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21 June 2006
Ovulation A Case Of Mind Over Matter?

Fertility researchers from Emory University in Georgia, speaking at the 22nd annual conference of the European Society of Human Reproduction and Embryology, claimed that fertility can be restored in some women by the use of behavioral therapy, thus negating the need for expensive fertility treatments and procedures.

Emory's Sarah L. Berga said that her work was the first to show that reducing stress through psychological intervention could restore ovulation in women whose ovarian function had previously been impaired. "Contrary to what had previously been believed, we found that multiple small stressors that seemingly would have minimal impact on reproductive competence can play a major role in causing anovulation [ovulation failure]. Up till now it was thought that failure to ovulate was usually caused by the energy deficits induced by excessive exercise and/or under-nutrition, but we asked why women undertake such behaviors. Often dieting and exercise are a way of coping with psychosocial stress, and our previous work had shown that such stress is often increased in women who do not ovulate," explained Berga.

Berga and her team set out to study the causes of functional hypothalamic amenorrhea (FHA) in women of normal weight who had not had a menstrual period for more than six months. FHA is caused by a prolonged reduction in gonadotropin-releasing hormone (GnRH), which signals the release into the bloodstream of hormones that simulate ovulation. Analysis of the cerebrospinal fluid in women with FHA, as opposed to women who were ovulating normally, showed increased levels of cortisol, a hormone related to stress.

Chronic cortisol increases can often be reversed with behavioral therapy, so Berga's team conducted a small study of 16 women, all with FHA. One-half of the women received cognitive behavior therapy (CBT) for 20 weeks and the other half were only observed. "A staggering 80 percent of the women who received CBT started to ovulate again, as opposed to only 25 percent of those randomized to observation", said Berga. "Neither group gained weight nor showed significant changes in their levels of leptin, a hormone involved in regulating body weight and metabolism. This study underlines the important contribution that lifestyle factors play in determining overall health and reproductive health in particular."

The most common treatment for anovulatory women is to offer hormonal treatments. "Aside from cost, these approaches mask ongoing endocrine disturbance", said Berga. "Since these disturbances pose a risk to overall health, it is important to use a therapy that restores the endocrine system, including the reproductive system. Cognitive behavior therapy offers a holistic treatment that is safe, cost effective, and easy to implement."

Berga now intends to conduct a multi-center trial involving a large number of women. "If the larger scale study confirms our earlier results," said Berga, "we will have very strong evidence for offering stress reduction as an effective therapy for a significant group of infertile women."

Source: European Society for Human Reproduction and Embryology

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