How do women feel in the two weeks between embryo transfer and the pregnancy test?
In a randomised trial in the Netherlands, 377 women undergoing IVF or ICSI completed questionnaires before the waiting period and again on day 10 of the 14-day wait. In every group, anxiety and depression were significantly higher during the wait than before treatment. The researchers describe this wait as one of the most stressful periods of fertility treatment (Ockhuijsen et al., 2014).
Feeling worse while you wait is a common response.
IVF is a medical process, but it is also an emotional one. This article looks at why treatment can be so stressful, what research says about stress and the chance of pregnancy, and one brief coping technique that was tested with women waiting for their result.
Why can IVF be so stressful?
People who are struggling to conceive often report depression, anxiety, isolation and a loss of control. Many infertile women do not share their story with family or friends, which can leave them more psychologically vulnerable (Rooney & Domar, 2018).
The burden is not only emotional. A systematic review of 22 studies, with 21,453 patients from eight countries, examined why people stop fertility treatment. After postponing treatment, the most often chosen reasons were physical and psychological burden, and relational and personal problems. Psychological burden appeared as a reason across the stages of treatment (Gameiro et al., 2012).
The authors concluded that treatment burden should be addressed through better organisation of care and support for patients (Gameiro et al., 2012).
Does stress lower the chance of pregnancy?
Many people worry that their stress will reduce their chances. The relationship between stress and infertility is complex, and the direction of cause and effect is still debated (Rooney & Domar, 2018).
Study
A meta-analysis combined 14 prospective studies with 3,583 women undergoing a cycle of assisted reproduction. Anxiety or depression measured before treatment was not associated with whether the women became pregnant. The authors concluded that their findings should reassure women and doctors that emotional distress caused by fertility problems, or by other life events during treatment, will not compromise the chance of becoming pregnant. They also found signs of moderate publication bias (Boivin et al., 2011).
Feeling stressed during treatment is not something to blame yourself for. Self-blame only adds another burden. The aim of support is to make the process more bearable, not to add pressure to “stay positive”.
How do uncertainty and flexibility fit in?
Uncertainty sits at the heart of IVF. Researchers describe the medical waiting period as unpredictable and uncontrollable (Ockhuijsen et al., 2014).
Dr. Soolmaz Dehghani co-authored a 2026 study in Brain and Behavior that examined psychological flexibility as a moderator in the relationship between intolerance of uncertainty and perceived stress among women undergoing IVF (Karimzadeh et al., 2026). See the publications page.
Further reading: Intolerance of Uncertainty: Why Not Knowing Feels So Hard
What kind of support can help?
A review concluded that psychological interventions for people with infertility can improve psychological outcomes and relationships between partners, although meta-analyses have not always agreed (Rooney & Domar, 2018).
Study
In a controlled clinical trial, 55 infertile women completed the Mindfulness-Based Program for Infertility: 10 weekly group sessions of about 2 hours each, with partners attending three of them. A control group of 37 infertile women did not receive the programme. By the end of the programme, the participants showed significant decreases in depressive symptoms, shame, and feelings of entrapment and defeat, and improvements in mindfulness skills and in their confidence in dealing with infertility. The control group showed no significant changes except a decrease in self-judgment (Galhardo et al., 2013).
The authors suggested that mindfulness and acceptance skills help women experience difficult inner states in new ways, so they become less entangled with them (Galhardo et al., 2013). This is close to what researchers call psychological flexibility.
Support can also come from the clinic. The European Society of Human Reproduction and Embryology (ESHRE) guideline guides fertility staff on how to detect and address patients’ behavioural, relational, emotional and cognitive needs before, during and after treatment (Gameiro et al., 2015).
When is it time to seek professional help?
Low mood and anxiety during treatment are common (Rooney & Domar, 2018). Some signs, however, call for more than self-help.
If low mood persists, affects your sleep or daily life, or if you have thoughts of harming yourself, seek professional help promptly.
You can also tell your clinic team how you are feeling. The ESHRE guideline counts emotional wellbeing among the needs that fertility staff can detect and address (Gameiro et al., 2015).
Try it: a positive reappraisal card for the two-week wait
Researchers at Cardiff University developed a brief self-help technique for the wait between embryo transfer and the pregnancy test. In a first trial with 55 women, those who used it rated it as more helpful, better suited to the situation and better at helping them feel positive than a card of positive self-affirming statements (Lancastle & Boivin, 2008).
Definition
Positive reappraisal coping means noticing the positive aspects of a difficult situation and taking them into account alongside the negative ones. It does not mean pretending that everything is wonderful, or ignoring what is hard (Bailey et al., 2015).
Exercise
The positive reappraisal coping intervention (PRCI) consists of a small card with 10 reappraisal statements and a leaflet that explains the approach. Women used it for the 14 days between embryo transfer and the pregnancy test.
- Read the statements at least twice a day, once in the morning and once in the evening, and at any other time you feel the need.
- Think about how each statement applies to you personally.
- Look for the positive aspects alongside the negative ones. The leaflet’s examples include the support and kindness that friends and family have shown, or a relationship with a partner that has grown stronger through the shared experience.
- Keep the card with you, in a purse or pocket, as a reminder wherever you are.
- Expect it to feel strange at first. The technique becomes easier the more it is practised.
(Procedure from the PRCI, as described in Lancastle & Boivin, 2008, and Bailey et al., 2015. The card’s own statements are copyrighted by Cardiff University and are not reproduced here.)
The larger Dutch trial compared the card, used together with daily emotional monitoring, with monitoring alone and with routine care. The card did not significantly reduce anxiety, depression or daily negative emotions during the wait. Women who used it, however, reported more positive emotions than the monitoring group and found it easy to use. Pregnancy outcomes did not differ between the groups (Ockhuijsen et al., 2014).
A card like this can add some positive moments to the wait. It is not a treatment for anxiety or depression.
Three questions to reflect on:
- During the waiting periods of your treatment, which moments have been hardest, and which have felt a little easier?
- Alongside the difficulties, what support or kindness have you noticed from the people around you?
- If you have a partner, how has going through treatment together affected your relationship?
Common questions
Is it normal to feel low during IVF?
Yes. In a large trial, women reported more anxiety and depression during the waiting period than before treatment (Ockhuijsen et al., 2014). If low mood persists or affects daily life, seek professional help.
Will my stress reduce my chances of becoming pregnant?
A meta-analysis of 14 prospective studies found that distress before treatment was not associated with the chance of pregnancy after a cycle of assisted reproduction (Boivin et al., 2011).
Can counselling help during fertility treatment?
Psychological interventions can improve psychological outcomes for people with infertility (Rooney & Domar, 2018), and a group mindfulness programme reduced depressive symptoms in infertile women (Galhardo et al., 2013). If you are considering online sessions, see Online Counselling: Does It Work, and What Happens in a First Session?
References
- Bailey, S., Bailey, C., Boivin, J., Cheong, Y., Reading, I., & Macklon, N. (2015). A feasibility study for a randomised controlled trial of the Positive Reappraisal Coping Intervention, a novel supportive technique for recurrent miscarriage. BMJ Open, 5(4), e007322. https://doi.org/10.1136/bmjopen-2014-007322
- Boivin, J., Griffiths, E., & Venetis, C. A. (2011). Emotional distress in infertile women and failure of assisted reproductive technologies: Meta-analysis of prospective psychosocial studies. BMJ, 342, d223. https://doi.org/10.1136/bmj.d223
- Galhardo, A., Cunha, M., & Pinto-Gouveia, J. (2013). Mindfulness-Based Program for Infertility: Efficacy study. Fertility and Sterility, 100(4), 1059-1067. https://doi.org/10.1016/j.fertnstert.2013.05.036
- Gameiro, S., Boivin, J., Dancet, E., de Klerk, C., Emery, M., Lewis-Jones, C., Thorn, P., Van den Broeck, U., Venetis, C., Verhaak, C. M., Wischmann, T., & Vermeulen, N. (2015). ESHRE guideline: Routine psychosocial care in infertility and medically assisted reproduction: A guide for fertility staff. Human Reproduction, 30(11), 2476-2485. https://doi.org/10.1093/humrep/dev177
- Gameiro, S., Boivin, J., Peronace, L., & Verhaak, C. M. (2012). Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment. Human Reproduction Update, 18(6), 652-669. https://doi.org/10.1093/humupd/dms031
- Karimzadeh, F., Abdollahi, A., & Dehghanidowlatabadi, S. (2026). Moderating role of psychological flexibility in the relationship between intolerance of uncertainty and perceived stress among women undergoing in vitro fertilization treatment. Brain and Behavior, 16(5), e71436. https://doi.org/10.1002/brb3.71436
- Lancastle, D., & Boivin, J. (2008). A feasibility study of a brief coping intervention (PRCI) for the waiting period before a pregnancy test during fertility treatment. Human Reproduction, 23(10), 2299-2307. https://doi.org/10.1093/humrep/den257
- Ockhuijsen, H., van den Hoogen, A., Eijkemans, M., Macklon, N., & Boivin, J. (2014). The impact of a self-administered coping intervention on emotional well-being in women awaiting the outcome of IVF treatment: A randomized controlled trial. Human Reproduction, 29(7), 1459-1470. https://doi.org/10.1093/humrep/deu093
- Rooney, K. L., & Domar, A. D. (2018). The relationship between stress and infertility. Dialogues in Clinical Neuroscience, 20(1), 41-47. https://doi.org/10.31887/DCNS.2018.20.1/klrooney