Just Relax? The IVF Advice That Needs to Retire

If you’re going through IVF, you’ve probably heard it: “Just relax.” It sounds comforting, but for many patients it feels like blame.

In this episode of Taco ’Bout Fertility Tuesday, Dr. Mark Amols breaks down what stress actually does during fertility treatment, what it does not do, and why the science does not support the simplistic idea that anxiety is what makes IVF fail. He also explains where stress does matter—your mental health, your relationships, your ability to keep going, and why untreated fertility stress can become a very real burden.

This episode covers the difference between emotional distress and IVF outcomes, why cortisol is not the smoking gun people make it out to be, how failed cycles can increase distress, and what actually helps: counseling, CBT, support systems, and real emotional care. Because IVF is a medical process, not a relaxation contest.

Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.

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Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Transcript

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Today we talk about why just relax may be one of the worst things you can say to someone going through IVF. I'm, Dr. Marc Amals, and this is Taco about fertility Tuesday. We're talking about a phrase that sounds helpful but usually lands like a brick to the forehead when people say, just relax. It's probably one of the most annoying things people can say, but the question is, is there any truth to it? So in today's episode, I want to talk about what stress actually does, what it does not do, and what the science says about IVF outcomes and why this whole just relax, it'll happen on its own isn't a good idea. So let's call it what it is. Infertility and IVF are stressful, not thick stress, not you need a day at the spa stress. We're talking real stress. One classic study found that infertile women had, global psychological symptom scores comparable to to women dealing with cancer, cardiac rehabilitation, and hypertension on, a validated symptom, inventory sheet. It doesn't mean infertility is cancer. It just means the emotional burden is serious and it deserves to be treated seriously. And more recent poll studies show high rates of anxiety, depression, and stress in infertility patients, with some analyses estimating that depression is around 30 to 40%. And anxiety is in a similar ballpark, depending on how you measure it. So this means if you're stressed during fertility treatment, that does not mean you're weak. It means you're human. But here's the question of why you started listening to this podcast. Can stress make IVF fail? And the honest answer is not in the simplistic way people think it does. One of the strongest perspective meta analyses looked at emotional distress before doing IVF treatment, and they found that there was no meaningful association with pregnancy outcome after a cycle of art. Essentially, they did not find there was any type of effect on the cycle success. Now, it doesn't mean all studies are going to show that. There are some small studies that do show small negative associations between stress and or anxiety and clinical pregnancy rates, but these effects were very small, and they were consistent and became very weak when you started looking at live birth outcomes versus just pregnancy. So the point is, if there is an effect, it's not the giant smoking gun people act like it is. So why is this important? Because this is not a situation where you're one meditation app away from having success. So next time someone tells you you just need to relax, tell them, that's garbage. Scientific Garbage, but still garbage. So then it means there's no association between anxiety and stress and ivf? Well, not so fast. This is the part people miss all the time. A really important prospective IVF study found that IVF failure predicts later distress, but baseline distress does not predict IVF failure. That's a big difference. In simple terms, that's saying patients are not failing because they're stressed. They're stressed because IVF is hard, uncertain, expensive, invasive, emotional, and sometimes heartbreaking. And that's really important because that distinction matters. Because when you tell someone, hey, just relax, what they hear is, if this doesn't work, it may be your fault. And that is a rotten message. Now, no one is saying stress is good, but there is different types of stress, and we sometimes use it as a grab bag term. People even love to drag cortisol into this, but that's a little bit different. Yeah, stress biology is real. Cortisol is real, too. But the IVF cortisol literature is a bit messy. Some studies link higher cortisol levels can worsen your outcome, but other studies show that lower cortisol can worsen your outcome. And some show no meaningful association at all. The point is, the data is inconsistent and most of it is low quality. So if someone tells you, well, your cortisol is probably running really high and that's affecting your implantation, well, that's just not true. So at this point, you're thinking, well, great, I can have as much stress as I want because there's no harm. Well, that's also not true because stress does matter, and not because it magically blocks pregnancy, but because it does affect your health, affects your relationships, and the ability to keep going on. In one study where patients stopped ivf, they found some very common reasons, such as, I just had enough, or the emotional costs were too high, or I could not cope with another failure. In other studies, they found that about 70% of the people who dropped out were due to physical and psychological burden being the major reason. So stress does matter, because if treatment becomes unbearable and patients stop before they ever reach the cycle that would have helped them, then it is affecting your chances. Even today, I was with a patient doing the consult, and she basically told me that, she's ready to stop, and that's okay because she's been through a lot. Probably more cycles than many of you have been through and probably more stress than many of you have been through. And even if she didn't go through the cycle, just getting canceled was such an emotional burden. She felt like, maybe it's just worth stopping now. But it goes even beyond dropping out. There are real mental health risks. There is data out there that has even found that women who underwent fertility evaluation and did not have a child had more than double the suicide risk compared to women who. Who did have a child after being evaluated. Even relationships have been shown to dissolve when you don't achieve parenthood, and this is a much higher rate than other couples. The stress is real. And that's why I hate the just relax line. It's trivializing something that can be psychologically brutal. But there's another layer here. Some patients don't just experience this distress. They experience it is trauma. In a 2026 study among people reporting infertility related traumatic experiences, 9% met criteria for PTSD and 32% for complex PTSD. And 61% said the care they receive actually made their distress worse. And that should be a wake up call, because the job of fertility care is not just to prescribe meds, retrieve eggs, and do transfers. It's also to avoid making a hard process even harder. This is why if you are stressed, you need to speak to your clinic. Everyone deals with stress differently. And if you don't, let them know they can't help. So then what should we do? Instead of saying, just relax. Well, we should offer real support. Many times I talk to patients and I tell them this can ruin relationships, that you got to take a step back and open up communication lines. That means either evaluation with a counselor. That means psychological interventions like cbt. This structured support can significantly improve anxiety and depression symptoms. and this has also been shown by data. There are recent meta analyses that have shown large reductions in anxiety and depression after intervention. Now, can these programs improve pregnancy rates too? Well, maybe a little. A 2023 meta analysis, which was a randomized trial, found a modest increase in pregnancy rates with a relative risk of 1.25. But the evidence quality was only low to moderate. I would liken this to acupuncture. We know acupuncture helps improve pregnancy chances with transfer, but we also know it may not be exactly due to the acupuncture. It could be a placebo effect because it may be reducing your stress. The point is, these interventions are absolutely worth doing for mental health, for coping, and for quality of life. They may even help outcomes in some settings, but they are not a fertility cheat code. Therapy is for healthcare, not to help the embryo implant. So if you're someone listening to this, and maybe you're not going through fertility but you have friends or family who are instead telling them to just relax. Maybe say, this seems really hard and your feelings make sense. Let them know they don't need to be calm to deserve good care. Let them know you're willing to plan support for them before maybe they get the results. Be there to listen when they need someone to listen and remind them that, their stress is not proof that they're causing these issues. And that last one matters. Now, if you're someone who's going through ivf, here's what I want you to remember. First, being stressed does not mean you've ruined your cycle. The best evidence does not support that idea. Second, IVF itself can induce distress, especially after a failed cycle. That means support should be built in before the hard moments hit. I find today, with such high pregnancy rates, it's, extremely heartbreaking when things don't work because people feel like it's always going to work. And so it's important to always have that support system there in case it doesn't. Third, and this is an important one, getting help is not weakness. Counseling, CBT support groups and structured coping programs can genuinely improve how you feel and can help your relationships in these very stressful times. And fourth, if your clinic acts like your mental health is your own side quest, that's not ideal. Good fertility care should include, emotional care, too. Even the ESHTRA guidelines support routine psychological care as part of the fertility treatment. So next time someone says, hey, man, just relax, remember this. IVF is a medical process, not a mood ring. Having anxiety is not proof that something is going wrong and that giving your mental health the care it needs is not being done to make your fertility work, but because you matter regardless of the outcome. If you found this podcast helpful, or maybe you know someone going through this, or maybe you know a family member who's supporting someone who's going through this, or a boss who has an employee going through fertility. This may be a good episode to let them know about. You may not help your friend get pregnant, but you can help them deal with the stress. As always, I greatly appreciate everyone that listens to this podcast. It's the reason I do it for you. As I mentioned, I don't make any money from it. I only do it because I know it's educational and helps people. If you like this podcast, give us a five star review on your favorite medium. But most of all, keep coming back. I look forward to talking again next week on Taco Belt Fertility Tuesday.