Psychological factors and infertility: Causal or consequential

The understanding of the relationship between psychological issues and infertility has undergone a major shift in emphasis during the past 10 years. The interpretation of psychological infertility has been reversed so that, with few exceptions, distress is now seen as the result, rather than the cause, of infertility. The possibility that the psychological distress resulting from infertility diagnosis, intrusive testing, and treatment also could influence outcome in a 'bidirectional fashion' is an important aspect for future study. There is a need to determine the most effective psychosocial or psychiatric interventions for infertility patients. Preliminary research supporting the efficacy of group behavioral treatment in reducing depression scores among infertile women is encouraging; however, there is a lack of systematic appraisal of the impact of psychotherapy on infertility patients. Most of the literature is based on clinical assertions rather than precise evaluations of the problems experienced by couples or the methods used to resolve them. Infertility is stressful, and emotional support is beneficial for most patients; however, there is little utility in blaming infertility on dysfunctional psychological characteristics. On the other hand, there is benefit in determining which patients are more likely to experience severe stress, anxiety, or depression. Those individuals can be followed even more intensively with the intent of making psychological services available as soon as they are ready and willing to use them.