Does psychology really matter?

Many studies have examined the role of psychological factors in the outcome of fertility treatment. But when we say that “psychology matters”, what exactly do we mean?

We are referring to a set of emotional and social factors that interact in complex ways. They can influence assisted-reproduction outcomes through biological mechanisms we are only beginning to understand — and their effect is not always the one we would expect.

How does communication within the couple change?

Many couples fall into a vicious cycle of “private” thoughts and feelings, which makes communication harder, raises stress, and narrows each partner’s options for coping. A cycle of anger and guilt often appears when one partner blames the other for the fertility problem.

What happens with habits such as smoking or weight?

Harmful habits — smoking, poor diet, excess weight — affect fertility. In the setting of infertility, however, these habits are harder to change, because they are often the very mechanism by which the person copes with the problem.

Does the way I handle difficult moments matter?

Yes. The common belief that “expressing your feelings leads to better outcomes” does not necessarily hold in fertility. The evidence suggests that techniques that draw attention away from the problem (distractions) — exercise, interests outside treatment, meaningful work — may help more than continuous engagement with the issue.

Do anxiety and depression play a role?

Symptoms of anxiety and depression often coexist with infertility — either pre-existing or emerging in reaction to the diagnosis. Whether or not they reach the level of a formal clinical diagnosis, they can adversely affect treatment outcome — and are the most common reason couples discontinue treatment before reaching pregnancy.

Does stress directly affect treatment success?

The data are not clear-cut. The stress of a single IVF cycle does not appear to meaningfully reduce the chance of pregnancy in that attempt. Chronic infertility-related stress, however, may contribute to the underlying fertility problem itself, and affects the psychological resilience needed for further attempts.

How is self-esteem affected?

Many women and men experience a sense of personal inadequacy linked to the inability to conceive. Their body “isn’t doing what it should”, their self-image is shaken, and this often spills over into other areas of life — professional, social, and family.

What changes in the couple’s sexual life?

Infertility and its treatments often have a negative impact on the couple’s sexual life. Sexual relations may take place only for reproduction, on a strict schedule, or may decrease because of medical restrictions and fluctuations in libido. This creates a second layer of tension within the relationship.

How are the financial burden and difficult decisions managed?

Assisted-reproduction attempts are expensive, and the cost accumulates with every failed cycle. At the same time, couples must make difficult decisions: when to start, how many attempts to make, and how to choose among alternatives such as adoption, egg or sperm donation. Psychological support helps the couple work through these decisions without the decisions themselves becoming a source of conflict.

Psychological support in infertility is not a fertility treatment. It is a way not to lose each other while you are trying to become parents.