Common Emotions Couples Experience During IVF

Three, and they are the same three across the studies ESHRE graded. Its 2015 guideline on routine psychosocial care states, at evidence grade B, that patients' emotional stress fluctuates during an IVF or ICSI cycle with peaks at the oocyte retrieval, at the embryo transfer, and during the waiting period before the pregnancy test, and that anxiety and stress are higher whenever patients are anticipating a result — including the gap between retrieval and transfer (Gameiro et al, Human Reproduction 2015;30(11):2476-85).

The guideline also records what happens at the end of a cycle: patients experience high emotional distress when told the treatment was unsuccessful, and when they are given that news, 1 to 2 in 10 women have clinically significant levels of depressive symptoms. Women's positive feelings decrease over the course of a cycle, and concerns about achieving a healthy live birth stay moderate to high throughout rather than easing.

Two practical details from the same guideline are easy to plan around and rarely mentioned: 6 in 10 patients report treatment-related absences from work during a cycle, missing an average of 23 hours, and the number of previous cycles is not associated with levels of depression or anxiety — a second or third attempt is not reliably easier or harder than the first. The wait itself has its own literature, covered in what is known about the two-week wait.

The best available answer is no, and it comes from prospective data rather than reassurance. A meta-analysis pooled 14 prospective studies covering 3,583 women undergoing a cycle of assisted reproduction and compared pretreatment anxiety or depression between those who became pregnant and those who did not. The difference was a standardised mean difference of -0.04 (95% CI -0.11 to 0.03) — effectively nothing. Subgroup analyses by previous treatment experience, by how the not-pregnant group was defined, and by when distress was measured were all non-significant. The authors write that the findings should reassure women and doctors that emotional distress caused by fertility problems, or by other life events happening alongside treatment, will not compromise the chance of becoming pregnant (Boivin et al, BMJ 2011;342:d223).

Two caveats belong with that, and the authors state both. The analysis found evidence of moderate publication bias, and it measured distress before a cycle rather than distress throughout one. What it does settle is the specific fear that being upset is sabotaging the treatment.

This matters beyond the cycle, because the belief that stress is causing the problem tends to convert into self-blame. What the studies on stress and conception actually measured covers the wider question of stress and fertility outside treatment, where the evidence is different and less settled.

Because, measured rather than assumed, they respond on different timescales. In a longitudinal study of 148 IVF patients and 71 partners assessed before treatment, immediately after the final cycle and six months later, women's anxiety and depression rose after unsuccessful treatment and fell after successful treatment, while men showed no change in either direction after either result. Six months on from unsuccessful treatment the women had not recovered, and more than 20% of them showed subclinical anxiety, depression or both (Verhaak et al, Human Reproduction 2005;20(8):2253-60).

ESHRE's graded statements point the same way and add the part men rarely say out loud: women are more likely than men to experience anxiety, depression, stress or psychiatric morbidity (grade B); men report lower perceived support than women at the start of stimulation, at oocyte retrieval and after the pregnancy test (grade C); and men report higher social isolation than women during a cycle (grade C). Women whose partner has male factor infertility experience higher anxiety than women with female factor infertility (grade C).

The guideline also records that in couples, the way one partner reacts to the infertility and its treatment is associated with how the other reacts, and that each partner's depressive symptoms are associated with both their own and their partner's infertility-specific distress. A mismatch is therefore normal and also not inert — it travels. On coping style, avoidant coping such as avoiding being around pregnant women is associated with higher infertility-specific distress, while expressing feelings to people close to you is associated with lower distress.

For most people yes, for a minority no, and the proportions have been measured. A cohort of 348 women was assessed at four points across treatment, and 108 of them again 11 to 17 years later. Grouped into trajectories (n = 348), 67% showed resilient anxiety and 86% resilient depression across treatment; 24% and 33% respectively were distressed during treatment and recovered afterwards; and among the same cohort (n = 348), 4.6% and 4.9% became distressed only after treatment ended, while 4.3% had chronic anxiety. One in ten women had a delayed or chronic trajectory, and those trajectories predicted serious mental health impairment 11 to 17 years later (Gameiro et al, Human Reproduction 2016;31(8):1788-98).

Non-resilient trajectories were associated with unsuccessful treatment, marital dissatisfaction, lack of social support and negative beliefs about infertility. A systematic review of 25 years of research reached a compatible summary: women starting IVF differ only slightly from population norms, unsuccessful treatment raises negative emotions and those persist across consecutive unsuccessful cycles, most women adjust well to unsuccessful treatment, and a considerable minority are left with subclinical emotional problems (Verhaak et al, Human Reproduction Update 2007;13(1):27-36).

Nothing in these studies says an individual should expect a particular trajectory. What they establish is that a delayed reaction — feeling worse months after the treatment stops — is a documented pattern rather than a personal failure. What tends to happen to a couple's intimacy after failed attempts covers a related and under-discussed part of the same aftermath.

On distress, the evidence is reasonably consistent. A systematic review and meta-analysis of 39 studies covering 2,746 men and women found psychosocial intervention associated with improved psychological outcomes overall (Hedges g 0.59, 95% CI 0.38 to 0.80), with cognitive behavioural therapy the largest single category (g 0.84), mind-body interventions at 0.61 and other types at 0.50 — differences the authors describe as not clear-cut between categories. Pooled effects were larger for women (0.51 to 0.73) than for men (0.13 to 0.34), and the difference reached statistical significance only for depressive symptoms (Frederiksen et al, BMJ Open 2015;5(1):e006592).

On pregnancy rates, the same review reported a risk ratio of 2.01 (95% CI 1.48 to 2.73) favouring intervention, and this is where honesty is required rather than a tidy conclusion: that result is hard to reconcile with Boivin's prospective finding that pretreatment distress does not predict outcome. Trials of an intervention and cohorts measuring distress are different designs answering different questions, both carry bias risks, and no retrieved source resolves the tension. Counselling is worth having for the reason it was designed for.

ESHRE's position is procedural and specific. Its guideline recommends that fertility staff refer patients at risk of clinically significant psychosocial problems to specialised infertility counselling or psychotherapy, and that they use the SCREENIVF tool — a validated 34-item infertility-specific questionnaire — before the start of treatment to identify women at risk. It is also candid about its own evidence base: of 125 recommendations, only 45 (36.0%) were based on high-quality evidence, and the group filled the gaps with good practice points drawn from expert opinion.

Two things the European cohorts cannot: prevalence measured in Indian clinical populations, and the role of the extended family. In a cross-sectional study of 150 women with infertility at a tertiary centre in New Delhi, 87 of 150 (58%) scored for depression on the Hamilton Depression Rating Scale, 36 of 150 (24%) for anxiety on the Hamilton Anxiety Rating Scale, and 36 of 150 (24%) for both. Women who scored for depression and anxiety reported significant discrimination, lower social acceptance and financial problems. Living in a joint family and using maladaptive coping were significant risk factors; the family's ability to provide support, share problems and help with decisions, together with support from the spouse, were the chief protective factors (Dadhwal et al, International Journal of Gynaecology and Obstetrics 2022;158(3):671-678).

A second study compared 250 women with primary infertility against 250 age-matched fertile controls aged 22 to 35 in north India, using the Perceived Stress Scale, GAD-7 and PHQ-9. Women with infertility were more likely to show stress, anxiety and depression than controls; none of the demographic or lifestyle variables measured were associated with those outcomes among the infertile women, while reproductive history was (Kamboj et al, PLoS One 2023;18(1):e0280054).

These are cross-sectional studies at single centres, so they describe those populations rather than the country. The practical implication is narrow and useful: in settings where the household is closely involved, who knows about the treatment is itself part of the emotional load. Prevalence figures across the wider literature are collected in how common distress actually is in infertility.

Often, and it is the part clinics measure least. A systematic review of 22 studies sampling 21,453 patients across eight countries examined stated reasons for discontinuing fertility treatment (n = 21,453). The physical and psychological burden of treatment was selected 19.07% of the time — psychological burden alone 14%, physical burden 6.32% of selections across those 22 studies (n = 21,453) — behind postponement of treatment (39.18%) and ahead of relational and personal problems (16.67%), treatment rejection (13.23%) and organisational or clinic problems. No predictor was consistently associated with discontinuation across studies (Gameiro et al, Human Reproduction Update 2012;18(6):652-69).

ESHRE's guideline adds that 1 in 10 patients referred for fertility treatment chooses not to start at all (grade C), and names psychological burden among the stated reasons both for not starting and for stopping. Deciding to stop is a legitimate decision rather than a failure of resolve, and burden is an acknowledged reason for it in the guideline literature.

If the difficulty is with the care rather than the treatment, that is a separable problem. When changing clinic or clinician mid-treatment is reasonable deals with that question on its own terms.

Several things commonly said about emotions during IVF are not supported by the sources retrieved for this page.

• That staying positive improves the outcome. The prospective evidence points the other way: pretreatment distress was not associated with achieving pregnancy across 14 studies and 3,583 women.
• That stimulation drugs cause the mood changes. No retrieved source measured a causal effect of fertility medication on anxiety or depression. The previous version of this page asserted it; the claim has been removed rather than softened.
• That couples pass through emotional stages in order. The measured pattern is fluctuation with peaks at retrieval, transfer and the wait, plus distinct multi-year trajectories — not a sequence anyone completes.
• That counselling raises the chance of pregnancy. One meta-analysis of intervention trials reported a risk ratio of 2.01 (95% CI 1.48 to 2.73) for clinical pregnancy; a meta-analysis of prospective cohorts found distress unrelated to outcome. These are not reconciled by any retrieved source.
• That men are less affected. What was measured is that men show smaller changes on the instruments used, report lower perceived support and report higher social isolation than women. Smaller measured change is not the same as feeling less, and the instruments were largely developed on women.
• That support groups, mindfulness or yoga produce a specific benefit here. The intervention meta-analysis pooled mind-body approaches at g 0.61 without separating out which components did the work, and ESHRE's own guideline notes that only 36% of its recommendations rest on high-quality evidence.
• That distress predicts who will stop treatment. Across 22 studies and 21,453 patients, no predictor of discontinuation was consistently associated with it.

What is established is worth holding onto: the hard points in a cycle are known in advance, clinical-level distress after a result is common rather than exceptional, partners genuinely diverge and that divergence is documented rather than a sign of a failing relationship, a minority are still affected years later and can be identified early, and none of it changes whether the cycle works.