Human Reproduction Vol.20, No.10 pp. 29692975, 2005 doi:10.

1093/humrep/dei219
Advance Access publication August 25, 2005.

Does psychological stress affect the outcome of in vitro

fertilization?

L.Anderheim1,3, H.Holter1, C.Bergh1 and A.Mller2

1
Reproductive Medicine, Department of Obstetrics and Gynaecology, Institution of Womens and Childrens Health,
Sahlgrenska University Hospital, Gteborg University, SE-413 45 Gteborg, and 2Nordic School of Public Health, Box 12133,
SE-402 42 Gteborg, Sweden
3
To whom correspondence should be addressed. E-mail: lisbeth.anderheim-soderqvist@vgregion.se

BACKGROUND: The aim of the study was to investigate the effect of psychological stress before and during IVF
treatment on the outcome of IVF, controlling for known physiological predictors. METHODS: This is a prospective,
longitudinal study. A total of 166 women were studied during their first IVF treatment. They answered question-
naires concerning psychological and social factors on two occasions. Psychological well-being was measured by the
Psychological General Well-Being (PGWB) index and psychological effects of infertility were assessed by 14 items.
RESULTS: In the analysis of the psychological variables, no differences were found between pregnant and non-
pregnant women. The total number of good quality embryos, the number of good quality embryos transferred, and
the number of embryos transferred were significantly higher in the pregnant than in the non-pregnant group. In a
multivariate analysis, the number of good quality embryos transferred was the only variable that was independently
associated with pregnancy. CONCLUSIONS: We found no evidence that psychological stress had any influence on
the outcome of IVF treatment. When counselling infertile couples, it might be possible to reduce the stress they
experience during the treatment procedure by informing them of these findings.

Key words: counselling/in vitro fertilization/outcome/psychology/stress/well-being

Introduction secretion of gonadotropin; (ii) by local effects of catecho-

For most couples unable to conceive, childlessness is a source
of stress. Both the condition of infertility and its treatment
cause stress, and it is well known that infertility can induce
psychological disturbances (Mller and Fllstrm, 1991;
Lalos, 1999). Infertility has been ranked as one of the greatest
sources of stress in a persons life, comparable to a somatic
disease such as cancer (Domar et al., 1993). The stress of infer-
tility treatment was ranked second to that involving the death
of a family member or divorce by couples undergoing this
treatment (Freeman et al., 1985; Baram et al., 1988).
The concept of stress can be defined and described in differ-
ent ways. In the present study, stress refers to reactions (psycho-
logical or physiological) to the differences between the
womans experience of demands, both internal and external,
and how she perceives her capacity to cope with these demands.
Several authors have discussed the concept of stress as an
aetiological factor related to infertility (Seibel and Taymor,
1982; Harrison, 1983; Harrison et al., 1986, 1987; Edelman
and Golombok, 1989; Reading et al., 1989; Domar et al., 1990;
Strauss et al., 1992; Wasser et al., 1993; Christie, 1994; Vartiainen
et al., 1994; Domar, 1996). The mechanisms in this interaction
are not yet known, but different ways in which psychological
stress reactions might influence reproduction have been sug-
gested (Reading et al., 1989). These are: (i) by disturbing the
lamines on the uterus and on the functions of the fallopian
tubes; (iii) by immunological processes that can disturb
implantation; and (iv) by influencing behaviour, e.g. drug
addiction and sexual problems. In addition, an association
between psychological stress and sperm quality has been
observed in some studies (Harrison et al., 1987; Ragni and
Caccamo, 1992), while others have found that the effect of
psychological stress on sperm quality is small or non-existent
(Hjollund et al., 2004). The stress caused by infertility itself
might also further diminish the chances of having a child irre-
spective of the primary cause of the infertility.
However, whether psychological factors have any independ-
ent influence on the outcome of in vitro fertilization is still
under discussion. Several researchers have demonstrated that
the treatment procedure can cause women to experience great
psychological stress (Newton et al., 1990; Litt et al., 1992;
Mahlstedt, 1994), but whether psychological stress has any
effect on treatment outcome is unclear. It seems, however, that
variables such as age of the woman, embryo quality, infertility
diagnosis, IVF technique and number of earlier trials do not
totally explain the variation in the results of IVF treatment.
Harlow and co-workers (Harlow et al., 1996) found no evid-
ence that psychological stress has any influence on the out-
come of IVF. The groups conceiving and not conceiving had

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L.Anderheim et al.
similar levels of state and trait anxiety. In another study, high
levels of anxiety and stress did not predict an adverse preg-
nancy outcome (Milad et al., 1998).
In contrast, other studies found an association between psy-
chological stress and the results of in vitro fertilization. In
these studies, the dependent variable was the outcome of IVF,
either as pregnancies or births. The independent variables were
anxiety (Demyttenaere et al., 1989, 1992, 1994; Merari et al.,
1992, 1996; Boivin and Takefman, 1995; Csemiczky et al.,
2000; Smeenk et al., 2001; Lancastle and Boivin, 2005),
depression (Reading, 1992; Merari et al., 1992, 1996; Smeenk
et al., 2001), coping patterns or coping resources (Demyttenaere
et al., 1992; Merari et al., 1992, 1996; Boivin and Takefman,
1995), psychosocial interventions ( Boivin, 2003), baseline and
procedural stress (Klonoff-Cohen et al., 2001), marital satis-
faction (Boivin and Takefman, 1995; Merari et al., 1996), per-
sonality (Kemeter, 1988), intensity of the child-wish (Stoleru
et al., 1996), sperm quality related to psychological stress
(Harrison et al., 1987; Ragni and Caccamo, 1992), participa-
tion in psychotherapy (Brandt and Zech, 1991), and vulnerabil-
ity to psychological stress (Facchinetti et al., 1997).
However, support for a causal relationship between psycho-
logical stress and results of IVF is often weak. Few studies
indicating an association between psychological stress and IVF
outcome have tried to control for known confounders. In addi-
tion, the number of women included has often been low.
Thus, several studies have shown certain physiological
markers such as age, duration of infertility, number of earlier
failed IVF cycles, tubal indication for infertility, previous preg-
nancies, number of good quality embryos transferred and
number of oocytes to be independent predictors of IVF out-
come (Stolwijk et al., 1996; Templeton et al., 1996; Strandell
et al., 2000).
The aim of the present study was to investigate the effect
of psychological stress before and during IVF treatment on
the outcome of IVF, controlling for known physiological
predictors. The hypothesis was that psychological stress
may have a negative influence on the results of IVF. Psy-
chological stress is expressed here as a low level of general
psychological well-being including experienced negative
psychological effects of infertility, negative effects of infer-
tility on the womans relationship with her partner, high
intensity of the child-wish, experiencing infertility as a threat
to a positive self-picture, experiencing life as meaningless
and feeling little affinity with others, and a major difference
between an ideal life situation and the way the woman experi-
ences the life she is living.
Materials and methods
Design
This is a prospective, longitudinal study of women during their first
IVF cycle at Sahlgrenska University Hospital, Gteborg, Sweden. The
women were recruited between March 1999 and June 2002 from the
Reproductive Unit, Department of Obstetrics and Gynaecology. They
answered questionnaires concerning psychological and social factors
on two occasions during the IVF treatment. The study was approved
by the ethics committee at Gteborg University.
2970
Subjects
Two hundred women planning to start their first IVF/ICSI treatment
were invited to participate in the study. Before their first visit to the
clinic, the women received a letter with information about the study.
Following an information meeting at the clinic, the women were
asked if they were interested in participating. The exclusion criteria
were inadequate knowledge of the Swedish language and participation
in other studies. A total of 166 women agreed to participate in the
study. The main reasons for not participating in the study were lack of
interest, considering the treatment too demanding, and not wanting
any more obligations. The mean age of those who declined to particip-
ate in the study was 32.3 years and did not differ significantly from
that of participants. The pregnancy rate per started cycle among
women not participating in the study was 38.2%, which did not differ
significantly from the rate of those who participated (34.9%).
The demographic data for all women who received embryo transfer,
obtained from the womens medical records, are presented in Table I.
The mean age of the women was 32.1 years. The majority (89.9%)
were working, 37.4% had a university/college level education, and
68.3% lived in urban areas. Among the women, 13% were smokers.
The cause of infertility was male factors in 41.7%, while the remain-
ing cases involved female factors, unknown factors and mixed factors.
Five women had a psychiatric history such as earlier depression, psy-
chosis, anxiety or anorexia. Somatic diseases such as diabetes,
asthma, epilepsy, gastro-intestinal disorders and gynaecological dis-
eases such as endometriosis were observed frequently.
IVF treatment
All women were treated using a stimulation procedure including down-
regulation with a GnRH agonist according to a long protocol starting
either in the follicular phase or the luteal phase (1.2 mg/day nasally or
1.0 mg/day as a subcutaneous injection; Suprecur or Suprefact;
Hoechst, Frankfurt, Germany). Down-regulation was followed by stim-
ulation with recombinant FSH (Gonal-F, Serono, Geneva, Switzerland
or Puregon, Organon, Oss, Netherlands). Monitoring was carried out by
vaginal ultrasound scans and serum estradiol measurements. When ade-
quate stimulation was achieved (3 follicles of 18 mm diameter),
10,000 IU HCG (Profasi, Serono) was administered.
Fertilization was performed by conventional IVF or by ICSI follow-
ing standard techniques. In general, two embryos were transferred two
or three days after oocyte retrieval using a Wallace or a Frydman cathe-
ter. Luteal support was given either with s.c. HCG or with progesterone
(i.m. or vaginally). Additional embryos of good quality were cryopre-
served and replaced later. Pregnancy was defined as a positive HCG test
in urine on day 19 post-transfer. Clinical pregnancy was defined as
ultrasound verified pregnancy 5 weeks after embryo transfer.
Measures
The women answered extensive questionnaires concerning psy-
chological factors. The first questionnaire was filled in directly
after the information meeting one month before onset of down-
regulation, and the second questionnaire one hour before
oocyte retrieval. The questionnaires included the following.
First occasion of measurement
Psychological well-being
General psychological well-being during recent weeks was
measured by the Psychological General Well-Being (PGWB)
index (Dupuy, 1984). PGWB contains 22 items with six response
alternatives (16). The higher the value, the better the well-being.
 Psychological stress of in vitro fertilization

Table I. Background variables for pregnant and non-pregnant women in patients receiving embryo transfer

Pregnant (n = 58) Non-pregnant (n = 81) P

Age (years), mean (SD) (range) 32.2 (3.4) (25.038.0) 31.9 (3.7) (24.043.0) 0.66
Duration of infertility (years), mean (SD) (range) 4.7 (2.6) (1.517.0) 4.2 (2.1) (1.512.0) 0.20
Waiting period for IVF-treatment (months), mean (SD) (range) 18.6 (9.0) (2.048.0) 17.6 (8.2) (2.036.0) 0.70
No. of previous IVF cycles,* mean (SD) (range) 0.02 (0.13) (0.01.0) 0.17 (0.54) (0.03.0) 0.04
Cause of infertility, n (%)
Male 24 (41.4) 34 (42.0) 1.0
Female 34 (58.6) 47 (58.0)
No. of women with previous pregnancies, n (%) 22 (37.9) 31 (38.3) 1.0
No. of women with children in earlier relationship, n (%) 6 (10.3) 10 (12.4) 0.79
No. of women with current somatic disease, n (%) 12 (20.7) 31 (38.3) 0.04
No. of women with previous somatic disease, n (%) 5 (8.6) 12 (14.8) 0.31
No. of women with current psychiatric disorder, n (%) 3 (5.3) 2 (2.5) 0.40
Smoking, n (%) 5 (8.6) 13 (16.0) 0.31
College/university, n (%) 19 (32.8) 33 (40.7) 0.37
Urban residence, n (%) 41 (70.7) 54 (66.7) 0.71
Rural residence, n (%) 17 (29.3) 27 (33.3) 0.71
Working, n (%) 53 (91.4) 72 (88.9) 0.78
Studying, n (%) 2 (3.5) 6 (7.4) 0.47
Unemployed, n (%) 3 (5.2) 2 (2.5) 0.65

*One woman in the pregnant group and nine women in the non-pregnant group had previously undergone 13 IVF-cycles at a private IVF clinic.

In addition to a total score for the index, there are sub-scores for
anxiety, depressed mood, positive well-being, self-control, gen-
eral health and vitality. In the current study, we focused on the
total score and two sub-scoresdepressed mood and anxiety.
The scale has been translated into Swedish and tested on
Swedish patients (Dimens et al., 1996). PGWB has shown
satisfactory reliability and validity (Dupuy, 1984; Naughton
and Wiklund, 1993).
In addition to the well-evaluated PGWB, psychological
effects of infertility were measured by 14 items (guilt, success,
anger, contentment, frustration, happiness, isolation, confid-
ence, anxiety, satisfaction, depression, powerlessness, compe-
tence and control). These items were devised for the present
study and seek to capture aspects of experiences often
expressed by infertility patients. The items were formulated as
questions like How much of the following feelings do you
experience during the present days: guilt, success, etc?. The
items were analysed separately.
Each item was graded from 1 to 5. Low figures indicate
well-being.
Relationship with her partner
The effects of infertility on the womans relationship with her
partner were estimated by two questions: (i) do you feel that
infertility has caused problems in your marriage? and (ii) do you
find it harder to talk to each other now than before? These items
were also graded from 1 to 5 (1 = not at all, 5 = very much).
Intensity of the child-wish
The strength of the child-wish was estimated by seven ques-
tions [visual analogue scale (VAS)] covering perceptions of
the womans own wishes (six questions) and of the expecta-
tions of others (one question).
Meaning of reproduction
The meaning of reproduction was estimated by six items (VAS)
covering aspects of self-picture, meaningfulness and affinity
(Mller and Fllstrm, 1991).
Difference between the ideal and the real-life situation
Seven items were formulated concerning the womans percep-
tions of the correspondence between how she wanted her life to
be and how she thought it was. The answers were given on a
VAS. The items covered work, leisure time, social contacts
with friends and relatives, relation with her partner, sexual life,
and life in general.
Optimism versus pessimism
Optimism/pessimism was captured by two questions: (i) what
do you think about the results of the treatment you are about to
start? And (ii) how do you describe yourself, as an optimist or
a pessimist? The answers were given on a VAS.
Second occasion of measurement
The same 14 items regarding psychological effects of infertil-
ity were assessed as at the first measurement occasion. The
same two questions regarding the relationship were asked as at
the first measurement occasion.
Subgroups
The following subgroups were analysed in relation to pregnant
versus non-pregnant:
(i) those with scores on the PGWB in the lowest quartile,
i.e. those who experienced the poorest psychological well-
being (n = 39);
(ii) those with scores for psychological effects of infertility in
the highest quartile at the second measurement occasion, i.e. those
who experienced the most negative effects of infertility (n = 35);
(iii) those who answered no to the question as to whether
they could consider an alternative to IVF (n = 36);
(iv) a combination of groups 13 (n = 8).
Statistics
Means, standard deviations, medians and ranges are descriptive
statistics. Continuous and ordered variables were compared by
2971
L.Anderheim et al.

the MannWhitney U-test, dichotomous variables by Fishers
exact test and the MantelHaenszel 2 test for the variable
number of previous IVF cycles. A stepwise forward logistic
regression analysis was performed for the dependent variable
clinical pregnancy. Variables with P < 0.1 in the univariate
analysis were included in the model. All significance tests
were two-sided and performed at a significance level of 0.05.
Results
Demographic and treatment variables for the pregnant and
non-pregnant groups are shown in Tables I and II. No differ-
ences between pregnant and non-pregnant women were found
regarding age, length of infertility or number of previous preg-
nancies/previous births. The total number of good quality
embryos, the number of good quality embryos transferred, and
the number of embryos transferred were significantly higher in
the pregnant than in the non-pregnant group (Table II).
All 166 women answered the first questionnaire and 151
women answered the second questionnaire. In seven patients,
the IVF cycle was cancelled before oocyte aspiration due to
poor ovarian response. Embryo transfer was performed in 139
(83.7%) out of 166 patients. Reasons for not reaching embryo
transfer were: risk of ovarian stimulation syndrome (n = 3);
fertilization failure (n = 3); bad quality embryos (n = 12); and
freezing of all embryos due to myoma uteri or intrauterine pol-
yps that had not been detected earlier (n = 2).
First measurement occasion
Psychological well-being
PGWB results did not differ between pregnant and non-pregnant
women. In general, PGWB values were comparable with
Swedish reference values (Dimens et al., 1996) reflecting that
the women starting IVF treatment were in good psychological
health.
When analysing each of the 14 items in the questionnaire
concerning the psychological effects of infertility, no signific-
ant difference was found. The mean scores for each of the 14
items were mainly in the middle of the scale (Table III). How-
ever, there was considerable variation between individual
women.

Table II. Treatment variables for pregnant and non-pregnant women in patients receiving embryo transfer

Pregnant (n = 58) Non-pregnant (n = 81) P

IVF, n (%) 26 (44.8) 33 (40.7) 0.73

ICSI, n (%) 32 (55.2) 48 (59.3) 0.60
No. of oocytes aspirated
mean (SD) 12.7 (5.3) 12.6 (6.9) 0.48
median (range) 12.0 (2.028.0) 12.0 (235.0)
No. of good quality embryos total
mean (SD) 4.4 (2.9) 3.6 (3.0) 0.04
median (range) 4.0 (1.0 12.0) 3.0(0.012.0)
No. of good quality embryos transferred
mean (SD) 1.9 (0.3) 1.6 (0.7) 0.001
median (range) 2.0 (1.02.0) 2.0 (0.02.0)
No. of embryos transferred
mean (SD) 1.9 (0.3) 1.8 (0.4) 0.05
median (range) 2.0 (1.02.0) 2.0 (1.02.0)

Table III. Psychological variables for pregnant and non-pregnant women in patients receiving embryo transfer

Pregnant (n = 58) Non-pregnant (n =81) P

Mean (SD) (range)

PGWB
Total for items 122 100.9 (14.0) (62120) 100.3 (15.9) (53127) 0.89
Depressed mood 15.4 (2.2) (9.018.0) 15.5 (2.5) (4.018.0) 0.53
Anxiety 21.0 (4.7) (9.029.0) 21.8 (4.8) (8.030.0) 0.32
Effect of infertility, the first measurement
Guilt 1.5 (0.7) (1.04.0) 1.4 (0.6) (1.03.0) 0.35
Success 3.1 (0.8) (2.05.0) 3.0 (1.0) (1.05.0) 0.32
Anger 2.1 (1.0) (1.04.0) 2.2 (1.1) (1.05.0) 0.79
Contentment 3.1 (0.9) (1.05.0) 3.0 (1.0) (2.05.0) 0.44
Frustration 3.0 (1.1) (1.05.0) 2.8 (1.2) (1.05.0) 0.24
Happiness 2.5 (0.8) (1.04.0) 2.6 (1.0) (1.05.0) 0.98
Isolation 1.5 (0.9) (1.04.0) 1.5 (0.9) (1.05.0) 0.67
Confidence 2.4 (0.8) (1.05.0) 2.2 (0.9) (1.05.0) 0.15
Anxiety 2.9 (3.0) (1.05.0) 2.7 (1.1) (1.05.0) 0.48
Satisfaction 2.8 (0.8) (1.05.0) 2.9 (0.9) (1.05.0) 0.62
Depression 1.8 (0.9) (1.04.0) 1.8 (1.0) (1.05.0) 0.84
Powerlessness 2.9 (1.2) (1.05.0) 2.8 (1.3) (1.05.0) 0.76
Competence 2.9 (1.0) (1.05.0) 2.8(1.1) (1.05.0) 0.68
Control 2.9 (0.9) (1.05.0) 3.0 (0.9) (1.05.0) 0.34

2972

There were no differences between women who got preg-
nant and those who did not with regard to the relationship with
her partner, intensity of the child-wish, meaning of reproduc-
tion, difference between ideal and real-life situations, and opti-
mism versus pessimism. For problems in the marriage, we
found a mean of 1.5 (SD 0.8) (range 14) in the pregnant group
versus a mean of 1.6 (SD 0.8) (range 14 ) in the non-pregnant
group. Regarding intensity of the child-wish (the sum of six
items), the pregnant women scored a mean of 35.7 (SD 10.0)
(range 14.654.9) compared with 34.9 (SD 10.2) (range
13.658.3) in the non-pregnant group.
Second measurement occasion
The results of the 14 items covering psychological effects of
infertility and the two questions covering the womans rela-
tionship with her partner did not differ between the women
who got pregnant and those who did not. In the pregnant group,
frustration measured a mean of 2.5 (SD 1.2) (range 1.05.0)
versus 2.8 (SD 1.4) (range 1.05.0) in the non-pregnant group.
The item anxiety scored a mean of 2.8 (SD 1.1) (range 1.05.0)
by the pregnant women and a mean of 2.9 (SD 1.2) (range
1.05.0) by the non-pregnant.
When analysing the subgroups, scores on the PGWB in the
lowest quartile (n = 39), scores for psychological effects of
infertility in the highest quartile (n = 35), those who could not
consider an alternative to IVF (n = 36) and a combination of
these groups (n = 8), no statistically significant differences
were found between the women who got pregnant and those
who did not [PGWB group (P = 0.70), effects of infertility (P =
0.32), those who could not consider an alternative (P = 0.85)
and a combination of the three subgroups (P = 0.46)].
Selected psychological variables in the univariate analysis
are presented in Table III.
A stepwise forward logistic regression analysis was per-
formed for variables that showed a difference at P < 0.1 in the
univariate analysis (number of good quality embryos trans-
ferred, total number of good quality embryos, number of
embryos transferred, number of previous IVF cycles, number
of women with current somatic disease). The only variable that
was significantly associated with pregnancy was the number of
good quality embryos transferred.
Discussion
During IVF treatment, patients frequently ask about the rela-
tionship between psychological stress and IVF outcome. They
often express worries that their own stress might have a nega-
tive influence on the outcome. The results of the present pro-
spective study do not indicate any relationship between
perceived psychological stress or perceived psychological
well-being before or during the first IVF treatment and out-
come of IVF. These results can be regarded as reassuring and
can help to decrease the stress experienced by patients.
Our findings are in accordance with some earlier studies
(Harlow et al., 1996; Slade et al., 1997, Ardenti et al., 1999).
However, we had expected to find such a relationship regard-
ing at least some of the variables or for the group of women
who scored in the lowest quartile on the PGWB index and in
Psychological stress of in vitro fertilization
the highest quartile for the questions on psychological effects
of infertility. A recent study from the Netherlands (Smeenk
et al., 2001) showed that psychological factors were independ-
ently related to treatment outcome. Differences in population
and choice of questionnaires may explain these differences. In
our study, a relatively large number of patients were included,
several different psychological measurements were used, and
the design was prospective. Even when analysing the subgroup
of patients with very high scores for stress, the results changed
only marginally and no significant differences between preg-
nant and non-pregnant women were noted.
Analysing all data including those patients not achieving
embryo transfer did not change the overall results
According to the PGWB results and those for other questions,
the women in this study, as a group, expressed surprisingly
good psychological well-being prior to the IVF treatment,
although there were large inter-individual differences. This
finding was somewhat unexpected and did not correspond with
our earlier clinical impression. One possible reason for this
could be that patients answers were more positive than what
they actually experienced, and that they kept their worries and
anxiety to themselves because they had great expectations
regarding both themselves and the anticipated treatment. Per-
haps they also wanted to show how well they felt and that they
could handle the treatment. It has been reported that infertility
patients suppress their feelings of stress because they want to
show the clinic that they are functioning well both socially and
psychologically (Demyttenaere et al., 1998).
Time points for questionnaires could, of course, always be
discussed. The choice of the first measurement was because we
wished to study the psychological status before any appoint-
ments at the clinic apart from the information meeting. The
second measurement was chosen based on our clinical experi-
ence that patients often express feelings of anxiety and stress
just before the oocyte retrieval. The day of embryo transfer is
certainly also a distressing moment for the patients and perhaps
it could have been valuable to measure on that occasion.
One of the chosen instruments, PGWB, has proven good
reliability and validity. It is also sensitive to changes (Dimens
et al., 1996). The other instruments have been devised for the
present study and have not been psychometrically evaluated.
The instruments were chosen in order to capture aspects of
stress seen in the literature and expressed by infertility patients.
One cannot exclude, however, that the failure to find an associ-
ation between psychological stress and outcome of IVF is due
to a lack of sensitivity of the instruments used.
Another aspect, at least in Sweden, is the observation that
patients tend to express negative emotions and psychological
strain in verbal interviews rather than in questionnaires (Sjgren,
1989; Forsberg-Wrleby et al., 2002). It could be regarded as
more definitive and dangerous to put experiences of negative
feelings in writing rather than expressing these feelings verbally
in an interview. The tendency to level out ones responses is
more pronounced when filling in questionnaires.
However, it is also true that when IVF treatment is immi-
nent, women have great hope for success. Couples have waited
2973
L.Anderheim et al.
for this possibility for years and their view is that at last
something concrete and hopeful is going to happen. If this
study had been performed after failed IVF treatments, the
results might have been different.
In conclusion, this study could not demonstrate an associa-
tion between psychological stress and IVF outcome. This
information should be reassuring and should help to reduce
womens stress and worry during infertility treatment.
Acknowledgements
We would like to thank Nils-Gunnar Pehrsson and Mattias Molin for
statistical assistance. The study was supported by grants from the
Vardal Foundation and Sahlgrenska Academy.
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Submitted on April 29, 2005; resubmitted on June 17, 2005; accepted on
July 4, 2005
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