Ask any couple who has been through it and they will tell you there is little as stressful as wanting a baby and not being able to have one.

Infertility-related stress is known to take its toll on relationships, and now a new study shows it can also affect the success of fertility treatments.

Researchers reported that the stress of infertility on marriages was a stronger predictor of treatment failure than personal stress or infertility-related strains on other relationships.

Women who reported the most marital stress required more assisted reproduction cycles to get pregnant than women who reported less stress in their marriages, researcher Jacky Boivin, PhD, tells WebMD.

“The bottom line is that if infertility is causing a lot of stress in a partnership it could very well have an impact on whether the woman gets pregnant or not,” Boivin says.

She says she did not believe stress played a significant role in infertility until recently, but the mounting evidence in favor of a link was impossible to ignore. She makes it clear, however, that biologic factors such as age and embryo quality are much more important in the success or failure of infertility treatments than stress.

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Male Stress Mattered

The study is one of the largest ever to examine the role of stress on the success or failure of infertility treatments.

Boivin and colleague Lone Schmidt, PhD, followed roughly 800 Danish couples undergoing infertility treatments. All of the participants completed questionnaires at the beginning of the study to assess stress levels. The researchers then looked at pregnancy rates one year later.

During the one-year study period:

-- 71 percent of couples required 1 or 2 infertility treatment cycles

-- 26 percent had 3 to 5 cycles

-- 2 percent had more than 5 cycles

Roughly 60 percent of couples achieved an ongoing pregnancy or live birth and 40 percent did not.

Couples who did not achieve a pregnancy tended to be older than those who did, and they had been infertile longer and had more treatment cycles during the study.

While stress in men was an independent predictor of treatment success, the impact was much smaller than the impact seen in women. Boivin says the finding suggests that infertility-related stresses compromise sperm quality or other factors associated with male fertility.

“It has been thought that it was all about the woman and what is going on with her psyche,” Boivin says. “But this suggests that the same stresses that affect female fertility can affect male fertility.”

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Does Counseling Help?

It is not clear from the study if stress plays a direct role in infertility, or is instead a predictor of other lifestyle behaviors that can have an impact on the ability to conceive.

“Couples who are highly stressed may smoke more or drink more or generally not take good care of themselves,” Boivin says.

The research has been mixed on whether psychological counseling may help stressed couples overcome infertility, although the benefits in terms of stress reduction are clear.

In a study reported by researchers at Harvard’s Beth Israel Deaconess Medical Center the pregnancy rate among infertile women who got counseling in addition to fertility treatments was more than double that of women given fertility treatments alone.

But infertility psychotherapist Alice Domar, PhD, who led the study, said more study is needed to establish a definite link between psychological counseling and better pregnancy results among infertile women.

“I don’t want to give the impression that if a woman doesn’t get pregnant it is due to stress alone,” says Boivin. “In most cases the reason that infertility treatments don’t work are biological, not psychological, and the importance of psychological factors probably differs from person to person.”

By Salynn Boyles, reviewed by Brunilda Nazario, MD

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SOURCES: Boivin, J. Fertility and Sterility, June 2005; vol. 83: pp. 1745-1752. Jacky Boivin, PhD, senior lecturer, School of Psychology, Cardiff University, Cardiff, Wales, U.K. Alice Domar, PhD, director, Mind/Body Center for Women’s Health and the Mind/Body Medical Institute, Beth Israel Deaconess Medical Center, Boston.