What Truly is the Relationship Between Stress and IVF Outcome?

By Alice Domar, PhD
Executive Director
The Domar Center for Mind/Body Health at Boston IVF


There has been a huge amount of media interest in the recent publication in the British Medical Journal of the meta-analysis by Jacky Boivin, Ph.D, and her colleagues at Cardiff University in Wales.  In this analysis, they pooled the results of 14 different studies which assessed the distress levels of women prior to an IVF cycle. They found that there was no significant relationship between distress and the pregnancy rate of that cycle. The authors concluded that women can stop worrying about their stress level since it won’t have any impact on their ability to conceive.

My first response – I wish. I wish we knew it were definitive that stress had no impact on outcome since that would take a lot of the guilt and worry that women have about how they are handling the psychological challenges of cycling.

The truth is, it’s too soon to make any definitive statements about the relationship between stress and outcome. There in fact have been 25+ studies on this topic and most have shown a positive relationship. The biggest study, out of the Netherlands, did not, and this study constitutes about a fifth of the data in the meta-analysis. The Netherlands study has one major issue-few of the participants expressed any distress at all, which made it impossible to show any relationship. The authors made note of this in their conclusion-culturally, women in that country tend to minimize their expression of distress, thus making it impossible to truly know what the relationship is.

You also can’t make any conclusions when you only assess distress at one point in time. In the vast majority of the studies included, women were assessed once and the time of the assessment varied from study to study. In fact, many women are highly optimistic prior to treatment and thus their true level of distress is masked.  We presented a study at the reproductive medicine meeting last fall where we actually measured distress not only prior to the cycle, but also daily during the cycle. We actually found that the more distressed the women were prior to cycling, the more likely they were to conceive, but only if their distress level came down while cycling.  In fact, women who were highly distressed prior to cycling but participated in a mind/body group and reported lower distress levels during their cycle had a 100% pregnancy rate.

So in conclusion, this meta-analysis provides us with more information about the stress/IVF relationship, but it is terribly premature to conclude that stress has no impact on outcome. We just don’t know, and need more research to provide us with definitive answers.



Alice D. Domar, PhD is a pioneer in the application of mind/body medicine to men’s and women’s health issues. She not only established the first Mind/Body Center for Women’s Health, but also conducts ongoing ground-breaking research in the field. Her research focuses on the relationship between stress and different women’s health conditions, and creating innovative programs to help women decrease physical and psychological symptoms.

Dr. Domar received her M.A. and Ph.D. in Health Psychology from Albert Einstein College of Medicine/Ferkauf School of Professional Psychology of Yeshiva University. Her post-doctoral training was at Beth Israel Hospital, Deaconess Hospital, and Children’s Hospital, all in Boston.

She has conducted research on infertility, breast cancer, menopausal symptoms, ovarian cancer, and premenstrual syndrome. Dr. Domar has earned an international reputation as one of the country’s top women’s health experts.

She is currently the Executive Director of the Domar Center for Mind/Body Health, and the Director of Mind/Body Services at Boston IVF. She is an assistant professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School, and a senior staff psychologist at Beth Israel Deaconess Medical Center.

Dr. Domar has compiled an impressive list of accomplishments as a best-selling author, media authority and sought-after public speaker. She is the author of numerous books, on the advisory board for Parents Magazine, Health Magazine, Conceive Magazine, and Resolve, and on the Board of Experts for LLuminari. Two of her books have been finalists for the Books for a Better Life Award. She was also the Series Editor for a series of mind/body books by Harvard Medical Publications/Simon and Schuster. She is the narrator of the DVD’s “Stress and Relaxation Explained” and “Infertility Explained”, both of which won silver Telly Awards.  Dr. Domar has appeared on the Today Show, Good Morning America, CBS This Morning, Dateline NBC, CNN, PBS, and the CBS and NBC Evening News, to name a few. She presents lectures and conducts workshops throughout the US and around the world and went on tour with Oprah in the spring of 2004 and 2005 with the LLuminari team. Dr. Domar was named to the prestigious list of 15 “Women to Watch in 2004″ by Lifetime TV. Her newest book is “Be Happy Without Being Perfect” (Three Rivers Press, March, 2009) and she is currently working on a new book, co-authored with Dr. Susan Love, called “Live a Little” (Crown, December, 2009). She is also a featured expert on the new online social health network BeWell.com.