Effects of Hormonal Infertility Treatment on Cognition in Pre-Menopausal Women

Much of our understanding of the effects of ovarian steroid hormones on cognitive functioning comes from studies of changes in cognitive function associated with hormone replacement therapy (HRT) in post-menopausal women and changes in menstrual cycle phase in premenopausal women. If fluctuations in ovarian sex steroid hormone levels across the normal physiological range affect cognitive functions in women, then marked alterations in hormone levels should have a notable effect on cognitive function.

Hormonal in-vitro fertilization (IVF) treatments for female infertility result in dramatic fluctuations in estrogen levels. Women awaiting infertility treatment report negative emotions, depressed mood, declines in memory and concentration, and higher levels of reported stress compared to women who have never experienced infertility.

Four groups of twenty women each will be recruited for this observational study:

• Group 1 - IVF treatment with GnRH-a alone
• Group 2 - IVF treatment with GnRH-a plus sex steroid stimulating hormones
• Group 3 - ADPT control (women in the process of adopting children)
• Group 4 - OC (oral contraceptives) control

All groups will receive a cognitive/affect assessment twice, with a 3-week interval between assessments. Blood and salivary samples will be taken on the two test days to measure ovarian sex steroid hormone levels and stress hormone levels. Salivary samples will also be taken on a third day in between the two test days. Heart Period Variability (HPV), a measure of cardiac functioning, will be measured using electrocardiogram (ECG).

Inclusion criteria

• Women 25 years and older, who are still ovulating
• Residing in Maryland or the Washington DC metropolitan area
• Healthy women in one of the following groups:
• 1) beginning or currently undergoing IVF infertility treatments with GnRH-a alone,
• 2) beginning or currently undergoing IVF infertility treatments with GnrH-a plus sex steroid stimulating hormones,
• 3) going through the adoption process, or
• 4) taking monophasic oral contraceptives for at least six months

Exclusion criteria

• English not the primary language
• Women who are peri- or post-menopausal
• Women who are currently taking anti-depressants or have a history of head injury or neurological/psychiatric condition
• Groups 1 & 2 (IVF) - women who are undergoing Inter-uterine insemination as an infertility treatment
• Group 3 (ADPT) - women who underwent hormonal infertility treatments within the previous 6 months
• Group 4 (OC) - women on progesterone only (mini-pill) oral contraceptives