The belief that psychologic factors play a role in infertility is long-standing, and there is evidence that stress levels influence the outcome of infertility treatment, as well as contribute to patients' decisions to continue treatment . Stress also affects patients' reactions to pregnancy loss during infertility treatment and pregnancy complications. Moreover, psychological distress is associated with infertility treatment failure, and interventions to relieve stress are associated with increased pregnancy rates.
In addition, preconception stress may increase the risk of infertility. In a 12 month, prospective observational study of women starting to attempt pregnancy naturally, salivary alpha-amylase (an index of stress) was measured at baseline . After adjusting for potential confounding factors (eg, age of the woman, consuming alcohol, and smoking cigarettes), the baseline level of alpha-amylase predicted subsequent infertility, such that infertility was more than twice as likely to occur in women with the highest tertile levels of alpha-amylase, compared with women in the lowest tertile.
ASSESSMENT OF STRESS
Stress is defined as a stimulus which produces mental tension or physiological reaction, for the purposes of this review, the experience of infertility is the stimulus. Distress is the experience of anxiety or suffering, for the purposes of this review, the experience of infertility leads to the suffering
Investigators have routinely utilized self-report questionnaires to evaluate the stress level of infertility patients. This approach may under-report the true level of distress since patients may feign emotional well-being in order to appear psychologically appropriate for infertility treatment. In research studies, the gold standard in psychological assessment is a structured personal interview with a trained mental health professional (psychiatrist or psychologist).
Clinically, the provider can assess stress by observation of the patient and inquiring about the patient's emotional state. Research shows that the main sources of stress for infertility patients are the impact of infertility on their social life, their sexual health, and their relationships with their partner. Thus, questions which ask about each of these areas are recommended. These could include the following: