The Use of Virtual Reality Technology in Infertile Women Undergoing in Vitro Fertilization-embryo Transfer: A Randomized Controlled Trial

In vitro fertilization (IVF) treatment involving ovarian stimulation, oocyte retrieval and embryo transfer (ET) is an effective treatment for various causes of infertility. Despite advances in ovarian stimulation regimens and laboratory conditions, many IVF cycles do not result in pregnancy, and repeated treatment cycles are required. According to the latest Assisted reproductive technology (ART) surveillance report in the United states, of 143,286 procedures that progressed to the ET stage, 50.9% resulted in a pregnancy and 41.4% in a live-birth. Achieving higher pregnancy and live birth rates remains a leading priority of IVF units worldwide. Both IVF practitioners and patients keep searching for new ways to improve reproductive outcomes.

IVF is a multidimensional stressor. The treatment itself constitutes the primary stressor and is most likely to evoke anxiety. The highest anxiety scores were experienced before embryo transfer and were comparable to anxiety scores obtained from surgical female patients in the immediate preoperative period. Hence, it is not surprising that ET is defined by many investigators as a crucial event for determining IVF outcome, and many patients perceive it as the culmination of the IVF treatment. The stress this procedure may cause can result in a variety of autonomous nervous system expressions, altered uterine gene expression, resulting in decreased uterine receptivity, or an increase in uterine contraction frequency, which may be inversely correlated to embryo implantation and pregnancy rates in IVF. Several studies found that women who did not become pregnant with IVF, reported experiencing more stress during treatment than those who achieved pregnancy.

Although the exact mechanism whereby stress interferes with reproductive processes is not fully understood, experimental evidence increasingly indicates that lower stress levels result in better fertility treatment outcome.

The use of complementary medicine or adjuvant therapies to reduce psychological stress during ART therapy and improve IVF outcomes is increasing. Various alternative therapies have been proposed to improve reproductive outcomes during IVF treatment, such as acupuncture and Chinese herbal medicines. However, the impact of these therapies on IVF outcomes was inconclusive.

The impact of medical clowning as a stress-reducing technique for 12-15 minutes after ET was found to increase the pregnancy rate - 36.4% in the intervention group compared with 20.2% in the control group. Other interventions, specifically prior or during the IVF-ET procedure itself have been studied in the context of improving cycle outcome and/or reducing anxiety levels.