Patients have rated the stress of undergoing IVF as more stressful than or almost as stressful as any other major life event, such as the death of a family member or separation or divorce.  

While general assumptions may be made about stress levels during IVF, the experience for infertility patients will be personal and unique--each patient will experience the stress differently based upon his or her own personality and life experiences.  Dealing with the medical staff and with the side effects or potential complications of medical treatment has its own stress: hot flashes, headaches, mood fluctuations, injections, sonograms, future health concerns, and decision making about embryos, their disposition and multiple pregnancies. 

Unexpected Challenges 

The aspects of IVF that are perceived as stressful by patients are multifaceted and affect all parts of their life/lives: marital, social, physical, emotional, financial, and religious. Time is stressful, both in the time commitment to an intense treatment which leads to disruption in family, work, and social activities, and for some, in long waiting periods for treatment services. IVF stress may impact the marital relationship, by reducing sexual intimacy.  Couples also may find themselves stretched financially, paying for the high cost of IVF treatment with a somewhat limited probability of success. Dealing with the medical staff and with the side effects or potential complications of medical treatment has its own stress: hot flashes, headaches, mood fluctuations, injections, sonograms, future health concerns, and decision making about embryos, their disposition and multiple pregnancies. Religious, social, and moral issues may also make IVF stressful, especially for those dealing with third- party reproduction, if these values conflict with the choice of treatment.

The first treatment cycle has been found to be the most stressful for patients, with the possibility of high levels of confusion, bewilderment, and anxiety. This may be due in part to the fact that it is a new experience with an unfamiliar medical process, medications and treatment protocols that can change during the cycle, and possibly working with a new team of healthcare professionals. Within a treatment cycle, patients view IVF as a series of stages which must be successfully completed before moving on to the next phase of treatment: monitoring, oocyte retrieval, fertilization, embryo transfer, waiting period, and pregnancy test stages. The level of stress, anxiety, and anticipation rises with each stage, peaking during the waiting period. Research has shown that in order of perceived stress for patients, waiting to hear the outcome of the embryo transfer is the most stressful, followed by waiting to hear whether fertilization has occurred, and then the egg retrieval stage. Patients are aware of the importance of these key phases in the IVF process, and the uncertainty of the outcome is often highly distressing.

Coping Strategies 

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 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.

IVF has the potential to be an emotionally, physically, and financially exhausting experience.  If you are a patient about to begin a cycle, here are some tips to help get ready for IVF:

1. 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. IVF is an anxiety-producing experience, and one of the best antidotes for anxiety is information and knowledge. 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.
    
2. 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 need to decide, along with your physician, how many embryos will be transferred while maximizing your chances for pregnancy and minimizing the possibility of multiple babies. You will also need to decide what you will do with extra eggs and/or embryos, i.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 guideline of the American Society for Reproductive Medicine.
    
3. Tend to your psyche and your relationships. A long struggle with infertility may have taken a toll on how you are feeling about yourself, your marital relationship, and/or your relationship with others, causing distress and isolation. You will want to be in a good place emotionally and have your relationship on 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, 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.
    
4. Garner 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 also is 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.
    
5. 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 ahead where your stresses may come from will help in developing coping strategies. 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. For example, women may need to talk and receive support, while men 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. In addition, exercise is one of the best ways to alleviate feelings of stress, anxiety and depression although the level of exercise may have to be adjusted during the treatment cycle. Humor is a great coping mechanism and can help you get through difficult times. No matter how tough things get, you can always find something funny about it and laughing about it is good for your health. Stress management classes, listening to relaxation tapes and other mind/body techniques used regularly can help in handling these feelings and dealing with treatment procedures. Of course, all of the above applies to single individuals undergoing IVF as well.
    
6. Decide what you have control over and what you don't. To help eliminate any unnecessary stress, you will want to make you 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. You do have control over the choices you make in your daily life while how the treatment course progresses is usually out of your hands.
    
7. Anticipate problem areas. Plan 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. There are possibilities for failure at every step of the cycle, from a poor response to medication to no fertilization after retrieval.

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 be when you receive the results (probably not at work) and 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.

Look past this cycle at the beginning. It is important to be looking ahead as you prepare for IVF and to consider your limits as you begin the process. It is easy to know how you will feel if treatment is successful and you become pregnant. However, you must also understand that if you are unsuccessful in achieving a pregnancy, you cannot get away from the sadness, loss, and disappointment that are part of the grieving process. Think about the number of cycles you are willing or able to do, and how much more time and money will be involved in infertility treatment, knowing that you can always reassess later. Remember that with each cycle new information is learned that can help future decision-making. Consider exploring other family building options, such as adoption, which will give you some control and provide information for future choices. No matter what the outcome of IVF, you need to recognize you have succeeded in doing all that is within your power to have a child, and can feel good about yourself. Doing so minimizes any possible future regrets. 

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