"Just Relax" and Other Unhelpful Things People Say About Fertility
Source: Generated with AI
If you are trying to conceive and finding it difficult, you may have heard people say: “Just relax and it will happen.” These words, however well-intentioned, can feel both dismissive and unhelpful. But the question behind them is a genuinely important one, and the scientific community has been working hard to answer it: does stress actually affect fertility?
This review brings together findings from a range of recent peer-reviewed studies to help you understand what we know, what remains uncertain, and what practical steps the research suggests. It is written for anyone affected by fertility challenges. Wherever possible, medical terms are explained plainly.
“Infertility is often a silent struggle. Patients who are struggling to conceive report feelings of depression, anxiety, isolation, and loss of control. Depression levels in patients with infertility have been compared with patients who have been diagnosed with cancer.” Rooney & Domar (2018, p. 41)
Key Takeaways
Stress and infertility are deeply intertwined, and the relationship runs in both directions: infertility reliably causes stress, and stress probably makes it somewhat harder to conceive, though it is rarely the sole cause.
Feelings of anxiety, depression, and grief during fertility struggles are a normal response to a genuinely difficult experience, not a sign that something is wrong with you.
Stress can affect the body’s reproductive systems through hormonal, physical, and inflammatory pathways, in both women and men.
Things like social stigma, financial pressure, and longer treatment duration can deepen distress, while mindfulness, social support, active coping, and self-compassion can help buffer against it.
Psychological support, including therapy, mindfulness programs, and structured mind/body interventions, is a well-evidenced part of fertility care that reliably improves wellbeing, and in some studies, pregnancy rates too.
How Common is Infertility, and What Does It Feel Like Emotionally?
Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse. It affects approximately 1 in 6 adults globally (Hu et al., 2025), and despite its prevalence, many people suffer in silence. The majority of infertile women do not share their story with family or friends, which only deepens their psychological vulnerability (Rooney & Domar, 2018).
The emotional toll is profound. Depression levels reported by infertile patients have been compared with those seen in people diagnosed with cancer, HIV, and heart disease (Rooney & Domar, 2018). In a large study of over 600 patients attending infertility clinics in northern California, 56% of women and 32% of men reported significant symptoms of depression, and 76% of women and 61% of men reported significant symptoms of anxiety (Rooney & Domar, 2018).
These figures are consistent across international research. A review of 61 studies encompassing 148,670 patients found that 41% of females struggling with infertility experienced clinically significant anxiety and 42% experienced depression (Hu et al., 2025). A review of anxiety specifically found a pooled prevalence of 36% across 13 studies, with rates considerably higher in low and middle-income countries (Kiani et al., 2020).
Important note: Feelings of grief, anxiety, and depression in the context of fertility challenges are a completely normal and understandable response to a very difficult situation. They do not mean anything is wrong with you as a person.
The Chicken or the Egg: Does Stress Cause Infertility, or Does Infertility Cause Stress?
This is the central question researchers have grappled with for decades, and the honest answer is: it is probably both, and they can reinforce each other (Rooney & Domar, 2018).
What is well-established is that infertility causes significant stress. The experience of being diagnosed, undergoing investigations, navigating treatment cycles, and coping with losses along the way creates a cumulative psychological burden that grows over time (Hu et al., 2025; Wu et al., 2023). The further into treatment a patient goes, the more frequently symptoms of depression and anxiety tend to appear (Rooney & Domar, 2018; Pasch et al., 2016).
What is less settled is whether stress causes infertility, or makes it harder to conceive. The evidence points toward a probable, though not certain, effect. The difficulty lies in measurement: people under stress do not always accurately report how stressed they feel on questionnaires, which complicates the research (Rooney & Domar, 2018).
A key study of 501 women in the United States used a biological marker of stress, measured through biomarkers found in saliva, rather than relying on self-report. It found that women with the highest stress-marker levels at the start of the study were twice as likely to subsequently experience infertility (Lynch et al., 2014; Rooney & Domar, 2018). Another study measured cortisol, the body’s primary stress hormone, in samples of hair, which capture cumulative stress exposure over the preceding 3 to 6 months rather than a single stressful moment. Women undergoing IVF with higher hair cortisol levels were significantly less likely to become pregnant than women with lower levels (Massey et al., 2016; Rooney & Domar, 2018).
The picture that emerges is of a cycle: infertility is stressful, that stress may compound fertility difficulties, and those difficulties in turn generate more stress (Rooney & Domar, 2018).
How Might Stress Affect the Body’s Reproductive System?
To understand how stress could affect fertility, it helps to understand a little of the biology. When we experience stress, the brain signals the release of hormones such as cortisol and adrenaline. These are helpful in short bursts, but when stress is chronic, these same hormones can begin to interfere with other body systems, including the reproductive system.
The hormone cascade. Stress disrupts the hypothalamic-pituitary-ovarian (HPO) axis, the chain of signals between the brain and the ovaries that governs the menstrual cycle and ovulation (Hu et al., 2025). Chronic stress can suppress the release of key reproductive hormones (LH and FSH), leading to irregular or absent ovulation (Seibel & Taymor, 1982). Stress also triggers elevated prolactin, which when too high, suppresses gonadotropins and disrupts normal follicle development (Seibel & Taymor, 1982). Women with major depressive disorder may have alterations in LH pulsatility that directly lead to changes in menstruation and fertility (Hudepohl & Smith, 2022).
In simple terms: stress can throw off the natural hormonal signals that tell the ovaries when to release an egg, which is why periods can become irregular or ovulation can stop altogether. It can also raise levels of a hormone called prolactin, which gets in the way of normal egg development, and for women dealing with depression, these hormonal shifts can directly affect their periods and ability to conceive. When ovulation becomes irregular or stops happening altogether, it means an egg isn't being released reliably each month, which directly lowers the chances of conceiving since there's no egg available to be fertilized.
The uterine environment. Psychological stress triggers the release of adrenaline-like chemicals (catecholamines), which cause smooth muscles to contract. In the uterus and fallopian tubes, this may interfere with ovum transport and the implantation of an embryo (Hu et al., 2025; Seibel & Taymor, 1982). In simple terms: when you're stressed, your body releases chemicals that can cause the muscles in your uterus and fallopian tubes to tighten. This can make it harder for an egg to travel where it needs to go, or for an embryo to settle in and implant successfully.
Inflammation. Depression in women undergoing fertility treatment is associated with elevated inflammatory markers, including C-reactive protein (Hudepohl & Smith, 2022). A subset of patients with depression-linked inflammation may respond to anti-inflammatory interventions such as omega-3 fatty acids, suggesting this is a meaningful biological pathway (Hudepohl & Smith, 2022). In simple terms: women dealing with depression while trying to conceive often have higher levels of inflammation in their bodies, and for some, things like omega-3 supplements may help calm that inflammation down, which suggests it's a real physical factor in fertility, not just an emotional one.
In men. Stress affects male fertility through similar hormonal channels. Higher depression and anxiety scores in men are associated with lower testosterone, higher cortisol, elevated prolactin, and lower sperm count and ejaculate volume (Hudepohl & Smith, 2022). This is an important reminder that fertility challenges are not solely a women’s issue. Heightened stress in the male partner is a contributing factor to infertility and unsuccessful ART outcomes, although to a lesser degree than for the female partner (Hudepohl & Smith, 2022).
In simple terms: stress and mental health affect men's fertility too. Higher anxiety and depression are linked to lower testosterone, more cortisol, and reduced sperm count and quality. It's a reminder that fertility struggles aren't just something women deal with. A stressed-out male partner can also make it harder for a couple to conceive, even if the effect tends to be smaller than what's seen in women.
What Makes the Impact of Stress Worse, or Better?
Not everyone who experiences stress will have impaired fertility, and not everyone undergoing fertility treatment will experience severe psychological distress. Research has identified a number of factors that appear to amplify or buffer the relationship between stress, anxiety, and fertility outcomes.
Factors That May Worsen the Impact
Personality traits. Traits such as neuroticism, stress susceptibility, and avoidance coping are associated with higher rates of depression and anxiety in people with infertility (Hudepohl & Smith, 2022). Unhelpful patterns of thinking such as catastrophising (“everything is ruined”) or rumination (replaying worries repeatedly) significantly increase anxiety and depression levels (Cao et al., 2022). In simple terms: people who tend to worry a lot, take things hard, or avoid dealing with problems head-on are more likely to struggle with anxiety and depression when facing infertility. Getting stuck in negative thought spirals, like assuming the worst or replaying the same worries over and over, only makes those feelings stronger.
Social stigma. Social stigma around infertility is significantly correlated with increased perceived stress and depression severity (Hu et al., 2025). This is especially pronounced for people with primary infertility, who may encounter judgemental attitudes or derogatory labels. Being unable to share one’s struggles due to shame or stigma removes a crucial source of support (Ghelich-Khani et al., 2021). In simple terms: the shame and judgment some people face around infertility can make their stress and depression worse, especially for those who never had children. When people feel too embarrassed or ashamed to talk about what they're going through, they lose out on the support that could help them cope.
Longer duration of infertility. The longer infertility persists, the worse anxiety and depression scores tend to become (Hu et al., 2025). People who have experienced a miscarriage carry a significant additional psychological burden: research shows that patients with a miscarriage history are more than twice as likely to develop depression during fertility treatment (Hu et al., 2025). In simple terms: the longer someone struggles to conceive, the more their anxiety and depression tend to build over time. Going through a miscarriage adds an extra layer of emotional weight, and people who experienced one are over twice as likely to become depressed during fertility treatment.
Financial pressure and poor knowledge of ART. A 2025 meta-analysis found that treatment costs were among the strongest predictors of anxiety and depression in women struggling with infertility. A lack of knowledge about assisted reproductive technologies also independently increased anxiety, suggesting that accessible information is genuinely protective (Hu et al., 2025). In simple terms: the cost of fertility treatment is one of the biggest drivers of anxiety and depression, and not understanding how the treatment process works can make people even more anxious. This shows that giving people clear, accessible information could genuinely ease some of that stress.
Treatment dropout. Stress does not only affect the body, it affects behaviour as well. More depressed patients are significantly more likely to drop out of fertility treatment after only one cycle, even when they have a good prognosis and the financial means to continue. Research has also shown that psychological distress is the most commonly cited reason for discontinuing treatment (Rooney & Domar, 2018; Hudepohl & Smith, 2022). In simple terms: stress doesn't just affect how people feel, it also affects what they do. People who are more depressed are more likely to quit fertility treatment early, even if they're likely to succeed and can afford to keep going, simply because the emotional toll becomes too much to bear.
Gender differences in burden. Anxiety, depression, and stress levels are consistently higher in women than in men, and interestingly, the psychological burden on women is heightened even when the infertility is attributable to the male partner (Khalesi & Kenarsari, 2024). Women typically bear a disproportionate share of the physical, emotional, and social burden of fertility challenges (Khalesi & Kenarsari, 2024). In simple terms: women tend to carry a heavier emotional load than men when it comes to infertility, and this holds true even when the fertility issue is actually on the male side. Overall, women shoulder more of the physical, emotional, and social weight of trying to conceive.
Factors That May Protect Against the Impact
Trait mindfulness. One of the most consistently researched protective factors is “trait mindfulness”, a person’s natural, everyday tendency to be present, aware, and non-judgemental. Across two studies of fertility patients in the United States, those higher in trait mindfulness had lower anxiety, lower depression, and less fertility-specific distress (Dillard et al., 2025). Mindfulness was also found to be especially protective in difficult moments: when imagining that IVF might fail, women higher in mindfulness anticipated significantly fewer negative emotions. The authors describe trait mindfulness as functioning as a “stress-buffering trait” (Dillard et al., 2025, p. 216).
In simple terms: people who are naturally better at staying present and not judging themselves tend to handle the stress of infertility better. They report less anxiety, depression, and fertility-related distress. Even when picturing a worst-case scenario like a failed IVF cycle, mindful women expected to feel less overwhelmed by negative emotions, which is why researchers think of mindfulness as a kind of emotional shock absorber.
Active coping. Not all ways of managing stress are equal. Avoidant coping like trying to push worries aside or escape the situation, is associated with worse emotional outcomes, whereas active coping is associated with positive adjustment (Hudepohl & Smith, 2022). Research has also found that a “letting go” style of coping is associated with better IVF treatment outcomes (Dillard et al., 2025). In simple terms: how you deal with stress matters. Trying to avoid or ignore your worries tends to make things worse emotionally, while facing problems head-on is linked to better outcomes. Interestingly, being able to "let go" and accept what you can't control has also been linked to better IVF results.
Social support. Having good social support buffers the psychological impact of infertility. Low social support, alongside high stress levels and reduced self-value, is a consistent predictor of poorer quality of life during fertility treatment (Hudepohl & Smith, 2022). In simple terms: having people around who genuinely support you can soften the emotional blow of infertility. On the flip side, feeling unsupported, overly stressed, and down on yourself tends to predict a lower quality of life during treatment.
Self-compassion, optimism, and gratitude. Emerging research points to the value of traits such as self-compassion, optimism, and gratitude as protective factors in fertility patients (Dillard et al., 2025). People who can respond to their own suffering with kindness rather than self-criticism appear to fare better emotionally during this difficult process. In simple terms: being kind to yourself, staying hopeful, and appreciating the good things in life all seem to help people cope better emotionally with infertility. Treating yourself with compassion instead of harsh self-criticism appears to make the experience more bearable.
Does Treating Stress Help? What the Interventions Show
Encouragingly, the answer here is broadly yes, though not uniformly so across all studies (Rooney & Domar, 2018).
Multiple systematic reviews and meta-analyses examined whether psychological interventions, including cognitive-behavioural therapy (CBT), mindfulness-based programs, group mind/body programs, relaxation training, and expressive writing, can reduce distress and improve outcomes in fertility patients. The most comprehensive of these, by Frederiksen et al. (2015), reviewed 39 studies and found statistically significant and robust overall effects of psychosocial interventions on both pregnancy rates and a variety of different psychological symptoms. Importantly, higher pregnancy rates were associated with greater decreases in anxiety (Rooney & Domar, 2018).
One of the best-studied programs is the Mind/Body Program for Infertility, developed in 1987. It runs over ten group sessions and incorporates CBT, relaxation techniques (including yoga, meditation, and progressive muscle relaxation), lifestyle changes, journaling, and social support. Randomised controlled trials of this program have found that participants show significantly lower levels of distress and higher pregnancy rates than control participants (Rooney & Domar, 2018).
Mindfulness-based interventions have also shown promise. A study of first-time IVF patients found that those who participated in a mindfulness-based intervention showed significant increases in mindfulness, self-compassion, and meaning-based coping, and had higher pregnancy rates than those in the control group (Li et al., 2016; Rooney & Domar, 2018).(Hudepohl & Smith, 2022).
It is worth noting that not all meta-analyses agree, and the evidence on pregnancy outcomes is not conclusive (Rooney & Domar, 2018). Results likely depend on the type and length of intervention and individual patient factors. What is consistent across the literature, however, is that psychological support reliably reduces distress and improves quality of life (Hudepohl & Smith, 2022). That alone is reason enough to prioritise mental health care in fertility treatment.
In simple terms
Overall, treating stress and supporting mental health during fertility treatment really does seem to help, though the research is not fully consistent across every single study. When researchers pooled together dozens of studies, they found that things like therapy, mindfulness programs, relaxation techniques, and group support not only helped people feel better emotionally, but were also linked to higher pregnancy rates. The more someone's anxiety dropped, the more likely they were to get pregnant.
One well-tested program combines therapy, relaxation (like yoga and meditation), journaling, and group support over ten sessions, and people who went through it felt less distressed and had better pregnancy outcomes than those who did not. Similarly, mindfulness programs helped people feel more self-compassion and cope better, and those participants also saw higher pregnancy rates.
That said, not every study agrees on exactly how much these approaches affect pregnancy rates specifically. The results can vary depending on the type of program and the individual person. But one thing researchers do agree on: getting psychological support consistently helps people feel less distressed and improves their overall quality of life during fertility treatment. Even if it did not directly boost pregnancy chances, that alone would be a good enough reason to make mental health support a standard part of fertility care.
“Irrespective of whether psychological interventions improve pregnancy rates, depression, anxiety, and emotional distress are common in the infertility population, and evidence-based treatment options should be offered.” Hudepohl & Smith (2022, p. 128)
A Note of Caution: What the Research Cannot Tell Us
It is crucial to be clear about what this evidence does not mean. None of it supports the idea that stress alone causes infertility, or that “just relaxing” will result in conception. Infertility is a complex medical condition with many causes (i.e., hormonal, anatomical, genetic, and lifestyle-related) and stress is one potential contributing factor among many (Rooney & Domar, 2018).
Telling someone with fertility challenges that they need to “stop stressing” is not only unhelpful but can actively compound the shame and self-blame that many people already carry (Ghelich-Khani et al., 2021). It shifts responsibility onto the person in a potentially harmful way.
The research also has real limitations. Many studies are cross-sectional (measuring things at one point in time rather than tracking change over time), the majority rely on self-reported measures of stress, and do not adequately control for confounding variables such as ge, duration of infertility, prior pregnancy loss, and underlying medical diagnoses, any of which could plausibly explain both the distress and the fertility difficulty (Hudepohl & Smith, 2022). Researchers acknowledge that the directionality of the stress-fertility relationship remains difficult to establish with certainty (Rooney & Domar, 2018).
Conclusion
The scientific literature paints a picture that is nuanced, but ultimately hopeful. Stress and anxiety are deeply intertwined with the experience of infertility. They are a natural response to a profoundly difficult situation, and they may, through biological pathways, compound fertility challenges in some people (Rooney & Domar, 2018; Hu et al., 2025). But they are not destiny.
What the evidence most strongly supports is this: your psychological wellbeing matters. Not just because it might affect treatment outcomes, but because you deserve to feel supported through one of the most challenging experiences a person can face. Seeking psychological support, whether through therapy, mindfulness, peer support groups, or structured programs, is a well-evidenced, clinically recommended part of fertility care.
For more information see resources below:
Cao, D., Bai, C., & Zhang, G. (2022). Psychological distress among infertility patients: A network analysis. Frontiers in Psychology, 13, Article 906226. https://doi.org/10.3389/fpsyg.2022.906226
Dillard, A. J., Williams, T., Wolfe, M., & Thakur, M. (2025). Trait mindfulness and distress in fertility patients. European Journal of Health Psychology, 32(4), 210–220. https://doi.org/10.1027/2512-8442/a000172
Frederiksen, Y., Farver-Vestergaard, I., Skovgård, N. G., Ingerslev, H. J., & Zachariae, R. (2015). Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: A systematic review and meta-analysis. BMJ Open, 5(1), Article e006592. https://doi.org/10.1136/bmjopen-2014-006592
Ghelich-Khani, S., Kazemi, A., Fereidooni-Moghadam, M., & Alavi, M. (2021). Psycho-social experience of oocyte recipient women: A qualitative study. BMC Women’s Health, 21, Article 406. https://doi.org/10.1186/s12905-021-01562-4
Hu, L., Yuan, Y., Li, Y., Cai, M., Yin, J., & Zhu, L. (2025). Prevalence and risk factors of negative emotions in infertile women: A systematic review and meta-analysis. Frontiers in Public Health, 13, Article 1701381. https://doi.org/10.3389/fpubh.2025.1701381
Hudepohl, N., & Smith, R. (2022). Infertility and its association with depression. Clinical Obstetrics and Gynecology, 65(1), 123–128. https://doi:10.1016/j.ypsc.2022.05.005
Khalesi, Z. B., & Kenarsari, F. J. (2024). Anxiety, depression, and stress: A comparative study between couples with male and female infertility. BMC Women’s Health, 24, Article 228. https://doi.org/10.1186/s12905-024-03072-5
Kiani, Z., Simbar, M., Hajian, S., Zayeri, F., Shahidi, M., Saei Ghare Naz, M., & Ghasemi, V. (2020). The prevalence of anxiety symptoms in infertile women: A systematic review and meta-analysis. Fertility Research and Practice, 6, Article 7. https://doi.org/10.1186/s40738-020-00076-1
Li, J., Long, L., Liu, Y., He, W., & Li, M. (2016). Effects of a mindfulness-based intervention on fertility quality of life and pregnancy rates among women subjected to first in vitro fertilization treatment. Behaviour Research and Therapy, 77, 96–104. https://doi.org/10.1016/j.brat.2015.12.010
Lynch, C. D., Sundaram, R., Maisog, J. M., Sweeney, A. M., & Buck Louis, G. M. (2014). Preconception stress increases the risk of infertility: Results from a couple-based prospective cohort study — the LIFE study. Human Reproduction, 29(5), 1067–1075. https://doi.org/10.1093/humrep/deu032
Massey, A. J., Campbell, B. K., Raine-Fenning, N., Pincott-Allen, C., Perry, J., & Vedhara, K. (2016). Relationship between hair and salivary cortisol and pregnancy in women undergoing IVF. Psychoneuroendocrinology, 74, 397–405. https://doi.org/10.1016/j.psyneuen.2016.09.010
Pasch, L. A., Holley, S. R., Bleil, M. E., Shehab, D., Katz, P. P., & Adler, N. E. (2016). Addressing the needs of fertility treatment patients and their partners: Are they informed of and do they receive mental health services? Fertility and Sterility, 106(1), 209–215. https://doi.org/10.1016/j.fertnstert.2016.03.006
Rooney, K. L., & Domar, A. D. (2018). The relationship between stress and infertility. Dialogues in Clinical Neuroscience, 20(1), 41–47. https://doi.org/10.31887/DCNS.2018.20.1/klrooney
Seibel, M. M., & Taymor, M. L. (1982). Emotional aspects of infertility. Fertility and Sterility, 37(2), 137–145. https://doi.org/10.1016/S0015-0282(16)46029-2
Wu, L., Sun, L., Wang, J., Sun, Y., Zhang, X., Huang, Y., Lu, Y., & Cao, F. (2023). Psychological distress among women undergoing in vitro fertilization-embryo transfer: A cross-sectional and longitudinal network analysis. Frontiers in Psychology, 13, Article 1095365. https://doi.org/10.3389/fpsyg.2022.1095365
