Psychological factors and infertility

Infertility affects about 9% of reproductive-age couples or more than 186 million people worldwide and up to 15% of couples in the USA. Infertility is a life event that results in significant psychological stress and women with decreased fertility have been found to have elevated levels of anxiety and depression. Moreover, stress and stress-related factors have an influence on the autonomic, neuroendocrine, and immune systems. In the past, psychological stress as a causative factor of infertility has been poorly investigated, however, several recent studies have shown that lowering psychological distress is linked with a significant increase in pregnancy rate. It has also been confirmed that stress stimulates and deregulates the hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal-medullary axis, which in turn plays a crucial role in women's reproductive functioning. There are studies that have further suggested an association between psychosocial stress and a diminished ovarian reserve and negative fertility outcomes. This chapter presents up to date information related to psychological factors and infertility, highlighting the impact of stress, anxiety, and depression on conception, impaired fertility, and infertility. Understanding the mechanisms behind the detrimental effects of psychological factors on female reproductive status is critically important knowledge for women's health care providers when screening for fertility risk factors and treating women with infertility. Women with fertility issues undergoing assisted reproductive technology procedures should be carefully evaluated for levels of stress, anxiety, and depression. Following evaluation, they should be offered appropriate counselling interventions to mitigate the adverse effects of psychological factors and to increase the success rate of infertility management procedures.