Association of daily perceived stress with fertility outcomes in natural and controlled ovarian stimulation cycles: a feasibility study
7 affiliations
- 1School of Medicine, University of California, La Jolla, San Diego USA
- 2Herbert Wertheim School of Public Health and Human Longevity Science, University of California, La Jolla, San Diego USA
- 3Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, La Jolla, San Diego USA
- 4Obstetrics and Gynecology Institute, Cleveland Clinic Foundation, Cleveland, USA
- 5Department of Psychiatry, University of California, La Jolla, San Diego USA
- 6Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, USA
- 7Moores Cancer Center, University of California, La Jolla, San Diego USA
Abstract
Purpose: Females with infertility perceive stress, but most studies rely on single assessments. We examined the feasibility of repeated ecological momentary assessment (EMA) during IVF and whether stress trajectories across two cycles were associated with reproductive and IVF outcomes.
Methods: In a prospective cohort at a single academic center, 26 females (18–42 years) undergoing IVF with luteal estradiol priming were recruited; 25 completed follow-up. Perceived stress was assessed via text-message EMA three times daily during a priming month and the subsequent controlled ovarian stimulation (COS) cycle. Primary outcomes were ovulation in the priming cycle and a composite poor COS outcome (cycle cancellation, < 4 oocytes retrieved, no blastocyst, or no euploid blastocyst). Functional principal components analysis characterized stress trajectories, and regression models tested associations with outcomes.
Results: Mean age was 36 (SD 3.6); 64% were White and 24% Hispanic. All participants ovulated during priming. Two stress patterns explained 96% of follicular-phase variability. The dominant pattern (early decline then plateau) was not associated with outcomes. A second pattern (peak around cycle day 6 with subsequent rise) was associated with lower peak LH (b − 2.85, 95% CI − 4.60 to − 1.06; adjusted p = 0.004). Ten participants (40%) met the composite poor COS outcome, which was not associated with either stress pattern. Stress levels were similar between priming and COS.
Conclusion: EMA is feasible during IVF. In patients reporting mild-to-moderate stress, perceived stress was stable and not associated with key IVF outcomes, though specific trajectories may modestly relate to hypothalamic-pituitary-ovarian-axis function.
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BibTeX
@article{strohl2026association,
title = {{Association of daily perceived stress with fertility outcomes in natural and controlled ovarian stimulation cycles: a feasibility study}},
author = {Harmonie Strohl and Nguyen Do and Howon Ryu and Olumayowa Dayo and Emily Ho and Jacey Hu and Alexander Kauffman and Ina Stelzer and Ariel Lang and Kellie Church and Jingjing Zou and Irene Su},
journal = {Journal of Assisted Reproduction and Genetics},
year = {2026},
month = jul,
doi = {10.1007/s10815-026-03972-5},
url = {https://doi.org/10.1007/s10815-026-03972-5},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association of daily perceived stress with fertility outcomes in natural and controlled ovarian stimulation cycles: a feasibility study
AU - Harmonie Strohl
AU - Nguyen Do
AU - Howon Ryu
AU - Olumayowa Dayo
AU - Emily Ho
AU - Jacey Hu
AU - Alexander Kauffman
AU - Ina Stelzer
AU - Ariel Lang
AU - Kellie Church
AU - Jingjing Zou
AU - Irene Su
PY - 2026
DA - 2026/07/24
JO - Journal of Assisted Reproduction and Genetics
DO - 10.1007/s10815-026-03972-5
UR - https://doi.org/10.1007/s10815-026-03972-5
AB - Purpose: Females with infertility perceive stress, but most studies rely on single assessments. We examined the feasibility of repeated ecological momentary assessment (EMA) during IVF and whether stress trajectories across two cycles were associated with reproductive and IVF outcomes. Methods: In a prospective cohort at a single academic center, 26 females (18–42 years) undergoing IVF with luteal estradiol priming were recruited; 25 completed follow-up. Perceived stress was assessed via text-message EMA three times daily during a priming month and the subsequent controlled ovarian stimulation (COS) cycle. Primary outcomes were ovulation in the priming cycle and a composite poor COS outcome (cycle cancellation, < 4 oocytes retrieved, no blastocyst, or no euploid blastocyst). Functional principal components analysis characterized stress trajectories, and regression models tested associations with outcomes. Results: Mean age was 36 (SD 3.6); 64% were White and 24% Hispanic. All participants ovulated during priming. Two stress patterns explained 96% of follicular-phase variability. The dominant pattern (early decline then plateau) was not associated with outcomes. A second pattern (peak around cycle day 6 with subsequent rise) was associated with lower peak LH (b − 2.85, 95% CI − 4.60 to − 1.06; adjusted p = 0.004). Ten participants (40%) met the composite poor COS outcome, which was not associated with either stress pattern. Stress levels were similar between priming and COS. Conclusion: EMA is feasible during IVF. In patients reporting mild-to-moderate stress, perceived stress was stable and not associated with key IVF outcomes, though specific trajectories may modestly relate to hypothalamic-pituitary-ovarian-axis function.
SN - 1058-0468
SN - 1573-7330
ER -