My IVF Cycle Failed – What Went Wrong? Question #15: Might My Mental State Have Played a Role?

16 Aug
Ask Dr. Sher A Question

This is the 15th in a series of responses to common questions about failed IVF

There is little doubt that stress and emotional lability plays a role in the normal physiological/hormonal regulation of the menstrual cycle.After all, Eskimos often stopped ovulating and menstruating during long dark winters, young women confronted by a major emotional trauma such as a broken love affair can develop irregular ovulation, menstruation and even amenorrhea, and chickens kept exposed to constant light will ovulate more frequently and yield more eggs.Against this background, women trying to achieve spontaneous pregnancies need to be made aware that one of their biggest enemies is stress.

On the other hand, when it comes to ovulation induction for IVF, the woman’s central regulatory mechanism is, so to speak, put on “automatic pilot,” such that stress plays much less of a role, if any at all.There is no such thing as a completely stress-free IVF experience and, when a question arises as to how this might affect outcome, I reassure my patients that it should not be of major concern.

This having been said, the financial and physical investment in IVF treatment will inevitably lead to stress, and it is accordingly in everyone’s best interest to place proper emotional preparation for IVF high on the “to-do” list.Since most infertile patients feel disempowered, it is advisable to have them fully informed and empowered to make decisions.In this regard, there is no greater advantage than to have an empathetic, sensitive and seasoned IVF medical team at the helm.Undoubtedly the nurse coordinator plays a pivotal role in this regard.There are cases where the IVF journey becomes overwhelming for patients.In such situations, a referral to a counselor is essential.Rarely does the degree of emotional lability relate to an underlying psychosis.In such cases, it is vital to refer the patients to a psychiatrist and to be ready to cancel the cycle of treatment should this become indicated.

Quite frankly, many patients undergoing IVF become duly stressed when being confronted with so many do’s and don’ts by the treating medical team.Directives such as “avoid caffeine,” “avoid hot tubs,” “get 10 hours of rest a night,” “don’t dare have a single glass of wine,” “beware of taking your medications even a few minutes outside of schedule” and many other such didactic rules tend to scare patients and lead them to the erroneous belief that even a single deviation could spell failure.In my opinion, this is totally unnecessary as no single infraction is detrimental by itself.


  • whitelamb says:

    dear dr sher, speaking of single infraction.
    i am on long cycle. started 3 mar on 20IU of Lupron. stims started 12 days later. last sat 22nd, I did 10IU of lupron instead of 20IU of lupron. my egg collection is on wed which means i have injected 20IU lupron from 3rd to 24th with 22nd being the exception as I did 10IU on that day. i did not ask my doc as i didn’t want to get asked why i did 10IU.
    would u be so kind to advise me if this deviation would still be ok?
    thank you so much.

  • Bortz says:

    Dr. Sher-
    Your last comment on this page said that herpes and acyclovir would not compromise an IVF cycle. I had a FET this morning, and later this evening noticed I have an outbreak starting (been HSV-2 positive for 10+ years). I am on suppressive therapy for my slightly abnormal NK cells and elevated ATA. I assume the suppression of my immune system has allowed the HSV to become activated, should I take Acyclovir, or would that just counter my attempts to suppress my immune system? Will this flare up affect the way my immune system treats the (hopefully) implanting embryo?
    Thank you!

    • Geoffrey Sher says:

      I do not think I said Acyclovir is known to have a damaging effect on the embryo. I think I inferred that since it is an ant-DNA substance ande discretion being the better part of valor, I would not use during an IVF cycle. I also do not believe that the immunotherapy we use for NKa+, will lower immunity and increase the risk of herpes.

      Good luck!

      Geoff sher

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