A 2011 meta-analysis found small links between stress or anxiety and lower pregnancy rates in IVF
Across 31 prospective studies, stress, trait anxiety and state anxiety each had a small, significant link with lower clinical pregnancy rates after assisted reproduction. The authors say the influence 'may appear somewhat limited'.
Suggestive but preliminary. Not settled. how we score evidence
Caveat on this rating: Small correlations, considerable heterogeneity, and a fail-safe number below criterion in every analysis; no link with live birth. The authors call the influence 'somewhat limited'. Boivin 2011 found no link. Read from the abstract only.
The same year a BMJ meta-analysis found no link between distress and IVF outcome, this one found a small one. Both are worth reading together.
Significant findings
Matthiesen, Frederiksen, Ingerslev and Zachariae pooled 31 prospective studies of women having assisted reproductive technology (ART). Stress meant perceived stress, work stress or life events; distress meant anxiety or depression.
"Small, statistically significant, pooled effect sizes were found for stress" (effect size correlation -0.08; 95% CI -0.15 to -0.01), "trait anxiety" (-0.14; -0.25 to -0.03) and "state anxiety" (-0.10; -0.19 to -0.01), "indicating negative associations with clinical pregnancy rates." Depression showed a "non-significant trend" (-0.11, p = 0.06). For positive blood tests and live births, links with trait or state anxiety "were not significant".
The other direction
The authors themselves are cautious. The fail-safe number, a check of how many unpublished null studies would erase a result, "did not exceed the suggested criterion in any analyses", "between-study heterogeneity was considerable", and age, length of infertility and first-time status changed several results. Their conclusion: "the influence of stress and distress on ART outcome may appear somewhat limited."
Boivin and colleagues (BMJ 2011, in this library) pooled 14 studies of pretreatment distress and found no link with pregnancy. The two used different studies and different outcomes. Even where Matthiesen found a link, a correlation of about -0.1 is small, and it cannot say which way it runs: a harder case can cause both worry and lower odds.
What this does not show
It does not show that stress causes a cycle to fail, or that a failed cycle is anyone's fault. It does not say that reducing stress improves IVF odds. Anxiety during fertility treatment is worth treating for its own sake.
Worth asking
Can we talk about support for how I am feeling during treatment, separate from whether it changes my odds?
Source
Stress, distress and outcome of assisted reproductive technology (ART): a meta-analysis — Matthiesen SM, Frederiksen Y, Ingerslev HJ, Zachariae R (2011)
Reputable peer-reviewed journal
Read the source: https://doi.org/10.1093/humrep/der246
DOI: 10.1093/humrep/der246
How this was scored
- Study design
- Systematic review of observational studies
- Funding
- Funding not disclosed
- Published in
- Reputable peer-reviewed journal
- Sample size
- not recorded
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
Read the full scoring rubric, including what it can't tell you.
Published October 2, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "early signal". Suggestive but preliminary. Not settled. It scores 52 out of 100 on our published rubric. One caveat travels with that badge: Small correlations, considerable heterogeneity, and a fail-safe number below criterion in every analysis; no link with live birth. The authors call the influence 'somewhat limited'. Boivin 2011 found no link. Read from the abstract only. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Stress, distress and outcome of assisted reproductive technology (ART): a meta-analysis — Matthiesen SM, Frederiksen Y, Ingerslev HJ, Zachariae R (2011). Published in: Reputable peer-reviewed journal. DOI: 10.1093/humrep/der246. The full source is linked on this page so you can read it yourself.
Who paid for this research, and does that matter?
Study design: Systematic review of observational studies. Funding: Funding not disclosed. Independence from the proponent is not recorded. Industry sponsorship is one of the most reliably measured biases in medicine, which is why funding carries real weight in the score rather than sitting in a footnote.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.