Just relax and you'll get pregnant? Meta-analysis examining women's emotional distress and the outcome of assisted reproductive technology

Couples worldwide are seeking treatment for infertility in growing numbers. Both infertility and its treatment are stressful experiences that generate considerable emotional distress. There is speculation that women's distress is associated with poorer likelihood of pregnancy via assisted reproductive technology (ART) and plausible psychobiological mechanisms bolster this association, although prior reviews of existing evidence find little support. A rigorous, comprehensive, and up to date analysis of research on the association of women's distress with ART outcomes is imperative. We systematically searched for and analyzed evidence regarding the association of women's distress before and during treatment with the likelihood of treatment success via ART. Meta-analysis using a random-effects model was conducted on prospective studies (k = 20) that compared levels of anxiety, depressive symptoms, or perceived stress before or during ART treatment in women who achieved successful pregnancy outcomes versus those who did not (total N = 4308). Anxiety, depressive symptoms, or perceived stress pre-treatment, and anxiety or depressive symptoms during treatment, were not associated with less favorable ART outcomes. Prior treatment experience, age, and duration of infertility were not significant moderators of these associations. No eligible studies examined perceived stress during treatment. Results cast doubt on the belief that distress impedes the success of infertility treatment, offering hope and optimism to the many women who feel emotionally responsible for the outcome of ART and informing the evidence-based practices of their health-care providers. We also identify specific areas and research methods needed to corroborate and extend study conclusions, including study of factors that elevate or attenuate distress in women undergoing infertility treatment.