The Relationship Between Stress and IVF 

Infertility and fertility treatment can come with layers of stress: emotional, physical, and financial. But does that stress actually impact IVF success rates? The short answer is that the evidence is mixed.  

In this article, we’ll explore the high-quality studies that find little to no association between patients’ distress and IVF pregnancy rates, along with the newer data suggesting that higher preconception stress may be linked to lower odds of live birth in IVF.  

What do researchers mean by “stress,” and how is it measured? 

“Stress” in IVF is usually measured in two ways:  

1. Self-report questionnaires (for example, the Perceived Stress Scale, depression and anxiety inventories) 

1. Biological markers such as cortisol or salivary α-amylase.  

Each captures different aspects of the stress response and they do not always agree, which partly explains why results across studies can differ 3  1 2 

Does stress lower IVF success? 

Large meta-analyses studies have reported no clear association between stress at the start of a cycle and clinical pregnancy after IVF/ICSI.  

For example, a 2018 meta-analysis concluded that pretreatment distress did not impede infertility treatment outcomes; similar findings have been observed in prospective cohorts. 1 2   3   

At the same time, newer prospective research known as the  EARTH Study (MGH/Harvard) found that higher perceived stress at preconception was associated with a lower probability of live birth. And that this association most evident among patients who conceived using IVF. 4 

A Closer Look at the “EARTH Study”: Stress Matters 

The study looked at stress before conception and followed women through pregnancy. Here’s what it found:4 

• No effect on babies once pregnancy was established: Among women who went on to deliver, stress levels measured before they conceived were not linked to differences in how long the pregnancy lasted (gestational age) or how big the babies were at birth (birthweight). 

• Where the effect might be happening:  Since stress didn’t seem to affect outcomes after implantation and pregnancy were established, the researchers reasoned that stress may be acting earlier, at the level of: 

1. Ovarian function and egg quality 
2. Fertilization or embryo development 
3. Implantation (when the embryo attaches to the uterus) 

In other words, the window in which an IVF outcome is vulnerable to stress is likely before or right around conception, rather than during the later course of pregnancy. 

Why this matters: This distinction is important because it suggests that if stress reduces the chance of live birth, it may be by lowering the odds of achieving pregnancy in the first place (e.g., implantation failure).  

What about stress at specific IVF stages? 

A 2024 review looked at studies that measured stress (both short-term stress, like anxiety on retrieval day, and longer-term stress, like chronic distress) at different points in the IVF process. Key findings include: 

• The most consistent stage that was impacted by stress was egg retrieval. Women with higher stress sometimes had fewer eggs retrieved or eggs of lower quality. 

• Other stages that were found to be impacted by stress, though less consistently across various studies, included fertilization, embryo transfer, or during the “two-week wait.”  

• Stress was not found to consistently impact outcomes such as fertilization success, implantation, or pregnancy rates. 

How Stress Might Affect Reproduction 

Stress sets off the body’s built-in “alarm systems,” releasing hormones that can disrupt the normal rhythm of reproductive hormones. 10 11 13 

In natural cycles, this is one reason stress has been linked to irregular ovulation or even missed periods.12  

During IVF, though, the picture looks a little different. Because fertility medications provide the hormones needed to grow eggs, they essentially bypass the brain’s usual signals.  

This means the most direct way stress interferes with ovulation is less relevant in an IVF cycle. 

Still, stress may play a role in other, more subtle ways, such as by affecting the environment inside the ovaries where eggs develop, by influencing the immune system as it interacts with early embryos, or by shaping lifestyle factors like sleep, nutrition, and treatment adherence. 

Impact of stress on the Fetus 

The impact of stress on the hormonal system, called the maternal-fetal hypothalamic-pituitary-adrenal axis, has also been found to disrupt the normal fetal environment. This disruption is a major risk factor for various neurodevelopmental issues in adulthood, such as major depressive disorder, anxiety, schizophrenia, and others.13 

Distress is common during Infertility Care 

Across settings, patients report elevated rates of stress, anxiety, and depressive symptoms during IVF.  

A 2024 study found medium/high perceived stress in 88% of respondents and probable depression in 44%, particularly among those actively undergoing treatment and not yet pregnant. 15 16 17 

Since we do know that stress is very common during fertility treatment, finding ways to manage it through support, relaxation, or emotional and physical intimacy can make the process feel more manageable.  

Managing stress is important for the health of the parent and future child, even if the impact on pregnancy rates in IVF is less certain.  

Indirect pathways: stress and treatment discontinuation 

Even if stress does not consistently reduce per-cycle success, it can still reduce the chance of eventually taking home a baby by increasing the likelihood of discontinuing treatment before achieving pregnancy.  

Researchers have found that the psychological burden of IVF and “treatment fatigue” are among the most commonly cited reasons for stopping care. Financial stress has also been found to loom large. 16 

Since it’s no surprise that lower discontinuation rates are linked to higher cumulative live-birth rates over time, managing stress can be the difference between IVF success and failure. 17  

Evidence-Based Takeaways for Patients 

Don’t blame yourself 

Many good studies show no clear link between baseline distress and IVF pregnancy in a given cycle.  

Guidelines from SART, the national authority on assisted reproduction, emphasizes that while infertility and IVF are stressful, stress itself is not proven to reduce IVF effectiveness. 19 18  

Take care of your well-being during preconception 

The EARTH cohort suggests that higher perceived stress before trying to conceive may be associated with lower live-birth probability, particularly in IVF.  

While the study didn’t draw a direct causal link, it’s should be standard practice to seriously attend to your mental health as part of preconception care.20 

Get psychological support 

Studies show that therapy, counseling, and group or online psychological support can reduce anxiety/depression and improve quality of life during treatment. In these studies, the direct effects on pregnancy and live birth remain inconsistent, but it goes a long way when it comes to sticking with the fertility journey for as long as it takes for you to take home your baby.21 

Male partners matter, too 

Because the female partner is subject to the majority of the medical intervention, men are often left out of care considerations.  

Yet, stress has been found to affect sexual function and the quality of semen. The quality of the relationship is another powerfully supportive factor on the IVF journey, so the emotional needs of men should not be overlooked. 22 23 

Choose Affordable Care 

CNY offers IVF packages with standard medications starting at $5,800. This is significantly lower than the national average of $15,000-$25,000 per cycle.   

CNY fertility also specializes in travel-friendly care and inclusive financing, making affordable IVF more accessible and less stressful.  

Schedule a consultation today, and explore the cost with our interactive calculator below.   

The Relationship Between Stress and IVF: The Bottom Line 

The connection between stress and IVF is complex. Many well-designed studies have found that stress doesn’t have a direct impact on a single IVf cycle. However, new studies suggest that higher stress before trying to conceive may reduce the overall likelihood of a live birth, especially with IVF. 

What’s clear is that stress during treatment is the norm. It may not always change medical outcomes directly, but it strongly affects how patients feel, their quality of life, and sometimes their decision about whether to keep going with treatment.  

Because IVF often takes more than one attempt, staying supported and motivated to stick with the process can make a big difference in long-term success. 

That’s why clinics like CNY Fertility emphasize whole-person care beyond medications and procedures. CNY Healing Arts center offers acupuncture, massage, and other form of support tailored directly to fertility patients.  

This kind of support doesn’t just make the process more bearable, it can help protect your overall health and give you the best chance of reaching your goal of bringing home a baby.