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Studies on psychosomatic implications of infertility--effects of emotional stress on fertilization and implantation in in-vitro fertilization.

A case report shows the long and stony path of a couple who had to go through eight attempts at IVF in 4 years until the desired child was achieved. The psychosomatic implications of the various 'failures' of treatment become clearer when compared with the results of a psycho-endocrinological questionnaire completed by 551 patients and 115 controls since 1982. This questionnaire contains among others the Giessen personality test for the image of self, mother and father, a somatic complaints score to evaluate the severity of autonomic disorders, items for the presence and severity of possible gynaeco-endocrinological symptoms and items to evaluate the reference persons and their changes during childhood. The following results could be obtained. In a comparison of the means of 58 different somatic complaints, patients rated significantly higher than controls (P = 0.002). Women with menstrual disturbances, menstrual pains, acne or unclear skin or dry skin also suffered more from other complaints. These symptoms were also correlated with a higher score for depressive mood. Those women who were not brought up by both parents during their childhood also scored significantly higher (P less than 0.0001) in the somatic complaints score. In the Giessen personality test patients appeared significantly more compulsive (P less than 0.002) and depressive (P = 0.003) than the controls and identified themselves more with their mothers. From 60 patients in our IVF programme, 19 had no fertilization of oocytes and scored significantly higher (P = 0.008) on the social potency scale than did the patients with fertilized oocytes. Women with unsuccessful treatments in terms of pregnancy scored significantly higher in the social resonance and social potency tests. We interpret this exaggerated positive attitude as an attempt to overcome inner fears, doubts and ambivalences. These results support the importance of psychosomatic aspects in infertility and reassure us of the necessity of including counselling in any infertility treatment, including IVF.