For many patients, the stress of infertility and undergoing IVF can be as great as the stress caused by the death of a family member or undergoing separation or divorce.  Although many people find IVF very stressful, every patient experiences IVF differently; people’s personalities and life experiences influence how challenging they find the process and which aspects of IVF are most difficult for them to cope with.

Many patients worry that the stress they experience during IVF will decrease their chances of becoming pregnant.  This is untrue; although infertility and fertility treatment are stressful, research shows that stress doesn’t cause infertility or make it less likely that IVF will work.  The coping strategies discussed below are suggestions for how to make a difficult experience easier; they are not shown to change the outcome of fertility treatment.

Possible Sources of Stress

Many aspects of the IVF process can cause or contribute to treatment stress.

Time commitment: IVF requires a time commitment that can lead to disruption in family, work, and social activities.  For some, a long wait for treatment services and the time that has already been spent waiting and hoping to become pregnant before starting treatment can be an additional stressor.

Relationship changes: IVF stress may impact the marital relationship.  Couples undergoing IVF may experience changes in their sexual life and find themselves having less frequent or less enjoyable sexual intimacy. They may also experience relationship strain related to differences in how they each cope with infertility and treatment. Couples may also find themselves stretched financially, paying for the high cost of IVF treatment without a guarantee of success. Relationships with family and friends may also be challenged as people decide how much information to share about their fertility journey and how to handle other people’s questions and comments about the process.

Treatment side effects and decisions: Dealing with the medical staff and with the side effects or potential complications of medical treatment has its own stress. For some patients, hot flashes, headaches, mood fluctuations, injections, sonograms, future health concerns, and decision-making about embryos, their disposition, and multiple pregnancies can be sources of concern. Religious, social, and moral issues may also make IVF stressful, especially for those dealing with third-party reproduction, if these values conflict with the available options for treatment.

Despite the stressful consequences of infertility and IVF, it is important to note that research has shown that the vast majority of patients adjust well emotionally. Further, there seems to be no long-term negative impact on the marital relationship and individual functioning. In fact, some research has shown that the crisis of infertility may actually improve marital communication and emotional intimacy. Couples may learn coping skills and communication patterns that provide life-long benefit. Those individuals who do develop uncomfortable anxiety or depression symptoms should consult with a mental health professional who has knowledge and experience with infertility.

If you are a patient about to begin a cycle, here are some tips to help get ready for IVF:

Gather information and plan ahead: Good decision-making involves being well educated and informed about your body, the IVF process, and your clinic/treatment program. Information and knowledge are helpful antidotes to anxiety. The more you know and understand about the process, the less stress you may feel. Look for articles and other reading materials about IVF. Take advantage of resources from your treatment center, talk to others who have been through IVF, and consider seeking support from the list below.
 
Prepare for decision-making: It is important to anticipate decisions that may occur during IVF and discuss your options ahead of time. Sometimes these decisions may have moral and religious implications that you will need to consider and discuss. You will also need to decide what you will do with extra eggs and/or embryos, (.e. freeze, dispose of, or donate them). If there is a possibility that donor gametes (sperm or egg) will be used in the cycle, it is important that you carefully discuss the issues involved in raising a donor-conceived child before starting the cycle. Counseling can assist you in exploring these issues and is recommended in the treatment guidelines of the American Society for Reproductive Medicine.
 
Tend to your psyche and your relationships: Taking care of yourself and your relationships will help you feel like you are on more solid ground before starting an IVF cycle. Facilitate communication with your partner by setting a limited amount of time to talk about IVF, such as 20 minutes a day, and then putting infertility talk aside. Discuss ahead of time your hopes and expectations of each other during the cycle. For example, decide whether you want to be together at appointments, on the day of the pregnancy test, and when you are expecting a call from the doctor. Counseling can be very helpful when you and/or your partner are feeling depressed, unusually anxious, emotionally stuck or in a rut. An ounce of prevention is worth a pound of cure, so get help early before problems arise.
 
Gather your support: Friends and family can be your best support or they can be your worst. Decide in advance who you will tell about the procedure by identifying who will give you the support you need. In hindsight, patients often wish that they had not told so many people at the start, as it sometimes adds to the pressure. It can be helpful to designate a friend/family member as a "spokesperson" who will let others know, when you are ready, what is going on. In addition, look outside your usual support network to those who truly understand other infertility patients. If it is available in your medical practice, consider joining an IVF support group, or check out other infertility self-help organizations. The internet is also a ready source of infertility support and information, through various websites and chat rooms. A great deal of healing can come from others who understand.

Be careful about spending too much time on the internet searching for information and support. Research has shown that online infertility support groups help reduce feelings of isolation, but people who spend too much time in infertility-related chat rooms and reviewing the same information multiple times often feel worse.

Identify your stresses and your coping mechanisms: Each person experiences stress in different ways, so it is helpful to identify where yours may come from. For some, it may be in just getting to the clinic in the morning for monitoring;  for others it may be injections. Anticipating where your stresses may come from will help in developing coping strategies. If you are part of a couple, know your own and your partner's styles for dealing with stress and what has helped in the past. It is not unusual for each member of a couple to react differently to stress. Some people may need to talk to trusted people and receive direct emotional support, while others may prefer to be involved in an activity or hobby to cope. Learning to accept differences in the way each of you handles and deals with your feelings can reduce conflict.
 
Exercise is one of the best ways to alleviate feelings of stress, anxiety and depression; check with your doctor to understand what kinds of exercise are OK at different phases of the treatment cycle. Try to spend some time doing things that bring out your sense of humor or make you feel relaxed, curious, or engaged in something besides fertility treatment; most people find that the things that mattered to them before they started trying to have a baby still bring them some pleasure and relief.   Stress management classes, listening to relaxation tapes and other mind/body techniques used regularly can also help in handling stress and dealing with treatment procedures.
 
Decide what you have control over and what you don't: To help eliminate any unnecessary stress, try to make your life as simple as possible during the cycle. This is not a time to make important decisions or changes in your life, such as a move or job change. If at all possible, avoid major undertakings at work that can add stress to your life. In addition, you will want to think about how to deal with other daily life challenges on the job, at home, and with family and friends. Although the way treatment progresses is usually out of your hands, you do have control over the choices you make in your daily life. 
Anticipate problem areas. Plan ahead for possible changes and difficult times during your cycle, such as the waiting period after transfer and the day you will get the results. Expect the unexpected, as changes are frequently made in the cycle because of everyone's unique medical situation.  Planning ahead also involves beginning to consider your limits before you begin IVF. Think about the number of cycles you are willing or able to do, , knowing that you can always reassess later. Remember that with each cycle new information is learned that can help future decision-making. The 10-14 day waiting period between transfer and receiving the pregnancy test results is often described as the most difficult part of the cycle. Having had daily contact with your medical support staff during monitoring and retrieval, you suddenly are on your own after transfer and just have to wait. You need to think about how to fill your time during this time, and then consider where you will want to be when you receive the results (probably not at work) and, if you have a partner, whether you want to be together to hear the news. To allow some time to deal with what you learn, you may want to consider "fibbing" to family and friends by telling them the results are due a few days later than reality. This will give you breathing space and time to adjust to the news before dealing with others.

Some people find counseling or therapy helpful in coping with the stress of IVF and sorting through treatment options.  A directory of qualified fertility counselors is available at https://www.reproductivefacts.org/find-a-health-professional/. 

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