Perceived stress and markers of ovarian reserve among subfertile women.

Lidia Mínguez-Alarcón, Paige L Williams, Irene Souter, Jennifer B Ford, Russ Hauser, Jorge E Chavarro

Journal: Reproductive biomedicine online 2023;46(6):956-964

PMID: 37085427

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Abstract

RESEARCH QUESTION

Is self-reported psychological stress associated with markers of ovarian reserve among subfertile women?

DESIGN

Observational study of women (n = 520) seeking fertility care at the Massachusetts General Hospital who enrolled in the Environment and Reproductive Health study between 2005 and 2019. Women completed the short version of the validated PSS4, which assesses psychological stress. Ovarian reserve markers included AFC and circulating serum levels of day-3 FSH, with AMH assessed in a subset of participants (n = 185).

RESULTS

Higher total PSS4 scores were negatively associated with AFC and serum AMH levels. Analyses adjusted for age, BMI, race, smoking, education, physical activity and type of infertility diagnosis. Women in the second and third tertiles of stress had lower AFC (13.3, 95% CI 12.7 to 13.8; and 13.5, 95% CI 13.0 to 14.1) compared with women in the lowest tertile of psychological stress score (14.3, 95% CI 13.8 to 14.9, both P < 0.05). Women in the second and third tertiles of total PSS4 scores also had lower mean serum AMH compared with women in the lowest tertile (2.99, 95% CI 2.24 to 3.74), and (2.99 95% CI 2.22 to 3.76) versus (3.94 95% CI 3.23 to 4.64). These associations varied by several socioeconomic factors, and were observed among women who were younger, belonging to minority races, with a college degree or with annual household income less than $100,000.

CONCLUSIONS

Higher perceived stress was negatively associated with AFC and serum AMH levels. These associations varied by several socioeconomic factors.

Address: Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital; Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, USA. Electronic address: [email protected].; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA; Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, USA.; Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.; Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, USA.; Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA; Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, USA.; Channing Division of Network Medicine, Harvard Medical School and Brigham and Women's Hospital; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA; Departments of Nutrition, Harvard TH Chan School of Public Health, Boston, USA.

DOI: 10.1016/j.rbmo.2023.01.024

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MeSH Terms: Female, Humans, Ovarian Reserve, Ovarian Follicle, Infertility, Female, Anti-Mullerian Hormone