Psychosocial Implications of Recurrent Implantation Failure

  • Andrea Mechanick Braverman
  • Keren Sofer


Infertility and recurrent pregnancy loss after infertility are increasingly recognized as experiences encompassing not only medical but also emotional, cognitive, economic, spiritual, and social realms for patients. Keeping pace with developments in reproductive medicine, psychological research regarding infertility and recurrent pregnancy loss has focused on the associated psychosocial factors and the impact of these factors on treatment and outcomes. This review of the psychological research reveals that the impact of the psychosocial functioning and mental health of infertility patients during all phases of treatment is far-reaching, influencing treatment initiation, dropout rates, treatment compliance, and the pursuit of psychological services and other interventions such as psychotropic medication. Knowledge of these psychosocial factors, along with the provision of psychological screenings and interventions, has the potential to positively impact outcomes for infertility patients, including those experiencing repeated implantation failure or pregnancy loss.


Infertility Psychosocial factors Psychosocial functioning Mental health Implantation failure Pregnancy loss 


  1. 1.
    Boivin J, Gameiro S. Evolution of psychology and counseling in infertility. Fertil Steril. 2015;104(2):251–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Berg BJ, Wilson JF. Psychological functioning across stages of treatment for infertility. J Behav Med. 1991;14(1):11–26.CrossRefPubMedGoogle Scholar
  3. 3.
    Ingram RE, Luxton DD. Vulnerability-stress models. In:Development of psychopathology: a vulnerability-stress perspective. Thousand Oaks: Sage; 2005. p. 32–46.CrossRefGoogle Scholar
  4. 4.
    Mazure CM, Greenfeld DA. J Assist Reprod Genet. 1989;6:242–56. Scholar
  5. 5.
    Verhaak CM, Smeenk JM, Evers AW, van Minnen A, Kremer JA, Kraaimaat FW. Predicting emotional response to unsuccessful fertility treatment: a prospective study. J Behav Med. 2005;28(2):181–90.CrossRefPubMedGoogle Scholar
  6. 6.
    Verhaak CM, Smeenk JM, Evers AW, Kremer JA, Kraaimaat FW, Braat DD. Women’s emotional adjustment to IVF: a systematic review of 25 years of research. Hum Reprod Update. 2007;13(1):27–36.CrossRefPubMedGoogle Scholar
  7. 7.
    Lok IH, Lee DTS, Cheung LP, Chung WS, Lo WK, Haines CJ. Psychiatric morbidity amongst infertile Chinese women undergoing treatment with assisted reproductive technology and the impact of treatment failure. Gynecol Obstet Investig. 2002;53(4):195–9.CrossRefGoogle Scholar
  8. 8.
    Mori E, Nadaoka T, Morioka Y, Saito H. Anxiety of infertile women undergoing IVF-ET: relation to the grief process. Gynecol Obstet Investig. 1997;44(3):157–62.CrossRefGoogle Scholar
  9. 9.
    Visser AP, Haan G, Haan G, Wouters I. Psychosocial aspects of in vitro fertilization. J Psychosom Obstet Gynecol. 1994;15(1):35–43.CrossRefGoogle Scholar
  10. 10.
    Edelmann RJ, Connolly KJ, Bartlett H. Coping strategies and psychological adjustment of couples presenting for IVF. J Psychosom Res. 1994;38(4):355–64.CrossRefPubMedGoogle Scholar
  11. 11.
    Hearn MT, Yuzpe AA, Brown SE, Casper RF. Psychological characteristics of in vitro fertilization participants. Am J Obstet Gynecol. 1987;156(2):269–74.CrossRefPubMedGoogle Scholar
  12. 12.
    Verhaak CM, Smeenk JM, Eugster A, van Minnen A, Kremer JA, Kraaimaat FW. Stress and marital satisfaction among women before and after their first cycle of in vitro fertilization and intracytoplasmic sperm injection. Fertil Steril. 2001;76(3):525–31.CrossRefPubMedGoogle Scholar
  13. 13.
    Williams KE, Marsh WK, Rasgon NL. Mood disorders and fertility in women: a critical review of the literature and implications for future research. Hum Reprod Update. 2007;13(6):607–16.CrossRefPubMedGoogle Scholar
  14. 14.
    Downey J, Yingling S, McKinney M, Husami N, Jewelewicz R, Maidman J. Mood disorders, psychiatric symptoms, and distress in women presenting for infertility evaluation. Fertil Steril. 1989;52(3):425–32.CrossRefPubMedGoogle Scholar
  15. 15.
    Fassino S, Piero A, Boggio S, Piccioni V, Garzaro L. Anxiety, depression and anger suppression in infertile couples: a controlled study. Hum Reprod. 2002;17(11):2986–94.CrossRefPubMedGoogle Scholar
  16. 16.
    Chen TH, Chang SP, Tsai CF, Juang KD. Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Hum Reprod. 2004;19(10):2313–8.CrossRefPubMedGoogle Scholar
  17. 17.
    Volgsten H, Svanberg AS, Ekselius L, Lundkvist Ö, Poromaa IS. Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Hum Reprod. 2008;23(9):2056–63.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Domar AD, et al. Psychological improvement in infertile women after behavioral treatment: a replication. Fertil Steril. 1992;58(1):144–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Holley SR, Pasch LA, Bleil ME, Gregorich S, Katz PK, Adler NE. Prevalence and predictors of major depressive disorder for fertility treatment patients and their partners. Fertil Steril. 2015;103(5):1332–9.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Abbey A, Halman LJ, Andrews FM. Psychosocial, treatment, and demographic predictors of the stress associated with infertility. Fertil Steril. 1992;57(1):122–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Van den Broeck U, D’Hooghe T, Enzlin P, Demyttenaere K. Predictors of psychological distress in patients starting IVF treatment: infertility-specific versus general psychological characteristics. Hum Reprod. 2010;25(6):1471–80.CrossRefPubMedGoogle Scholar
  22. 22.
    Volgsten H, Svanberg AS, Ekselius L, Lundkvist Ö, Poromaa IS. Risk factors for psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Fertil Steril. 2010;93(4):1088–96.CrossRefPubMedGoogle Scholar
  23. 23.
    Baldur-Felskov B, Kjaer SK, Albieri V, Steding-Jessen M, Kjaer T, Johansen C, Dalton SO, Jensen A. Psychiatric disorders in women with fertility problems: results from a large Danish register-based cohort study. Hum Reprod. 2013;28(3):683–90.CrossRefPubMedGoogle Scholar
  24. 24.
    Gameiro S, Boivin J, Peronace L, Verhaak CM. Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment. Hum Reprod Update. 2012;18(6):652–69.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Verhaak CM, Lintsen AM, Evers AW, Braat DD. Who is at risk of emotional problems and how do you know? Screening of women going for IVF treatment. Hum Reprod. 2010;25(5):1234–40.CrossRefPubMedGoogle Scholar
  26. 26.
    Boivin J, Takefman J, Braverman A. The fertility quality of life (FertiQoL) tool: development and general psychometric properties. Fertil Steril. 2011a;96(2):409–15.CrossRefPubMedGoogle Scholar
  27. 27.
    Donarelli Z, Coco GL, Gullo S, Salerno L, Marino A, Sammartano F, Allegra A. The fertility quality of life questionnaire (FertiQoL) relational subscale: psychometric properties and discriminant validity across gender. Hum Reprod. 2016;31:2061.CrossRefPubMedGoogle Scholar
  28. 28.
    Newton CR, Sherrard W, Glavac I. The Fertility Problem Inventory: measuring perceived infertility-related stress. Fertil Steril. 1999;72(1):54–62.CrossRefPubMedGoogle Scholar
  29. 29.
    Boivin J. Is there too much emphasis on psychosocial counseling for infertile patients? J Assist Reprod Genet. 1997;14(4):184–6.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Parcesepe AM, Cabassa LJ. Public stigma of mental illness in the United States: a systematic literature review. Adm Policy Ment Health Ment Health Serv Res. 2013;40(5):384–99.CrossRefGoogle Scholar
  31. 31.
    Boivin J, Scanlan LC, Walker SM. Why are infertile patients not using psychosocial counselling? Hum Reprod. 1999;14(5):1384–91.CrossRefPubMedGoogle Scholar
  32. 32.
    Cantor MH. Neighbors and friends: an overlooked resource in the informal support system. Res Aging. 1979;1(4):434–63.CrossRefGoogle Scholar
  33. 33.
    Rosenstock IM. Why people use health services. Milbank Q. 2005;83(4):Online-only.Google Scholar
  34. 34.
    Suls J, Wan CK. Effects of sensory and procedural information on coping with stressful medical procedures and pain: a meta-analysis. J Consult Clin Psychol. 1989;57(3):372.CrossRefPubMedGoogle Scholar
  35. 35.
    Domar AD, Clapp D, Slawsby E, Kessel B, Orav J, Freizinger M. The impact of group psychological interventions on distress in infertile women. Health Psychol. 2000;19(6):568.Google Scholar
  36. 36.
    Boivin J, Griffiths E, Venetis CA. Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies. BMJ. 2011b;342:d223.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Psaros C, Kagan L, Shifren JL, Willett J, Jacquart J, Alert MD, Macklin EA, Styer AK, Denninger JW, LaRoche KL, Park ER. Mind–body group treatment for women coping with infertility: a pilot study. J Psychosom Obstet Gynecol. 2015;36(2):75–83.CrossRefGoogle Scholar
  38. 38.
    Ying L, Wu LH, Loke AY. The effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization: a systematic review. J Assist Reprod Genet. 2016;33:689–701.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Domar AD, Gross J, Rooney K, Boivin J. Exploratory randomized trial on the effect of a brief psychological intervention on emotions, quality of life, discontinuation, and pregnancy rates in in vitro fertilization patients. Fertil Steril. 2015;104(2):440–51.CrossRefPubMedGoogle Scholar
  40. 40.
    Cousineau TM, Green TC, Corsini E, Seibring A, Showstack MT, Applegarth L, Davidson M, Perloe M. Online psychoeducational support for infertile women: a randomized controlled trial. Hum Reprod. 2008;23(3):554–66.CrossRefPubMedGoogle Scholar
  41. 41.
    Akioyamen LE, Minhas H, Holloway AC, Taylor VH, Akioyamen NO, Sherifali D. Effects of depression pharmacotherapy in fertility treatment on conception, birth, and neonatal health: a systematic review. J Psychosom Res. 2016;84:69–80.CrossRefPubMedGoogle Scholar
  42. 42.
    Cesta CE, Viktorin A, Olsson H, Johansson V, Sjölander A, Bergh C, Skalkidou A, Nygren KG, Cnattingius S, Iliadou AN. Depression, anxiety, and antidepressant treatment in women: association with in vitro fertilization outcome. Fertil Steril. 2016;105(6):1594–602.CrossRefPubMedGoogle Scholar
  43. 43.
    Urato AC. Are the SSRI antidepressants safe in pregnancy? Understanding the debate. Int J Risk Saf Med. 2015;27(2):93–9.PubMedGoogle Scholar
  44. 44.
    Kalra S, Born L, Sarkar M, Einarson A. The safety of antidepressant use in pregnancy. Expert Opin Drug Saf. 2005;4(2):273–84.CrossRefPubMedGoogle Scholar
  45. 45.
    Domar AD, Moragianni VA, Ryley DA, Urato AC. The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond. Hum Reprod. 2013;28:160.CrossRefPubMedGoogle Scholar
  46. 46.
    Gameiro S, Boivin J, Domar A. Optimal in vitro fertilization in 2020 should reduce treatment burden and enhance care delivery for patients and staff. Fertil Steril. 2013;100(2):302–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Sidney Kimmel Medical College of Thomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Independent PracticePhiladelphiaUSA

Personalised recommendations