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Psychological stress and infertility

Alice D Domar, PhD
Section Editor
Jonathan M Silver, MD
Deputy Editor
David Solomon, MD


The belief that psychologic factors play a role in infertility is long-standing, and there is evidence that stress levels may influence the outcome of infertility treatment, as well as contribute to patients' decisions to continue treatment [1,2]. 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 [3].

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 [4]. 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.

Many patients with infertility and psychological stress (eg, anxiety and/or depressive symptoms) do not receive mental health services [5].


Psychological distress (eg, anxiety and/or depressive symptoms) is common in couples with infertility, and appears to be more common in the partner with the fertility problem [6]:

A prospective study followed women (n = 352) who presented for treatment at an infertility clinic for up to 18 months, along with their male partners (n = 274), using self-report instruments to assess clinically significant symptoms of anxiety and/or depression [5]. The primary findings included the following:

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Literature review current through: Nov 2017. | This topic last updated: Jun 08, 2017.
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