Perceived Stress and Outcomes in Assisted Reproductive Technologies (ART): Evidence from Human and Animal Studies

Document Type : Scientific Review

Author
Arefeh Akbari Javar 1 , 2
1 Department of Obstetrics and Gynecology, School of Medicine, Kerman University of Medical Sciences, Kerman, Islamic Republic of Iran
2 Afzalipour Clinical Center for Infertility, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Islamic Republic of Iran
10.18502/jimpc.v9i1.22980
Abstract
Background: Psychological stress is common among individuals with infertility or undergoing treatment, but its relationship with reproductive outcomes remains uncertain, with heterogeneous human findings and complementary animal evidence on possible mechanisms. This review synthe-sized human and animal evidence on psychological stress and reproductive outcomes, focusing on ART outcomes, gamete/embryo parameters, reproductive endocrine pathways, dyadic/psychoso-cial effects, and psychological interventions.
Methods: PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to Sep-tember 5, 2026, for human studies examining psychological, perceived, infertility-related, or phys-iological stress, plus relevant reviews and meta-analyses, alongside animal studies on stress and reproductive, gamete, embryo, endocrine, or fertility outcomes. Given heterogeneity, findings were synthesized narratively, with human and animal evidence analyzed separately.
Results: Human evidence showed no consistent association between female stress and definitive ART outcomes (pregnancy, embryo-related outcomes), though some stage-specific associations during IVF emerged. In men, stress was linked to adverse semen/sperm parameters, potentially via oxidative and neuroendocrine pathways. Dyadic stress affected relationship functioning, coping, and treatment persistence. Interventions generally improved stress, anxiety, depression, and coping, but effects on reproductive outcomes were inconsistent. Animal studies showed stress can alter ovarian function, folliculogenesis, oocyte competence, uterine function, implantation, spermato-genesis, and endocrine regulation .
Conclusion: Human evidence does not support a simple causal link between stress and ART suc-cess; associations vary by sex, timing, stress measurement, endpoint, and study design. Animal models support biological plausibility but cannot establish human causality. Interventions consist-ently benefit well-being, while reproductive effects remain uncertain.
Keywords
Infertility
Assisted Reproductive Technology
Psychological Stress
In Vitro Fertilization
Psychological Adaptation
Male Infertility
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Journal of Integrated Maternal and Pediatric Care
Volume 9, Issue 1
September 2026
Pages 4-20