Can Stress Reduce IVF Success Rates? The Science Explained with Dr. Ali Domar

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In this episode of the Love and Science podcast, Dr. Erica Bove sits down with Dr. Ali Domar, PhD — internationally recognized expert in stress and infertility and Chief Compassion Officer at Inception Fertility.

We cover the most controversial question in reproductive medicine: does stress impact fertility and IVF outcomes?

In this conversation, you’ll learn:

-How stress and infertility interact (and why infertility distress is comparable to other major medical diagnoses)

-What the research shows about psychological interventions and pregnancy rates

-How cortisol may predict IVF outcomes, including emerging physiologic measures

-Why the stimulation phase of IVF may be the most physiologically stressful part of the cycle

-How chronic stress can affect inflammation, blood flow, uterine receptivity, and potentially egg quality

-What mind body programs actually include and why there isn’t one “magic” intervention

-How to cope with loss, the two week wait, and the social pain of infertility

This episode is part of our Love and Science Fertility Framework series: Season 1, The Biology Beneath the Surface — where we explain fertility physiology in a clear, evidence-based way.

About Dr. Ali Domar 

Alice “Ali” Domar, Ph.D., joined Inception Fertility™ in 2022 as Chief Compassion Officer. She is also currently the Director of the Inception Research Institute and an associate professor of obstetrics, gynecology, and reproductive biology, part-time, at Harvard Medical School.

Dr. Domar is a health psychologist who focuses on the application of mind/body medicine to women’s health issues. Her research focuses on the relationship between stress and infertility, with a focus on the impact of cognitive behavioral interventions as well as access to care and patient retention.

@prelude_fertility

@inceptionfertility

Transcript

Hello, my loves, and welcome back to the Love and Science podcast. I am ridiculously excited about the conversation we’re about to have.

I have Dr. Ali Domar with me, and I will give her bio in just a second. She’s a friend, she’s a colleague, and when I heard her speak for the first time, I was drawn to everything she had to say. Her work has dramatically influenced what I do at Love and Science and continues to shape how we evolve.

By way of introduction, Dr. Ali Domar, PhD, joined Inception Fertility in 2022 as Chief Compassion Officer. She is currently Director of the Inception Research Institute and the Prelude clinics, and she is an Associate Professor of OB-GYN and Reproductive Biology part-time at Harvard Medical School.

Dr. Domar is a health psychologist focused on the application of mind body medicine to women’s health. Her research focuses on the relationship between stress and infertility, including cognitive behavioral interventions, access to care, and patient retention.

Her book, Conquering Infertility, was recently updated, and we’re reading it at our next Love and Science book club.

Dr. Domar, it’s so wonderful to have you here.

Dr. Ali Domar:

I’m so happy to see you.

Dr. Erica Bove:

You are truly an international expert on stress and infertility, and I get asked constantly: infertility causes stress, but does stress contribute to infertility? Can stress reduce fertility? Can it reduce IVF success rates?

Dr. Ali Domar:

That is the hottest question in my world. As soon as I answer it, I’ll retire.

Scientifically, we all agree infertility causes significant stress. I published a study years ago showing women with infertility had similar levels of anxiety and depression as women with cancer, AIDS, or heart disease, and that’s been confirmed repeatedly.

The controversial question is the other direction: does stress reduce fertility or reduce treatment success? Most REIs do not believe stress can influence IVF outcomes. I’ve literally had colleagues say, “I don’t care how many studies you show me.”

But the data tells a different story. If stress affects IVF outcomes, then psychological interventions should improve pregnancy rates. Meta-analyses in recent years show that women who participate in psychological interventions have higher pregnancy rates and lower distress. Longer interventions with mind body or cognitive behavioral focus show the strongest effects.

There’s also emerging data using physiologic markers. Hair cortisol can reflect cortisol exposure over the previous three to six months. Studies have shown hair cortisol levels can predict IVF pregnancy rates: higher cortisol, lower success.

More recently, we partnered with a Canadian company, Oura/Otto (FDA-approved device), measuring cardiovascular and central nervous system activity. We studied women starting their first IVF cycle and collected data across baseline, stimulation, and transfer.

What we found is that physiologic stress during stimulation was the highest level the company had ever seen — higher than Navy SEALs, astronauts, and professional athletes. It validated physiologically how hard stimulation is.

And we found something else: a subset of healthy women had serious cardiac arrhythmias during stimulation despite no cardiac history. This shows the magnitude of physiologic stress on the body during IVF.

Dr. Erica Bove:

This aligns with what I saw in training. We were taught stress is hard to measure and subjective, and clinicians didn’t know what to do about it. But if stress is present and potentially affecting outcomes, we should intervene.

From a physiology perspective, chronic stress activates the HPA axis, increases corticosteroids, increases inflammation, and may alter blood flow and uterine receptivity. I see patients start mind body work, regulate their nervous system, and then transfers work.

Dr. Ali Domar:

I don’t think stress just affects receptivity. I think it affects egg quality, too. That’s why we need intervention during stimulation, not just the two week wait.

Dr. Erica Bove:

This is why Love and Science exists. Female physicians have very high infertility rates, and it’s not just age. Even at the same age, treatment can work less well in physicians. There’s something about this physiology.

Dr. Ali Domar:

In mind body work, there’s no single magic tool. It’s a buffet. People need options: relaxation techniques, cognitive strategies, social support, journaling, exercise, healthy eating, reducing perfectionism. When stress decreases, outcomes improve — and we get babies.

Dr. Erica Bove:

Yes. And these are tools that help with parenting and life, too.

Dr. Ali Domar:

Please don’t sit at home and suffer. There are resources. Try something. My goal is that patients never regret decisions. You will find something that helps you feel better.

Dr. Erica Bove:

Thank you, Dr. Domar. To the pod squad, my loves, you know how much I love you. Until the next time. Bye.