Feb. 25, 2011 -- In January, Kristen Hale of Shawnee, Kan., underwent her first round of intrauterine insemination (IUI), where her husband Bill's sperm was artificially placed within her body closer to the egg.
"The whole time you're laying there you're thinking, am I going to have to do this again, and how much are we spending?" Hale, 28, said. "We hoped it would be our first and only time."
It won't be.
Kristen had learned months before that she has polycystic ovarian syndrome, and that her husband's sperm-count was low during their natural attempts. They were told IUI could significantly increase their chance of getting pregnant. But the first attempt didn't work for the Hales, so they're going in for another visit next month.
"We have babies on the mind 24-7," Hale said. "It's all we talk about, think about. We're stressed because we're thinking about not being stressed."
Like many women, Kristen says she believes the emotional pressure she feels is one of the major reasons why she could not get pregnant on her first IUI try.
"Most of the stress is the two-week wait [after insemination]," said Hale. "You're constantly wondering if every feeling is a symptom of pregnancy. It's like your mind playing tricks on you."
It's a thought that crosses the minds of many women who are struggling to conceive. Does a woman's stress level contribute to her chances of conceiving?
The research, along with many experts, is divided. A review of European studies released Thursday found that women who are stressed have a near-equal chance of conceiving with fertility treatments as less-stressed women. Women have long believed that stress could interfere with hormone levels and affect their chances of pregnancy.
And it could be true for some women who naturally try to conceive, said Dr. James Grifo, director of NYU Fertility Center and professor of the department of obstetrics and gynecology at NYU Langone Medical Center.
Stress can stop ovulation, he said. And the constant worry of infertility could also impair a couple's physical and emotional capacity to have sex.
But many are not convinced that stress promotes infertility for couples who are already undergoing fertility treatments.
"We certainly know that infertility causes stress, but there's no good data to say that stress causes infertility," said Dr. Jeffrey Goldberg, head of the infertility treatment clinic at the Cleveland Clinic in Ohio.
Still, many experts say an overwhelming amount of research suggests the opposite.
Besides changes in hormone levels, stress also contributes to a couples' attitude and behavior toward assisted fertility methods.
"It's the number one reason they drop out of treatment," said Alice Domar, director of the Domar Center for Mind Body Health at Boston IVF. "I'm not saying that stress is the cause of all infertility, but it could contribute to the problem."
Previous research also suggests that women who are the most stressed about missing work for treatment or how much an IVF cycle will cost may also be less likely to get pregnant.
Domar says many women struggling with infertility bottle up their emotions because they feel ashamed.
"It becomes this secret cell of pain," she said. It's understandably difficult when women see so many around them having babies with ease."
While many factors contribute to a couple's anxiety, the major focus of mental health care for infertile couples is to help them cope with the emotional impact of infertility treatment. Joining a support group and participating in relaxation approaches like meditation have shown to help some couples, if not to conceive, to overcome their feeling discouraged.
"We talk about how to handle feelings of guilt and shame," she said.
Kristen Hale's friends have recommended all types of alternative treatments -- everything from meditation to herbal drinks, she said. But because she feels like she's got a lot riding on her upcoming IUI treatment, she feels like investing her time in other methods could interfere with her chances.
"Maybe I could do both but I feel like it would be starting over for me. I'll feel like I'm going backwards by not putting all my focus on the medical procedure," said Hale.
In fact, while some evidence supports alternative therapies to enhance fertility in some women, a mind-body approach may not be the best fertility method, said Grifo.
"I don't think there's a right or wrong for fertility treatments. A lot of patients benefit from mind-body approaches while others don't," said Grifo. "You should not feel obligated to do anything."
And for some couples for whom no approach may work, more important than stress relief is to support the couple as they overcome their emotional grief, he said.
"Telling women that fertility treatments didn't work because they were stressed is making them feel bad for no reason because it's not even right," said Grifo.
Grifo equated conception to a numbers game. For many, it's about the right egg at the right time. Not all eggs work and not every cycle guarantees pregnancy, he said.
"Women should know not to worry if they're stressed out, it's not going to keep you from getting pregnant," said Grifo. "It's not your fault the cycle failed. It could be that just that time you didn't get the one good embryo."