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Yoga Can Improve Assisted Reproduction Technology Outcomes in Couples With Infertility

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Abstract

Context • Depending on the cause of the infertility, nonsurgical or surgical treatments may be used to treat men and women with infertility. Despite improved outcomes due to medical advances, assisted reproductive technology (ART) for couples with infertility is sometimes unsuccessful. Success may be affected by the patient's social, psychological, and physical status. Objective • The study examined the effects of yoga-including asanas (yoga poses), pranayama (proper breathing), shavasana, and meditation-on male and female fertility and ART outcomes. Design • The research team performed a literature review, electronically searching for articles published between January 1978 and January 2016 in the PubMed, Scopus, ScienceDirect, and Google Scholar databases. Setting • The study took place at the Reproductive Biotechnology Research Center at the Avicenna Research Institute at the Academic Center for Education, Culture, and Research (Tehran, Iran). Participants • Participants were couples with infertility taking part in 87 reviewed studies. Intervention • Yoga was the intervention. Outcome Measures • The outcome measures comprised fertility factors in males and females, fertility rate, and ART success rate. Results • The reviewed studies showed that yoga can provide stress management for patients with infertility, with beneficial effects on fertility, helping couples give birth. They found that yoga also could reduce pain; decrease depression, anxiety, and stress; reduce the rate of assisted vaginal delivery; and improve fetal outcomes. Conclusions • Yoga can help couples overcome infertility and increase the ART success rate by improving the physiological and psychological states of both men and women.
Darbandi—Improving ART Outcomes
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Yoga Can Improve Assisted Reproduction
Technology Outcomes in Couples With Infertility
Sara Darbandi, PhD(c); Mahsa Darbandi, PhD(c); Hamid Reza Khorram Khorshid, MD, PhD;
Mohammad Reza Sadeghi, PhD
REVIEW ARTICLE
ABSTRACT
Context • Depending on the cause of the infertility,
nonsurgical or surgical treatments may be used to treat
men and women with infertility. Despite improved
outcomes due to medical advances, assisted reproductive
technology (ART) for couples with infertility is sometimes
unsuccessful. Success may be aected by the patient’s
social, psychological, and physical status.
Objective • e study examined the eects of yoga—
including asanas (yoga poses), pranayama
(proper breathing), shavasana, and meditation—on male
and female fertility and ART outcomes.
Design • e research team performed a literature review,
electronically searching for articles published between
January 1978 and January 2016 in the PubMed, Scopus,
ScienceDirect, and Google Scholar databases.
Setting • e study took place at the Reproductive
Biotechnology Research Center at the Avicenna Research
Institute at the Academic Center for Education, Culture,
and Research (Tehran, Iran).
Participants • Participants were couples with infertility
taking part in 87 reviewed studies.
Intervention • Yoga was the intervention.
Outcome Measures • e outcome measures comprised
fertility factors in males and females, fertility rate, and
ART success rate.
Results • e reviewed studies showed that yoga can
provide stress management for patients with infertility,
with benecial eects on fertility, helping couples give
birth. ey found that yoga also could reduce pain;
decrease depression, anxiety, and stress; reduce the rate of
assisted vaginal delivery; and improve fetal outcomes.
Conclusions • Yoga can help couples overcome infertility
and increase the ART success rate by improving the
physiological and psychological states of both men and
women. (Altern er Health Med. [E-pub ahead of print.])
Sara Darbandi, MSc, is a PhD student; Mahsa Darbandi, MSc, is
a PhD student; and Hamid Reza Khorram Khorshid, MD, PhD,
is a full professor at the Genetics Research Center, University
of Social Welfare and Rehabilitation Sciences, in Tehran,
Iran. Mohammad Reza Sadeghi, PhD, is a full professor at
the Reproductive Biotechnology Research Center, Avicenna
Research Institute, Academic Center for Education, Culture,
and Research, in Tehran, Iran.
Corresponding author: Mahsa Darbandi, PhD(c)
E-mail address: mahsadarbandi@hotmail.com
Corresponding author: Mohammad Resa Sadeghi, PhD
E-mail address: sadeghi@avicenna.ac.ir
Fertilization is viewed as a simple notion, wherein
sperm and ova join and the result is a new life, but the
process is actually a series of long and complex events
that must take place in a certain order. Infertility occurs in
8% to 12% of the world’s couples because of genetic,
psychological, anatomical, endocrinological, and
immunological problems that aect both female and male
reproductive health.1,2
Infertility rates vary signicantly among countries and
regions, based on the prevalence of disease leading to
infertility.2 General factors aecting female infertility
(ie, the ability to ovulate, conceive, or deliver a child
successfully) include age, endometriosis, polycystic ovarian
syndrome (PCOS), chronic diseases, hormonal imbalance,
environmental factors, excessive or very low body fat, sexually
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transmitted diseases, mullerian anomalies, fallopian tube
disease, blockage of the cervix, multiple miscarriages, and
amenorrhea.2-6
Although womens infertility is the greater focus of
research and attention in health care, male infertility is the
cause in or contributing factor to infertility in approximately
half of couples with infertility.1 Nearly 30% to 40% of all
infertility is a result of male factors, and approximately 8% of
men request medical help for problems associated with
fertility.1,7,8 Some risk factors that can result in a decline in a
mans seminal quality include a history of prostatitis, genital
infections, sexually transmitted diseases, oxidative stress,
hernia repair, undescended testicles, and mumps aer
pu ber ty.2,6,9,10 Investigators have found that a 2% reduction in
the quality of male sperm occurs annually.2,11
Environmental stress and pollution are important
parameters that can reduce hormonal proles that stimulate
spermatogenesis.2 Recently, infertility rates have been
growing throughout the world, and the need for infertility
treatments and assisted reproductive technologies (ARTs)
has increased.1,7 Accordingly, nonsurgical or surgical
treatments, including hormone therapy, in vitro fertilization
(IVF), and intracytoplasmic sperm injection, may be used to
treat men and women with infertility. Despite these medical
improvements, treatment remains largely unsuccessful.
Studies have shown that patients’ social, mental, and
physical states can strongly aect ART’s success.12-15 Although
antianxiety and antidepressant medications can reduce stress,
they have side eects, such as a decrease in sexual drive, an
inability to orgasm, and erectile dysfunction.16,17
Complementary approaches to reproductive wellness,
such as the methods of traditional Chinese medicine,
ayurveda, yoga, and mind-body techniques for stress reduction
have recently been introduced in the ART eld.7,18-21 Yoga is a
form of alternative medicine that claims to improve a person’s
health by reducing stress and regulating hormonal
secretions.18,19,21-23
e aim of the current study was to review the eects of
yoga—including asanas (yoga poses), pranayama
(proper breathing), shavasana, and meditation—on couples’
fertility and on ART outcomes.
METHODS
Procedures
In this review, the research team searched the following
electronic databases between January 1978 and January 2016.
e documents were obtained from PubMed, Scopus, Science
Direct, and Google Scholar using the keywords yoga, fertility,
infertility, and reproduction. Two members of the research
team evaluated the studies. e study included articles if the
studies evaluated the eects of yoga on fertility factors and
pregnant women who were randomized to yoga and control
groups. ere were no severe limits on control groups.
erefore, any trials that compared yoga to usual care or any
other physical or mental care were qualied. Today, there are
dierent types of yoga. Some included only physical exercise,
such as stretching, shavasana, or other asana postures. Other
kinds of yoga also included pranayama, meditation, or deep
relaxation. e research team included all types of studies
and all types of yoga and reviewed only studies in English.
e search provided 43 169 articles. Nonrandomized or
uncontrolled trials, irrelevant articles, duplicated articles, or
articles with duplicated data were excluded, and the remaining
87 articles were evaluated.
Participants
Participants were couples with infertility taking part in
the 87 reviewed studies. Couples with infertility were married
couples not being able to get pregnant aer trying for 1 year.
e present study comprised couples who were aged 18 to 45
years and evidence was from 5 continents.
Intervention
is study included all types of yoga as the intervention.
Yoga combines breathing, meditation, and postures to bring
harmony to the chakra system. It is also used to awaken the
essential life force, known as kundalini energy, which is
housed in the root base chakra at the base root of spine. e
studies generally were between 6 and 20 weeks in duration.
Outcome Measures
e outcome measures comprised fertility factors in
males such as sperm count, sperm motility, prostate
secretion, genital inammatory, varicocele, intravaginal
ejaculation time, testosterone secretion, sexual desire and
arousal, and DNA integrity of sperm. In females, fertility
factors measured may include ovulation management and
oocytes improvement; the serum levels of cortisol,
adrenaline, noradrenaline, dopamine, testosterone,
luteinizing hormone (LH), and antimullerian hormone
(AMH); fertility rate; ART success rate; back, lumbopelvic,
and other physical pain; satisfaction with pain relief;
depression; anxiety; and stress.
RESULTS
In total, 87 articles were evaluated in the review.
Women With Infertility
Stress Relief. e reviewed studies supported the
hypothesis that yoga could help couples give birth24-31 by
(1) reducing their anxiety and depression31-57; (2) improving
their sleep58; (3) helping them manage the stresses of pregnancy,
labor, and birth32-42,44,45,47,48,55,59-68; and (4) improving their
quality of life during pregnancy or aer stillbirth for women.55,69
Yoga also was found to (1) reduce back, lumbopelvic,
and other physical pain51,53,56,70-73 and (2) increase satisfaction
with pain relief.70
Investigators also reported that stress management in
patients with infertility had benecial eects on fertility.74-78
In couples with infertility, yoga could (1) manage ovulation
and oocytes improvement for fertility79,80 and (2) decrease
depression, anxiety, and stress.53,81,82
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Yoga Types and Poses
Qualied breathing can help the body’s organs receive
proper oxygen and energy for full functionality.19,104,105 For
people dealing with infertility, studies have found that the
benecial yoga asanas for strengthening core, legs, and feet
and can help to move energy in the sacral chakra area, while
being rmly rooted through the feet and balanced throughout
the root chakra. ese poses are (1) Standing Forward Bend
(Uttanasana), (2) Garland (Malasana), (3) Head-to-Knee
Forward Bend (Janu Sirsasana), (4) Reclining Bound Angle
(Supta Baddha Konasana), (5) Wide-Legged Forward Bend
(Prasarita Padottanasana), (6) Warrior II (Virabhadrasana II),
(7) Mountain Pose (Tadasana), (8) Warrior One Pose
(Virabhadrasana 1), and (9) Bridge Pose
(Setu Bhandasana).19,28,106 Other poses that could be useful
are (1) Pigeon, (2) Wide-Angle Seated Forward Bend
(Upavistha Konasana), (3) Cow Face (Gomukhasana),
(4) One-Legged King Pigeon (Eka Pada Rajakapotasana),
(5) Bound Angle (Baddha Konasana), (6) Revolved Triangle
(Parivrtta Trikonasana), (7) Full Boat (Paripurna Navasana),
(8) Chair (Utkatasana), (9) Triangle Pose (Trikonasana),
(10) Child Pose (Balasana), (11) Cobra Pose (Bhujangasana),
(12) Dancer’s Pose (Natarajasana), and (13) Sun Salutation
(Surya Namaskar),19,28,106 which benets the whole body and
all of the chakras.
DISCUSSION
e reviewed studies provide evidence that yogacan help
couples overcome infertility and improve the ART success rate
by reducing anxiety and depression,40,107,108 decreasing stress,107
regulating 8 hormonal secretions, increasing quality of life, and
raising fertility rates.10,18,19,22,23,104,105,109-111
Following stress, the endocrinal organ system releases
stress-related hormones, such as cortisol and adrenalin.15,112
Smith et al113 showed that the LH hormone levels decreased
in female ovaries as a result, and ovulation was disrupted or
even paused.
High levels of cortisol have been found to be strongly
associated with miscarriage.15,112 Studies from the past several
decades have demonstrated that high stress levels are strongly
correlated to infertility.74,114-116 In IVF patients, some studies
have shown that the rates of implantation increased when
daily adrenalin levels were lower.19,114,115 Other studies have
shown a similar correlation when measuring cortisol
levels.19,114,115
ese results indicate that couples with infertility can
be more successful at reproduction when they lead less
stressful lives.117,118 Frederiksen et al119 showed that
chronically stressed women produced less of the
gonadotropin-releasing hormone, which prevented
ovulation by starting a cascade of hormonally related
changes. One study showed that women who are very
underweight or overweight do not ovulate normally and
also have hormonal imbalances.120
In men, stress was shown to aect fertility both by
lowering sperm volume and by raising the percentage of
Hormonal Changes. Two studies found that alpha
brain waves increased and serum cortisol signicantly
decreased during yoga.10,83 Schmidt et al found the 3 months
of yoga could decrease the rate of urinary excretion of
adrenaline, noradrenaline, dopamine, and aldosterone as
well as improve the serum levels of testosterone and LH and
increase cortisol excretion.84 Other researchers have
conrmed that yoga can reduce cortisol levels in
women.46,50,85-87
Exercise via 30 minutes per day of asanas, pranayama,
meditation, and shavasana helped patients with PCOS lose
weight and manage stress, which ultimately stabilizes the
normal function of the hypothalamic-pituitary-ovarian
axis.88 Also, in 3 studies,89,90,91,92 a 12-week yoga program
helped participants reduce their levels of AMH, LH, and
testosterone, and one of those studies found improved
menstrual frequency90; one found lower anxiety90; and one
increased the quality of life of adolescents with PCOS.91
Pregnancy. Yoga was found to (1) reduce hypertensive-
related pregnancies,62,92 (2) improve fetal outcomes,62,92
(3) increase the infants’ birth weights,61 (4) decrease
intrauterine growth retardation,61,62 and (5) reduce the rate of
assisted vaginal delivery.70
One study found that women who were more distressed
than other women were more likely to accept psychological
support before starting an IVF cycle.93 A study of
143 women with infertility demonstrated that yoga could
decrease distress in women before they started their rst
IVF cycle93 and showed that it was better to start its practice
at least 6 weeksbefore starting the cycle.94 In addition, for
women who become pregnant via IVF, yoga decreased
stress, anxiety, and labor pains and increased delivery
condence.39,95
Men With Infertility
e benets of regular yoga practice were not limited to
women with infertility; men with infertility also
beneted.11,96-99 Sperm count, sperm motility, and prostate
secretion showed improvement in men who practiced yoga.10
Some investigators indicated that yoga could improve genital
inammatory conditions, in addition to increasing sperm
parameters and motility, and also could improve immune
system disorders, varicocele,96 and intravaginal ejaculation
time and decrease sexual dysfunction.100
Hu et al96 also found that yoga could help regulate
endocrinal glands and the autonomic nervous system (ANS).
In men, practicing the Root Bond pose (Mula Bandha) was
found to be correlated with relieving spermatorrhea,
preventing inguinal hernia and regulating testosterone
secretion,10 whereas the Mula Bandha pose could increase
genital arousal sensations for improving sexual desire and
arousal.10 Other ndings showed that yoga could aect the
DNA integrity of sperm and reduce some markers of oxidative
stress, such as telomerase activity, telomere length, and DNA
fragmentation,101,102 and also could delay aging, which can be
applied for women, too.101,103
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abnormal sperm.119 ree studies have found that men who
were underweight or overweight had imbalanced levels of
testosterone and lower sperm count and concentrations.121-123
Incorporating yoga into a daily routine has been found
to be a great way to balance the body in both genders.10,104,105,124
Prior et al86 found it could be benecial to do yoga to reduce
stress and increase the fertility rate, because cortisol levels
can have a signicant eect on fertility. From the current
review, it is clear that yoga can be used to prevent or reduce
obstetric complications53 and improve sexual functions in
women.125 Researchers have suggested that asanas, pranayama,
shavasana, and meditation are related to the cerebrospinal
uid, endocrinal secretion, and the ANS.2,104,105,126-128
CONCLUSIONS
Yoga can help couples experiencing the challenges of
infertility by increasing clarity of mind, maintaining
homeostasis, and giving them real power while undergoing
the therapeutic rigors of ART. When patients recognize the
state of their bodies, they can achieve physical relaxation,
have a better sense of themselves and begin to treat their
problems with more interest and strength. Patients can
report to their doctors more easily about the state of their
bodies and their sensations in ART cycles. Yoga can also
improve fertility rates in ART by diminishing stress and
modifying the body’s hormonal secretions, ANS, genital
health, and sexual arousal. However, these ndings should be
reconrmed by future well-designed, randomized clinical
studies.
AUTHOR DISCLOSURE STATEMENT
No competing nancial interests exist for the authors.
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... In addition, it is noteworthy that the spouse and mental health areas showed significant differences between the two groups. Therefore, it could be inferred that during real-time video conferencing exercise sessions, the spouse took care of the children; thus, the emotional support improved the spouse's relationship area and affected mental health-related areas [39,40]. Therefore, in future programs, it is suggested that organizing programs for families or groups to be eliminated restrictions on time and cost more effectively. ...
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... In this sense, yoga practices before assisted reproductive treatment seem to be effective in reducing emotional distress or pressure for the expectative, increasing the in vitro fertilization outcomes [49]. Another study focused on examining the effects of yoga on male and female fertility and assisted reproduction technology outcomes found that yoga practice manages the stress associated with infertility, reduces pain, decreases depression, anxiety and improves fetal outcome [51]. Other researchers reported that yoga therapy has a potentially positive impact on the mental health of women undergoing infertility treatment [35]. ...
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The practice of meditation today has an objective to test the malleability of the brain based on neuroplasticity. Science is discovering the physiological and psychological benefits of meditation, since it is fundamental to consider all aspects that influence health. Among a large number of meditation techniques currently used, this chapter focuses on the benefits of practicing mindfulness and yoga used in addition to medicine and psychology resources for patients undergoing assisted human reproduction. Growing knowledge about psychological implications of infertility demonstrates that medical and psychological factors cannot be separated, both in terms of diagnosis and treatment. Assisted reproductive techniques and infertility treatments are multidimensional stressors. Fertility problems are accompanied by much emotional distress, and infertile women have higher levels of anxiety and depression than normal. In addition, mood disorders are common in both women and men undergoing in vitro fertilization procedures. This chapter will present studies which show that mindfulness and yoga could be helpful for people suffering from infertility, undergoing in vitro fertilization, or even improving semen quality.
... Based on the Fertility Problem Stress Scale, the difference between the pre-and posttest for the experimental group was greater than for the control group. In a literature review based on 87 studies on infertility, yoga reduced pain as well as stress, depression and anxiety and yoga improved fetal outcomes Darbandi & Sadeghi [17]. ...
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... For this reason, the interventions (such as psychotherapy, web-based psychotherapy, group therapies, cognitive therapy, yoga, social support couple therapy and solution-oriented strategies), especially the infertility treatment groups, which aim to decrease the emotional symptoms of infertility (such as hopelessness, anxiety, uneasiness, anger, stress, uncertainties and sexual problems) should be a significant part of infertility treatment plan. (Darbandi et al., 2018;Ghavi et al., 2015;Sexton et al., 2010;Myers & Wark, 1996;Van den Broeck et al., 2010;Ying et al., 2016). Sense of insufficiency, stigmtize and social isolation should be searched in relation with the available coping strategies ...
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... [126] In a prospective RCT at Boston IVF, the women who were randomized to a mind/body program before starting their first IVF cycle were found to have higher pregnancy rates (52%) then for the control group (20%). [127] In a literature review by Darbandi et al. [128] it was concluded that Yoga can help couples overcome infertility and increase the ART success rate by improving the physiological and psychological states of both men and women. In a RCT by Nayar et al. [129] the clinical pregnancy rate was significantly better in group A women (N=52) who attended three months of Yoga sessions involving asana (exercises) and pranayama (regulated breathing) before undergoing frozen embryo transfer than group B women (N=53) who underwent frozen embryo transfer without Yoga therapy. ...
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One of the early scientific understandings of how the mind and body interact was achieved by Walter Cannon at Harvard Medical School. By injecting cats with catecholamines from an extract of their adrenal glands he found a consistent arousal of the sympathetic nervous system: increased blood pressure, increased heart rate, increased metabolism, and 300 to 400% increase in muscle blood flow. He reasoned that this prepared the animals for running or for fighting—hence the name “fight-or-flight” response. It is also called the “emergency response.”
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