The association of physiological cortisol and IVF treatment outcomes: a systematic review
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REVIEW ARTICLE
The association of physiological cortisol and IVF treatment outcomes: a systematic review Adam J. Massey • Bruce Campbell • Nick Raine-Fenning • Navneet Aujla Kavita Vedhara
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Received: 11 February 2014 / Accepted: 24 March 2014 Japan Society for Reproductive Medicine 2014
Abstract Purpose A systematic review was conducted to (1) collate and synthesise the available evidence for the role of cortisol in relation to IVF treatment outcomes; (2) to establish the strength of an association between cortisol and IVF; and (3) to assess the overall quality of the studies and guide future research in this area. Methods Seven electronic databases, including the reference lists of published papers, were searched. Inclusion criteria qualified any prospective/observational cohort study that reported original data. Quality assessment of eligible studies was conducted using the STROBE statement, which was used to assess the risk of bias and the quality of observational studies included in this review. Result(s) A total of eight studies reported a significant association between cortisol and IVF outcomes. Three studies found that higher cortisol may be associated with
(PROSPERO registration number: CRD42013003566). A. J. Massey (&) B. Campbell N. Raine-Fenning Faculty of Medicine and Health, School of Clinical Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2RD, UK e-mail: [email protected] B. Campbell e-mail: [email protected] N. Raine-Fenning e-mail: [email protected] N. Aujla K. Vedhara Division of Primary Care, University of Nottingham, 13th Floor Tower Building, University Park, Nottingham NG7 2RD, UK e-mail: [email protected] K. Vedhara e-mail: [email protected]
more favourable IVF outcomes, whereas five studies found that lower cortisol levels may be conducive to IVF success. Eleven of all studies included in this review were regarded as low quality publications. Conclusion(s) Study findings were that the evidence for the role of cortisol in relation to IVF outcomes is currently mixed. Future researchers are encouraged to consider the methodological limitations highlighted in this review and to utilise more robust assessment methods when examining the influence that chronic, rather than acute, stress may have on IVF outcomes. Keywords Cortisol Hypothalamus pituitary adrenal (HPA) axis Infertility In Vitro Fertilisation (IVF) Stress
Introduction An area that has received growing interest in recent years is the potential role that psychological stress may play in determining in vitro fertilisation (IVF) treatment outcomes. At least anecdotally, many infertile women and health care professionals alike believe that the experience of stress can play an important role in the difficulties that infertile patients face, and thus may be a contributing factor in determining the eventual outcome of IVF [1]. Whilst research in this area has been mixed, two recent systematic reviews suggest that self-reported p
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