An abundant literature shows trait dimensions of optimism and pessimism are related to diverse health outcomes. To date, however, no study has examined these traits in relation to pregnancy outcome in IVF treatment among women seeking medical intervention for infertility. Additionally, two general issues remain outstanding in the literature. One is whether optimism and pessimism are independent dimensions with differing effects on health and the second concerns the role of trait negative affect as a potential confounder of the effects of optimism/pessimism on health. The latter may depend on whether optimism and pessimism are evaluated separately as well as whether the health outcome of interest is objective or subjective in nature. Results from the current investigation showed that women who endorsed greater pessimism, measured as a separate unipolar dimension, at baseline assessment were more likely to experience treatment failure following their first IVF treatment cycle, occurring at any time over the 18-month study period. This relation was independent of risk factors for poor fertility treatment response (e.g., female age) as well as trait negative affect. In contrast, greater optimism/less pessimism, measured as a single bipolar dimension, was associated with a reduced probability of experiencing IVF treatment failure but this relation did not persist independently of statistical control for trait negative affect. Optimism, measured as a separate unipolar dimension, was unrelated to the outcome of the IVF cycle.
In considering why pessimism predicts failure among women undergoing IVF treatment, it is possible that the findings are due to reverse causal mechanisms. That is, women with poorer prognoses may be able to accurately appraise their fertility status and as a result report greater pessimism. Although plausible, there are several counterpoints to this explanation. First, pessimism was evaluated as a trait dimension in reference to a woman’s global outlook on her life rather than to her specific expectations about the outcome of the IVF treatment cycle. Secondly, the study findings persisted after controlling for the primary parameters that would indicate one’s fertility status, including female age, socioeconomic status, parity, duration of attempted pregnancy, prior history of infertility treatment, and number of infertility-related diagnoses. In zero-order association, older female age, the most reliable predictor of IVF treatment outcome, was actually related to less pessimism. Additionally, all of the women in the current study were naïve to IVF treatment, limiting the possibility that prior experiences with IVF treatment that would reflect their current chances of success could have influenced their self-reports of pessimism at the baseline assessment. Nonetheless, it remains possible that third variables unmeasured in the current study (e.g., BMI) which may covary with pessimism and IVF treatment prognosis could be driving this association.
The mechanisms by which pessimism relates to IVF treatment failure are unknown. Previous studies have proposed that greater optimism (or lower pessimism when optimism and pessimism are measured as a single bipolar dimension) may buffer psychological stress and/or enhance neuroendocrine regulation of the stress response, thereby, diminishing stress effects on susceptible health outcomes (35
). Conversely, greater pessimism when measured as a single unipolar dimension may amplify stress responsivity and neuroendocrine dysregulation. Connections between optimism and pessimism and the immune system have also been made (33
), although whether these dimensions promote or reduce immune system function in the face of psychological stress may depend on contextual factors (33
). Previous studies have also examined behavioral pathways, demonstrating that greater optimism relates to positive health behaviors such as improved nutrition, increased physical activity, non-smoking, and treatment adherence (22
). Many of these same behavioral factors (e.g., overweight/obesity, diet, and smoking) have been related to infertility as well as IVF outcomes (e.g., (47
The relevance of the above-mentioned biological and behavioral pathways in the current study remains speculative, although it is plausible that these same mechanisms may operate by affecting intermediate processes critical to IVF outcomes such as suppression of ovarian function or interference with embryo implantation. With respect to a possible hormonal mechanism, it is not known whether stress hormones typically implicated in explaining links between stress and health (e.g., cortisol) may promote stress-related neuroendocrine effects on IVF treatment response, especially in the context of the superphysiologic doses of gonadotropins administered in IVF treatment protocols. Additionally, with respect to a possible behavioral mechanism, women seeking fertility treatments are relatively young and typically in good health which likely constrains variability in relevant health behaviors. For example, in the current study, no woman reported cigarette smoking which has known effects on fertility. Thus, it remains the work of future research to delineate the candidate mechanisms by which pessimism, either through a hormonal, behavioral, or some other yet unidentified mechanism, confers risk for IVF treatment failure.
Recommendations for intervention on the basis of findings from the current study alone would be premature, however, it is notable that although pessimism is considered a stable disposition (15
), empirical evidence suggests such personality traits are amenable to change. For example, in a study of breast and colorectal cancer patients, a meaning-making intervention to improve psychological adjustment to the cancer diagnosis was found to increase optimism (53
). Similarly, in a study of patients awaiting lung transplantation, coping skills training promoted greater increases in optimism in the treatment versus usual care group (54
). Evidence also supports the malleability of pessimism. Cognitive-behavioral therapeutic approaches, which have been shown to be effective treatments for numerous psychiatric conditions (55
), operate by addressing patterns of negative or pessimistic thinking which are hypothesized to drive negative mood states and maladaptive behaviors (56
). Thus, evidence supports the plausibility of affecting change on a trait dimension such as pessimism should such an intervention strategy appear warranted in this population.
Strengths of the current study are a large sample size relative to similar studies in the literature and a longitudinal study design which enables stronger conclusions regarding the direction of effects. Limitations of the current study are the self-reported nature of the psychological factors of interest and the absence of the measurement of possible biological or behavioral mechanisms by which pessimism and IVF treatment outcomes may be related. Additionally, women in the sample represented a broad range of infertility diagnoses including but not limited to fallopian tube damage or blockage, endometriosis, ovulation disorders, and male factor infertility. This variability in women’s experiences precludes assessment of how pessimism and its effects on IVF treatment outcome might manifest differently in different patient groups. To address this, future investigations should either include samples of large enough size to enable statistical analyses stratified by infertility diagnosis or include only women with one particular diagnosis.
In summary, the current study is the first investigation of the prospective relation between traits of optimism and pessimism and pregnancy outcome in IVF treatment among women seeking medical intervention for infertility. Results suggest that pessimism (measured as a separate unipolar dimension) may confer risk for IVF treatment failure independently of other predictors of poor treatment response as well as trait negative affect. In contrast, the examination of optimism/pessimism as a single bipolar dimension was not independently related to IVF treatment outcome and optimism (measured as a separate unipolar dimension) was unrelated to IVF treatment outcome. Findings highlight that optimism and pessimism are independent dimensions with differing impacts on health outcomes and that the role of trait negative affect as a potential confounder of links between optimism/pessimism and health may be minimized when examining objective rather than subjective indicators of health.