Unexplained infertility

Robert J. Edelmann responds.

Louise Goddard-Crawley cites a paper in the Journal of Neuroscience which she suggests provides ‘the missing link between stress and infertility’ (June issue). She then suggests that working through psychological issues will impact unexplained infertility. The research Goddard-Crawley refers to is derived from experimental studies with mice, and to make the inferential leap from this to counselling as the answer to unexplained infertility is concerning.

Whilst stress may well play a role in reproductive failure (as we discussed over 30 years ago – Edelmann & Golombok, 1989 in the Journal of Reproductive and Infant Psychology) there is very clearly not a one-to-one link between stress and reproductive failure (where there is no evident medical reason for that failure) given, for example, that conception can occur under very traumatic circumstances.  

The biopsychosocial model is as relevant in the context of unexplained infertility as with other ‘medical’ conditions. However, suggesting that helping patients with stress ‘can clear a mental pathway to fertility’ is not evidence based, and if such a message were provided without very clear caveats to couples with unexplained infertility it could further increase their emotional upset in the absence of conception.

Robert J Edelmann
Emeritus Professor, Department of Psychology, Roehampton University
[email protected]

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