Optimising success in reproductive techniques

fertility Optimising success in reproductive techniques: Decreasing emotional distress by improving personal care 

by Ana Rita S. Coutinho,
Clinical Embryologist,
certified (CFAS), MDV, PhD
Founder and Scientific Director for Animus Biotechnology, Montreal, Quebec, Canada.


Successful pregnancy requires the coordination of an array of signals and molecules from multiple tissues that can be compromised by several stress agents. Reproductive health problems and subsequent treatment can be a source of distress such that 20-25% of the women experience minor to severe distress, which can either reduce quality of life or efficacy of continuation of reproductive techniques (Verhaak et al., 2010; Gameiro et al., 2013). Natural interventions to reduce stress have been shown to have positive effects on pregnancy rates, without harm or unintended effects on assisted reproduction (Kiltz, 2014; Van Dogean et al., 2016). Non-invasive techniques (e.g. IUI) will provide a lower level of distress when compared to invasive techniques. IVF/ ICSI success rates are much higher than they were before compared to IUI that has not been changed. Although IUI is widely practiced, the technique is still used as an empiric treatment with little evidence of effectiveness (5 to 17%), directly influenced by the laboratory standards (Rao 2014).
Stress connection
It has already been demonstrated that natural therapies such as psychological support and exercize reduce stress and improve empowerment in patients undergoing surgery or chemotherapy (Braun, 2016; Van den Berg et al., 2012). The link between infertility and stress is also well recognized, confirming that under a lower level of stress the conception rates are higher (Domar et al., 2000).
Emotional distress produces toxic markers that, at a high level, may negatively interfere with the communication between the endometrium and the embryo, increasing the chance of implantation failure and miscarriage. Detecting and addressing emotional distress is required for patients and recommended by the ESHRE 2015 guideline. To reduce stress during fertility care is paramount to create a relationship of trust among doctor, patient and paramedical group; whereas, full anamneses and precise diagnostic will support the patient’s expectation. In addition, the study of the reproductive system under lower-level distress is important to better understand the ideal scenario for a successful pregnancy.

Integrated care

Physicians, psychologists, embryologists, nurses, laboratory technicians, natural therapists and others actively support the field of reproductive medicine and should be part of the care team. The group should have a comprehensive understanding of the patient’s prognosis in order to ensure the right fertility treatment incorporated with an alternative plan with one goal: improve daily life’s behavior to enhance conception. Alternative treatments address a variety of conditions associated with reproduction including stress and anxiety reduction that is fundamental to, regulating the menstrual cycle with better accuracy of ovulation timing in natural and modified-natural stimulation, improving egg and sperm quality during the three months prior to conception, improving blood flow in the uterus, decreasing the chance of miscarriage and others. It is important to meet the patients’ needs; consequently, more therapy choices are offered with better personalized plans. These integrated therapies may include lifestyle coaching, exercises, nutritional counselling, acupuncture, massage, art therapies and others that could be offered in isolated or combined therapies.

Increasing effectiveness and decreasing cost

The prevention of infertility is still the most important and cost-effective treatment strategy that could be supported by the members of integrative care. Low-cost ovarian stimulation protocols encourage the use of natural cycles, modified-natural cycles and mild ovarian stimulation. Improving IUI efficiency is a requisite to avoid more costly and invasive procedures that will contribute to increasing patient compliance and avoid discontinuation of IVF treatment. Everyone will benefit and the budget, normally offered by the national healthcare, will be better allocated among the target population. It is essential to work up with eligible couples (e.g. woman less than 40 years with good ovarian reserve, normal or mild male factors infertility) in order to reach higher effectiveness using IUI. Because of the differences among patients, standard management should be avoided. A personal program is required either to monitor the follicular phase or to optimize sperm washing to reach the ideal amount of motile sperm (TCM between10 to 20 million/mL).


Personalized care in assisted fertility is recommended and promising. Improving patients’ supervision will create a trusted environment with the active partnership among the mains actors (physician-patient-paramedical) that will reduce distress levels in treated patients with a positive effect on assisted reproduction. In parallel, non-invasive treatment will offer a natural model to investigate the reproductive pathways using a model closer to the physiological system using minimal hormonal stimulation. Although developments in ART have led to numerous interventions designed to improve human fertility, infertility care is not a priority in almost all reproductive health care centres. Consequently, further investigation to improve fertility programs’ success and feasibility must be achieved in multiple places and countries in order to improve participation and generalization.


Posted with the kind permission of Ana Rita S. Coutinho                                                                                                                             Article first appeared in Fertility Magazine • Volume 19 • www.FertMag.com



Domar, A.; Clapp, D.; Slawaby, E.; Dusek, J.; Kessel, B., Freizinger, M (2000) Impact of group psychological interventions on pregnancy rates in infertile women. Fertility and Sterility 73(4): 805-811. Braun, D (2016) Cancer therapy. In. ‘The New Yorkes’, pp.9-10. Gameiro, S.; Boivin, J.; Domar, A (2013) Optimal in vitro fertilization in 2020 should reduce treatment burden and enhance care delivery for patients and staff. Fertility and Sterility 100: 302-308. Kiltz, R. (2014) The fertile secret: an integrative approach to fertility care. In. ‘Fertility Magazine’. pp. 36-37. Rao, K.; Carp, H.; Fisher, R (2014) Principles & practice of assisted reproductive technology, 632-649 (Jaypee brothers medical publishers) Van Dongen, A.; Nelen, W.; IntHout, J.; Kremer, J.; Verhaak, C (2016) e-Therapy to reduce emotional distress in womwn undergoing assisted reproductive technology (ART): a feasibility randomized controlled trial. Human Reproduction 1: 1-12.


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