Is self-reported psychological stress associated with markers of ovarian reserve among subfertile women?
This observational study included 520 women seeking fertility care at the Massachusetts General Hospital who enrolled in the Environment and Reproductive Health (EARTH) study between 2005 and 2019. Women completed the short version of the validated Perceived Stress Scale 4 (PSS-4), which assesses psychological stress. Ovarian reserve markers included Antral Follicle Count (AFC), circulating serum levels of day-3 follicle stimulating hormone (FSH) and anti-Müllerian hormone (AMH) assessed in a subset of participants (n=185).
We observed that higher total PSS4 scores were negatively associated with AFC and serum AMH levels in analyses adjusted for age, BMI, race, smoking, education, physical activity, and type of infertility diagnosis. Specifically, women in the second and third tertiles of stress had, on average, -7 (95% CI=-20, -13) % and -6 (95% CI=-11, -1) %, respectively, lower AFC compared to women in the lowest tertile of psychological stress score. Women in the second and third tertiles of total PSS4 scores also had -24 (95% CI=-43, -9) % and -24 (95% CI=-34, -5) %, respectively, lower mean serum AMH compared to women in the lowest tertile. These associations varied by several socioeconomic factors and were observed primarily among women who were younger, belonging to minority races, with a college degree, or with annual household income <$100,000.
Higher perceived stress was negatively associated with AFC and serum AMH levels, and these associations varied by several socioeconomic factors. These results add to the existing epidemiologic literature on health effects of psychologic stress in women.
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Dr. Mínguez-Alarcón is an Assistant Professor at the Harvard Medical School/Brigham and Women's Hospital in Boston and her research focuses on identifying chemical and non-chemical stressors of human fertility, reproductive and cardiometabolic health.
Accepted: January 31, 2023
Received in revised form: January 30, 2023
Received: October 31, 2022
Publication stageIn Press Journal Pre-Proof
Study funding: The project was financed by Grants (R01ES022955, R01ES033651, R01ES009718 and P30ES000002) from the National Institutes of Health. This project was also supported by NIH Research Grant 1U54 AG062322-01 funded by The National Institute on Aging (NIA) and Office of Research on Women's Health (ORWH).”
© 2023 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.