- Email: [email protected]
The relationship between stress and IVF outcome
O-224 Wednesday, October 27, 2010 04:30 PM MINNESOTA MULTIPHASIC PERSONALITY INVENTORY 2 (MMPI-2) SUPPLEMENTARY SCALE PROFILES OF APPLICANTS TO A GESTATIONAL CARRIER (GC) PROGRAM. T. H. Simpson, T. L. Raque-Bogdan, E. J. Mindes, C. B. Toll, K. S. Richter, S. N. Covington. Shady Grove Fertility Reproductive Science Center, Rockville, MD; Department of Counseling and Personnel Services, University of Maryland, College Park, MD. OBJECTIVE: The MMPI-2 is often used as part of GC psychological screening. No known research has examined the MMPI-2 supplementary scales profiles of GC candidates. The purpose of this study was to examine several supplementary scales of the MMPI-2 profiles of GC applicants, compare mean supplementary score profiles with the MMPI-2 normative sample, and compare mean MMPI-2 supplementary scores between applicants excluded or not excluded by the psychological screening process. DESIGN: Observational study. MATERIALS AND METHODS: Charts of all GC applicants at a large fertility center from 6/07-12/09 were reviewed. Applicants underwent standardized psychological screening including clinical interviews and MMPI-2. Mean T-scores of MMPI-2 supplementary scales among GCs were compared with mean T-scores (50) of the supplementary scales normative sample by t-test. T-tests were used to compare T-scores of the supplementary scales between applicants excluded or not by the psychological screening process. RESULTS: Mean T-scores of GC applicants (n¼101) were above the norm on the supplementary scales R (56, p< .0001), Es (59, p< .0001), Re (59, p< .0001), and O-H (61, p< .0001) and below the norm on the MAC-R (47, p¼ .002), AAS (45, p< .0001), and APS (43, p< .0001). Scores on the R, Es, Re, O-H, MAC-R, AAS, and APS failed to be statistically different for those applicants who were rejected based on psychological reasons compared to the applicants who were accepted. CONCLUSION: No known research had examined the MMPI supplementary scale score results among GC candidates. Scores reflected GC participants as more socialized and responsible as well as having adopted a conventional and cautious lifestyle. In addition, the results of the study demonstrated GC applicants have a tendency to attempt to create a favorable impression, place emphasis on setting high standards for themselves, and are stable, reliable, responsible, and self-confident. Finally, the participant scores suggest lack of alcohol or other substance abuse problems.
O-225 Wednesday, October 27, 2010 04:45 PM THE RELATIONSHIP BETWEEN STRESS AND IVF OUTCOME. A. D. Domar, K. L. Backman, D. Friscia, J. Orav, J. Nikolovski. Domar Center for Mind/Body Health, Boston IVF, Waltham, MA; Johnson & Johnson Consumer and Personal Products Worldwide, Division of Johnson & Johnson Consumer Companies, Inc., Skillman, NJ; Department of Medicine, Brigham and Woman’s Hospital, Boston, MA. OBJECTIVE: Determine the relationship between stress and outcome in first-time IVF patients. DESIGN: Randomized controlled prospective study. MATERIALS AND METHODS: 148 women completed a series of baseline psychological questionnaires prior to being randomized to 10 session mind body(MB) program or to control group(C). Subjects were followed for up to two cycles and data were analyzed across both cycles. RESULTS: There were no differences between the groups on baseline variables; both groups had lower mean baseline stress scores than normally seen for infertility patients. To increase power, data for the groups were combined; analyses were adjusted for intervention. The average time between completion of the baseline variables and cycle 1 start was 30 days. All psychological variables had the same relationship: higher scores at baseline were associated with greater chance of pregnancy. Two of the measures reached significance: Perceived Stress Scale(PSS) p¼ .02 and the State/Trait Anxiety Inventory, p¼ .04. When group assignment was accounted for, MB patients who conceived had a mean baseline Beck Depression score of 10.1 while the ones who did not had a score of 5.7. For C subjects, those who conceived had a baseline score of 9.8 and those who did not it was 10.8. For patients whose baseline on the PSS was over 20, 100% of the MB patients conceived versus only 57% of the C’s. Adjusting for baseline PSS, MB was significantly related to pregnancy across both cycles (p¼ .03). CONCLUSION: In this sample of patients with low to moderate levels of stress, those with moderate levels at baseline were more likely to conceive than those with low levels. MB patients with moderate levels of stress at base-
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Abstracts
line were more likely to conceive than control patients with moderate levels. The relationship between stress and IVF outcome is complex; it is possible that a moderate level of stress prior to cycle start is beneficial as long as patients have the opportunity to learn stress-reduction skills. Supported by: Johnson & Johnson Consumer Companies, Inc.
O-226 Wednesday, October 27, 2010 05:00 PM ACCESS TO FERTILITY PRESERVATION AND POST-CHEMOTHERAPY ASSISTED REPRODUCTION IN WOMEN WITH BREAST CANCER. S. Lee, E. Heytens, S. Ozkavukcu, A. Rosen, F. Moy, K. Oktay. Institute for Fertility Preservation/Department of Obstetrics & Gynecology, New York Medical College, Valhalla, NY; Biometrics, Data Management and PK/PD Unit/Department of Pathology, New York Medical College, Valhalla, NY. OBJECTIVE: Fertility preservation (FP) is an emerging discipline that now has a key place in the care of young people with cancer. We evaluated the socio-economic, demographic, and medical factors that influence referral either before cancer treatment to FP or post-chemotherapy to assisted reproduction (PCART). DESIGN: Retrospective analysis of data from a Cancer & Fertility program. MATERIALS AND METHODS: Data were available from 314 patients with breast cancer (BCa) who were counseled for FP (n¼218) or PCART (n¼96) from June 1999 to July 2009. Household income estimates were generated from a public database based on postal codes. RESULTS: Mean age at diagnosis trended higher (34.5 5.0 vs 30.9 7.8, p¼0.056) and the proportion of women <35 years of age was lower (63.6% vs 76.8%, p¼0.014) in FP vs PCART. Ninety percent presented with early stage (%3) cancer. Before 2000, all were referred post-chemo for ART; none were evaluated by a mental healthcare professional (MHP). From 2000 to 2009 proportion of referrals for FP increased continually; 62.4% in 2000-2003, 74.1% in 2004-2007, and 92.5 % in 2008 or later. In 2009, nearly all (95.5%) were FP patients and all were counseled by a MHP. The majority (63.8%) was referred from an academic center, 27.9% from a local oncologist, and 2.5% from a community hospital. Patients with a family history of BCa but no other type of cancer were more likely to consult for FP before chemo, compared to those without (75.2% vs 64.3%, p¼0.044). There was no association with occupation, income, race, ethnicity, obstetrical history, and prior infertility. Only 22.9% of those counseled in PCART compared to 45.0% in the FP group proceeded with a procedure (p<0.001). CONCLUSION: There has been an increasing trend within the last 10 years for early referral of BCa patients to FP and MHP. Factors favoring referrals are older age, early stage cancer, family history of BCa, and receiving cancer care at an academic center. Those seen before chemotherapy are more likely to receive an intervention. Supported by: NIH HD 053112.
O-227 Wednesday, October 27, 2010 05:15 PM MINNESOTA MULTIPHASIC PERSONALITY INVENTORY 2 (MMPI-2) SCORES COMPARING OOCYTE DONOR (OD) AND GESTATIONAL CARRIER (GC) APPLICANTS. S. N. Covington, S. C. Klock. Shady Grove Fertility Reproductive Science Center, Rockville, MD; Feinberg School of Medicine, Northwestern University, Chicago, IL. OBJECTIVE: The MMPI-2 is frequently used in the psychological screening of OD and GC applicants, yet no research has compared scores between these two groups. The purpose of this study was to examine similarities and differences in MMPI-2 scores among these different participants in third party reproduction. DESIGN: Observational study. MATERIALS AND METHODS: Women who applied to be ODs and GCs were identified from a large fertility program. All OD and GC applicants underwent a preliminary medical screening and were then referred for psychological assessment, completing the MMPI-2 along with clinical interviews. The MMPI-2 validity, clinical and supplementary scale T-scores were compared between the two groups with a level of p < .001 considered significant. RESULTS: The sample was comprised of 419 prospective ODs and 97 GCs. The aggregate MMPI-2 profiles for both groups were in the normal range. Typical elevations on L and K, indicating defensiveness in the evaluative setting, were noted for both groups.
Vol. 94., No. 4, Supplement, September 2010
O-225 Wednesday, October 27, 2010 04:45 PM THE RELATIONSHIP BETWEEN STRESS AND IVF OUTCOME. A. D. Domar, K. L. Backman, D. Friscia, J. Orav, J. Nikolovski. Domar Center for Mind/Body Health, Boston IVF, Waltham, MA; Johnson & Johnson Consumer and Personal Products Worldwide, Division of Johnson & Johnson Consumer Companies, Inc., Skillman, NJ; Department of Medicine, Brigham and Woman’s Hospital, Boston, MA. OBJECTIVE: Determine the relationship between stress and outcome in first-time IVF patients. DESIGN: Randomized controlled prospective study. MATERIALS AND METHODS: 148 women completed a series of baseline psychological questionnaires prior to being randomized to 10 session mind body(MB) program or to control group(C). Subjects were followed for up to two cycles and data were analyzed across both cycles. RESULTS: There were no differences between the groups on baseline variables; both groups had lower mean baseline stress scores than normally seen for infertility patients. To increase power, data for the groups were combined; analyses were adjusted for intervention. The average time between completion of the baseline variables and cycle 1 start was 30 days. All psychological variables had the same relationship: higher scores at baseline were associated with greater chance of pregnancy. Two of the measures reached significance: Perceived Stress Scale(PSS) p¼ .02 and the State/Trait Anxiety Inventory, p¼ .04. When group assignment was accounted for, MB patients who conceived had a mean baseline Beck Depression score of 10.1 while the ones who did not had a score of 5.7. For C subjects, those who conceived had a baseline score of 9.8 and those who did not it was 10.8. For patients whose baseline on the PSS was over 20, 100% of the MB patients conceived versus only 57% of the C’s. Adjusting for baseline PSS, MB was significantly related to pregnancy across both cycles (p¼ .03). CONCLUSION: In this sample of patients with low to moderate levels of stress, those with moderate levels at baseline were more likely to conceive than those with low levels. MB patients with moderate levels of stress at base-
S66
Abstracts
line were more likely to conceive than control patients with moderate levels. The relationship between stress and IVF outcome is complex; it is possible that a moderate level of stress prior to cycle start is beneficial as long as patients have the opportunity to learn stress-reduction skills. Supported by: Johnson & Johnson Consumer Companies, Inc.
O-226 Wednesday, October 27, 2010 05:00 PM ACCESS TO FERTILITY PRESERVATION AND POST-CHEMOTHERAPY ASSISTED REPRODUCTION IN WOMEN WITH BREAST CANCER. S. Lee, E. Heytens, S. Ozkavukcu, A. Rosen, F. Moy, K. Oktay. Institute for Fertility Preservation/Department of Obstetrics & Gynecology, New York Medical College, Valhalla, NY; Biometrics, Data Management and PK/PD Unit/Department of Pathology, New York Medical College, Valhalla, NY. OBJECTIVE: Fertility preservation (FP) is an emerging discipline that now has a key place in the care of young people with cancer. We evaluated the socio-economic, demographic, and medical factors that influence referral either before cancer treatment to FP or post-chemotherapy to assisted reproduction (PCART). DESIGN: Retrospective analysis of data from a Cancer & Fertility program. MATERIALS AND METHODS: Data were available from 314 patients with breast cancer (BCa) who were counseled for FP (n¼218) or PCART (n¼96) from June 1999 to July 2009. Household income estimates were generated from a public database based on postal codes. RESULTS: Mean age at diagnosis trended higher (34.5 5.0 vs 30.9 7.8, p¼0.056) and the proportion of women <35 years of age was lower (63.6% vs 76.8%, p¼0.014) in FP vs PCART. Ninety percent presented with early stage (%3) cancer. Before 2000, all were referred post-chemo for ART; none were evaluated by a mental healthcare professional (MHP). From 2000 to 2009 proportion of referrals for FP increased continually; 62.4% in 2000-2003, 74.1% in 2004-2007, and 92.5 % in 2008 or later. In 2009, nearly all (95.5%) were FP patients and all were counseled by a MHP. The majority (63.8%) was referred from an academic center, 27.9% from a local oncologist, and 2.5% from a community hospital. Patients with a family history of BCa but no other type of cancer were more likely to consult for FP before chemo, compared to those without (75.2% vs 64.3%, p¼0.044). There was no association with occupation, income, race, ethnicity, obstetrical history, and prior infertility. Only 22.9% of those counseled in PCART compared to 45.0% in the FP group proceeded with a procedure (p<0.001). CONCLUSION: There has been an increasing trend within the last 10 years for early referral of BCa patients to FP and MHP. Factors favoring referrals are older age, early stage cancer, family history of BCa, and receiving cancer care at an academic center. Those seen before chemotherapy are more likely to receive an intervention. Supported by: NIH HD 053112.
O-227 Wednesday, October 27, 2010 05:15 PM MINNESOTA MULTIPHASIC PERSONALITY INVENTORY 2 (MMPI-2) SCORES COMPARING OOCYTE DONOR (OD) AND GESTATIONAL CARRIER (GC) APPLICANTS. S. N. Covington, S. C. Klock. Shady Grove Fertility Reproductive Science Center, Rockville, MD; Feinberg School of Medicine, Northwestern University, Chicago, IL. OBJECTIVE: The MMPI-2 is frequently used in the psychological screening of OD and GC applicants, yet no research has compared scores between these two groups. The purpose of this study was to examine similarities and differences in MMPI-2 scores among these different participants in third party reproduction. DESIGN: Observational study. MATERIALS AND METHODS: Women who applied to be ODs and GCs were identified from a large fertility program. All OD and GC applicants underwent a preliminary medical screening and were then referred for psychological assessment, completing the MMPI-2 along with clinical interviews. The MMPI-2 validity, clinical and supplementary scale T-scores were compared between the two groups with a level of p < .001 considered significant. RESULTS: The sample was comprised of 419 prospective ODs and 97 GCs. The aggregate MMPI-2 profiles for both groups were in the normal range. Typical elevations on L and K, indicating defensiveness in the evaluative setting, were noted for both groups.
Vol. 94., No. 4, Supplement, September 2010