Objective
Embryo transfer (ET) is a crucial event in determining in vitro fertilization (IVF) outcome, perceived by many patients as the culmination of treatment. Therefore, it is often a stressful procedure for patients. We hypothesized that the stress accompanying this procedure may be inversely correlated with cycle outcome. The use of complementary therapies to reduce anxiety and improve IVF outcome is increasing. Various interventions have been studied, but their efficacy remains uncertain. Virtual reality (VR) technology, has been gaining attention over the past two decades, owing to evidence of it’s therapeutic potential for anxiety management and stress reduction. This study aimed to examine the possible effect of VR exposure on anxiety level and clinical pregnancy rate (CPR) in women undergoing IVF-ET.
Design
A prospective randomized controlled trial (Clinical Trials.gov Protocol Registration: NCT04394962).
Materials and Methods
The study was conducted at the CReATe Fertility Centre (Toronto, Canada) after obtaining REB approval. Recruitment period was May 2019-March 2020 (suspended due to Covid-19). Infertile women aged 21-45-year-old using own ovum or older using donor eggs, starting a frozen ET cycle, were recruited. All participants provided a written informed consent before study entry. Exclusion Criteria were contraindications to use VR technology, anxiety disorder and major uterine anomalies. Participants were withdrawn if ET was cancelled. Patients were randomized (1:1) into 2 groups: A. Study group: 15-30 minutes of passive VR exposure (calming environment of choice) before ET; B. Control group: routine care only. Anxiety was assessed at 3 time points: T1=recruitment; T2=pre ET; T3=Post ET, using the validated “State-Trait Anxiety Inventory” questionnaire, heart rate (HR) and blood pressure (BP) measurements. The primary outcome was the CPR and the secondary outcomes were patients’ anxiety parameters. T-test or chi square were used as appropriate. P<0.05 was considered statistically significant.
Results
Seventy six patients were included in the analysis, 38 in each study arm. Patient and cycle characteristics were comparable between the groups. The mean VR exposure time was 23.2 ±14.1 minutes, the majority chose a beach environment (78.9%) and stated they would recommend VR (75.3%). No serious adverse events were reported. HR was higher in T2 vs T1 and T3 (p=0.002), but the mean BP and HR did not differ between the groups. T1 and T2 ‘trait’ anxiety scores were comparable between the groups. No significant differences were found between the VR group to control in the ‘state’ anxiety scores during T2 (40.3 vs 39.3) and T3 (38 vs 38), respectively (P>0.05). CPR was comparable between the VR and the control group (50% vs 34.2%, respectively; p=0.42).
Conclusions
This is the first study to assess VR use in assisted reproduction. The preliminary findings suggest that VR exposure prior to ET does not reduce patients’ anxiety levels. Although non-significant, a higher CPR trend in the VR group suggests that this intervention may have a beneficial effect, but a larger sample size is needed to confirm this.
P-288 4:30 PM Sunday, October 18, 2020
Footnotes
SUPPORT: CReATe Fertility Centre