Pandemic Pressure: COVID-19 Amplified Stress in Women Undergoing Fertility Treatment

Women undergoing intrauterine insemination during the COVID-19 pandemic carried a heavy psychological burden, according to a new study published in Discover Psychology. Researchers led by Xin Wang and Fang Lyu at the Reproductive Medicine Center of the Second Affiliated Hospital of Soochow University in Suzhou, China, followed 243 infertile women receiving IUI treatment between January 2019 and July 2021, a window that straddles the period before and after the outbreak of the pandemic. Their goal was twofold: to identify which factors drive infertility-related stress in this population, and to determine whether that stress influences the clinical success of the procedure itself. The results paint a detailed picture of how a global public health crisis layered additional strain onto an already emotionally demanding medical journey, while also revealing that the measurable biological outcome of treatment appeared, at least in this cohort, to be independent of the psychological load the women were carrying.

Intrauterine insemination is one of the most widely used forms of assisted reproductive technology. The procedure involves preparing a semen sample in the laboratory and then depositing the washed sperm directly into the uterine cavity around the time of ovulation, bypassing the cervix and shortening the distance sperm must travel to reach the egg. Compared with in vitro fertilization and embryo transfer, IUI is less invasive and less expensive, which makes it a common first-line treatment for couples with unexplained infertility, mild male factor infertility, or cervical factors, as well as for women with conditions such as polycystic ovarian syndrome. Yet despite its relative simplicity, the treatment cycle is psychologically intense. Patients face uncertainty about whether the cycle will succeed, repeated clinic visits timed to ovulation, hormonal monitoring, and the emotional whiplash of hope and disappointment that accompanies each attempt. Infertility itself is recognized by the World Health Organization as a medical condition, and a substantial body of literature has documented elevated anxiety, depression, and perceived stress among people navigating fertility care.

The Suzhou team enrolled participants from the hospital’s reproductive center and asked each woman to complete a battery of validated psychometric instruments. The General Information Questionnaire captured demographic and socioeconomic characteristics, including educational level and monthly household income. The Fertility Problem Inventory, commonly abbreviated FPI, measured infertility-related stress across multiple domains, producing a global stress score along with subscale scores reflecting concerns about social relationships, sexual relationships, the need for parenthood, the rejection of a child-free lifestyle, and the perceived importance of having children. The Stress Response Questionnaire, or SRQ, assessed the intensity of the women’s physiological and psychological reactions to stress, while the Coping Style Questionnaire, or CSQ, distinguished between positive coping strategies, such as active problem-solving and seeking social support, and negative coping strategies, such as avoidance and resignation. Follow-up sessions then recorded pregnancy outcomes, including clinical pregnancy and live birth rates, allowing the researchers to connect psychological profiles with reproductive results.

The headline finding was that these women reported substantial stress. The average global stress score on the Fertility Problem Inventory was 135.1, with a standard deviation of 18.2. To appreciate that number, it helps to understand how the FPI is constructed: higher scores reflect greater perceived stress related to the fertility problem, and a mean in the mid-130s indicates a clinically meaningful psychological burden across the group as a whole. The researchers then used general linear regression to evaluate which participant characteristics were associated with higher FPI scores. Three factors emerged as statistically significant: the outbreak of COVID-19, educational level, and monthly household income, each with P values below 0.05. In other words, women whose treatment intersected with the pandemic period, and women whose educational or economic circumstances differed, did not experience infertility-related stress equally.

The pandemic’s role deserves particular attention. Fertility care is uniquely vulnerable to public health disruptions. Treatment cycles require precise timing, frequent hospital visits, and laboratory procedures that cannot be postponed without losing the cycle entirely. During the COVID-19 outbreak, many reproductive centers faced restrictions, closures, or reduced capacity, and patients faced additional fears of infection, quarantine requirements, and uncertainty about whether their next appointment would proceed. The study’s finding that the COVID-19 outbreak significantly influenced infertility-related stress is consistent with the broader understanding that pandemic-era disruptions compounded the anxiety inherent in fertility treatment. For women already coping with the emotional weight of infertility, the pandemic added a second, independent layer of stress to an experience that was already among the most psychologically demanding in medicine.

Beyond the demographic and pandemic-related factors, the researchers examined how stress responses and coping styles related to the level of infertility-specific stress. Using Pearson correlation coefficients, they found that stress reactions measured by the SRQ were positively correlated with FPI scores, and that negative coping styles measured by the CSQ were also positively correlated with higher infertility-related stress, both with P values below 0.001. This pattern is psychologically coherent. Women who reacted to stressors with stronger physiological and emotional responses reported more infertility-related stress, and women who relied on maladaptive strategies such as avoidance reported more stress as well. The correlation does not establish causation in either direction; it is possible that high stress amplifies stress reactions, that reactive temperament magnifies perceived stress, or that both are driven by shared underlying factors. What the data do establish is that these psychological variables travel together, and that coping style is a meaningful correlate of how much distress a woman experiences during treatment.

The second major question the study addressed was whether this psychological burden translated into reproductive outcomes. Using logistic regression, the team analyzed the relationship between coping styles, perceived stress, the various FPI domains, and pregnancy outcomes. The result was, in one sense, reassuring: no statistically significant relationship was found between these psychological measures and clinical pregnancy or live birth. Women with higher stress scores and more negative coping styles were not, in this cohort, less likely to achieve a clinical pregnancy or deliver a live-born infant than women with lower stress and more adaptive coping. This finding aligns with a long-running and often contentious debate in reproductive medicine about whether psychological stress causes infertility treatment failure. While popular narratives frequently advise patients to simply relax in order to conceive, rigorous studies have repeatedly struggled to demonstrate a robust, independent effect of stress on treatment success, and the present results add to that skeptical literature.

The absence of an effect on outcomes should not be mistaken for evidence that the stress does not matter. The authors emphasize that women undergoing IUI exhibit significant levels of infertility-related stress, influenced by the COVID-19 outbreak, educational level, and family income, and that perceived stress and negative coping styles contribute to this burden. Chronic psychological distress is associated with diminished quality of life, strained relationships, and reduced treatment adherence and persistence, all of which affect patient well-being even if they do not alter the biology of implantation. The findings underscore, in the authors’ words, the need for targeted psychological interventions to support the well-being of women undergoing IUI, particularly during public health crises when external stressors multiply. Counseling, cognitive behavioral approaches, mindfulness-based stress reduction, and screening for maladaptive coping are all plausible avenues for such support within fertility clinics.

Methodologically, the study has notable strengths. It used validated, widely deployed instruments rather than ad hoc measures, tracked participants prospectively through follow-up to capture actual pregnancy outcomes, and applied a coherent statistical strategy: general linear regression for the determinants of stress, Pearson correlations for the relationships among psychological scales, and logistic regression for the link between psychological variables and outcomes. The study received ethical approval from the Institutional Review Board at the Second Affiliated Hospital of Soochow University, was conducted in accordance with the Declaration of Helsinki, and obtained informed consent from all participants. It was funded in part by the National Natural Science Foundation of China and by institutional and municipal grants, and the authors declared no competing interests. The work is published open access, making the full data and analysis available to clinicians and researchers worldwide.

There are, of course, limits to how far the conclusions can be generalized. The cohort comprised 243 women at a single reproductive center in Suzhou, and the study period, from January 2019 to July 2021, reflects the specific circumstances of the pandemic’s early phase in China. Stress, coping, and access to fertility care vary across cultures, health systems, and phases of a crisis, and the correlational design cannot disentangle cause from effect among the psychological variables. Nevertheless, the study offers a rare, quantified window into the mental health of fertility patients during a global emergency, and it delivers a clear message to clinics: the pandemic did not merely complicate the logistics of assisted reproduction, it measurably deepened the psychological burden on the women undergoing it. As health systems prepare for future crises, integrating psychological screening and support into fertility care should be treated not as an optional extra but as an essential component of treatment, even when, as here, the stress itself does not determine whether a pregnancy succeeds.

Subject of Research: Psychosocial stress and coping styles among women undergoing intrauterine insemination during the COVID-19 pandemic

Article Title: Psychosocial stress in women undergoing intrauterine insemination in the COVID-19 pandemic

Article References: Wang, X., Wu, L., Zhou, L., Shen, S., & Lyu, F. (2026). Psychosocial stress in women undergoing intrauterine insemination in the COVID-19 pandemic. Discover Psychology. https://doi.org/10.1007/s44202-026-00887-1

Image Credits: AI Generated

DOI: 10.1007/s44202-026-00887-1

Keywords: infertility, intrauterine insemination, COVID-19, psychosocial stress, coping styles, assisted reproductive technology, Fertility Problem Inventory, pregnancy outcomes, mental health, fertility treatment, China, public health crisis