of a lower risk versus a higher risk option - SET versus two embryo transfer (2ET), and 2ET versus three embryo transfer (3ET), and then rating the riskiness of each choice", said Dr. Newton.
"We found a significant association between women's mood states and their perceptions of the likelihood of a multiple pregnancy. Women estimated their chance of having a multiple pregnancy as lower when they were experiencing more negative moods.
When asked to choose between SET and 2ET, women with more negative moods also rated their choices as more risky. One possible explanation is that negative moods lead women to knowingly make more risky choices."
In a follow up study, Dr. Newton and his team plan to determine whether providing women with accurate risk information will influence their decisions about how many embryos to transfer.
"If infertility patients were to gain a better understanding or the risks and benefits of transferring more or fewer embryos, and the acceptability of SET were to increase, there could be huge benefits, not just emotional and physically to mothers and children, but also in terms of costs to healthcare systems", he said.