Examining the Impact of Cognitive-Behavioral Therapy-Based Counseling on Female Infertility

Examining the Impact of Cognitive-Behavioral Therapy-Based Counseling on Female Infertility

Indhira Garcia

Suny Downstate Medical Center

Midwifery Education Program


Examining the Impact of Cognitive-Behavioral Therapy-Based Counseling on Female Infertility


Infertility is a significant health issue affecting millions of people worldwide (Rooney & Domar, 2018). According to Hajela et al. (2016), the global estimate of infertile couples ranges from 8-12%, with 3-5% of this population accounting for couples with unexplained infertility. As of 2016, approximately 60-80 million couples were suffering from infertility (Hajela et al., 2016). Infertile patients of the reproductive age group experience substantial emotional turmoil and an increased risk of distress, depression, and anxiety disorders (Hajela et al., 2016; Khodakarami et al., 2020; Simionescu et al., 2021; Rooney & Domar, 2018). Typical responses to infertility include anger and frustration, sadness, loss of self-esteem, depression, and loss of sense of control (Simionescu et al., 2021). Hajela et al. (2016) reveal that a higher stress level among infertile couples is seen in females compared to their male counterparts, which further endangers their mental well-being.

Research reveals that psychological distress negatively impacts the infertility treatment process (Hajela et al., 2016). Therefore, to deal with infertility, which is a major health issue of concern, there is a need to reduce stress among infertile people of the reproductive age group, especially the female partners who are most affected. Cognitive-Behavioral Therapy-Based (CBT) counseling assists in stress reduction and balancing human emotions. Golshani et al. (2021) provide evidence that cognitive behavioral therapy-based counseling is an effective intervention for reducing stress in pregnant women with a history of primary infertility. Furthermore, Golshani et al. (2021) urge that pregnant women with a history of primary infertility may experience less stress, anxiety, and poorer quality of life after receiving CBT counseling. Sahraeian et al. (2019) also add that psychosocial support groups can influence the effectiveness of CBT in improving the mental health of infertile women. Golshani et al. (2021) further add that to help pregnant women with a history of infertility, the CBT counseling strategy is advised in addition to other counseling strategies. However, to the best of my knowledge, this statement is not supported by empirical study findings but rather by the assumption that stress causes infertility. Thus, the proposed study aims to explore the impact of CBT counseling on female infertility to determine whether stress management interventions can be useful in the infertility treatment process.

Problem Statement

The relationship between stress and infertility is complex, with infertile couples experiencing higher stress levels along with an increased risk of developing psychological disorders such as depression, anxiety, and stress. On the other hand, higher stress levels cause infertility (Cheng et al., 2019; Simionescu et al., 2021). Bhardwaj et al. (2018) also support that stress contributes to infertility. The authors elucidate that oxidative stress damages the reproductive physiology of females by interfering with an individual’s antioxidant defense system. According to Bhardwaj et al. (2018), a variety of toxicants alter this defense system and cause various reproductive disorders such as implantation defects, impaired folliculogenesis, miscarriages, follicular atresia, and endometriosis; thus, directly affecting female’s fertility and reproductive physiology.

Furthermore, Golshani et al. (2021) urge that ovulation, fertilization, and implantation, regardless of the origin of the stressful stimuli, can all be affected by stress on the female adrenal and HPO axis. Derivations in LH pulses induce or inhibit ovulatory function directly or indirectly by influencing ovarian steroid production. Work-induced stress affects LH plasma levels directly during the follicular and luteal phases of the ovarian cycle (Golshani et al., 2021). It has been shown that distress in the general population, as well as in infertile women, leads to lower conception rates, longer menses (35 days), and lower fertility outcomes, including oocyte retrieval, fertilization, pregnancy, and live births (Golshani et al., 2021). Women with infertility who experience chronic psychosocial stress have also been found to have a reduced ovarian reserve. The presence of these markers was associated with a greater likelihood of a diminished ovarian reserve. Undernutrition, financial hardship, and low socioeconomic status may negatively impact ovarian reserves.

Purpose of Research

The primary goal of this study is to examine the impact of Cognitive-Behavioral Therapy-Based Counseling, a renowned stress management strategy, on female infertility. Usually, infertility may lead to several problems for couples, among which include increased marital conflicts. Since stress and anxiety may lead to infertility and increase marital disputes, it is important to provide counseling to reduce stress. Stress is believed to be a cause of infertility. However, to the best of my knowledge, scholars are yet to examine the impact of stress management strategies on infertility. Thus, this study will seek to fill this research gap by examining whether Cognitive-Behavioral Therapy-Based Counseling reduces infertility among women of the reproductive age group.

Research Question

What is the impact of Cognitive-Behavioral Therapy-Based Counseling on female infertility?


Ho: Cognitive-Behavioral Therapy-Based Counseling has a positive and significant influence on female infertility.

H1: Cognitive-Behavioral Therapy-Based Counseling has no significant influence on female infertility.

Description of Research Design

This study will adopt a randomized research design. This research design entails randomly assigning research subjects to either a control or an experimental group. Usually, the expected difference between the experimental and the control groups in a randomized study is the outcome variable under investigation. This study will be conducted as a randomized clinical trial with a total of 50 research subjects. Participants will include infertile women visiting a particular public healthcare hospital in the US. The 50 participants will be divided into two equal groups: one group will serve as an experimental group and the other as a control group. The experimental group for the proposed study will receive a 30-45 minutes counseling session twice a week. The counseling session will use a CBT stress reduction approach and run for 8 weeks. The control group will not be exposed to any stress reduction technique. After the 8 weeks, demographic characteristics and Harry’s Stress Assessment questionnaires will be used for data collection. SPSS version 26.0 will be used to perform an independent and paired t-test to determine whether the stress reduction strategy has led to reduced stress among the experimental group. When it is confirmed that the applied stress reduction approach has led to reduced stress levels, the two groups will then be advised to try to conceive in the next three-six months. Final clinical evaluations will be made to determine the difference between the fertility level of the two groups.


This study will have two main variables. The independent variable will be cognitive-behavioral therapy-based counseling, and the dependent variable will be female infertility. The study will explore the nature of the relationship between these two variables. Data on the impact of cognitive-behavioral therapy-based counseling will be measured using Harry’s Stress Assessment questionnaires. Female fertility will be measured as the women’s capacity to get pregnant and deliver the baby in the next.

Definition of Terms

Stress: In the context of the proposed study, stress refers to a dynamic condition where a person is faced with an opportunity, demand, or constraint related to what they desire and for which the outcome is considered to be indeterminate but imperative.

Infertility: Infertility in the context of the proposed study refers to a situation whereby couples belonging in a reproductive age group are not in a position to become pregnant after at least one year of unprotected sex.

Cognitive-Behavioral Therapy: In the proposed study, CBT will be used to refer to a form of psychological treatment that aims to minimize symptoms of different mental health conditions such as anxiety, and depression disorders.


Delimitations are the decisions that the researcher makes in order to govern the parameters of the study. The first delimitation for the proposed study is on sample selection. Only infertile women within the reproductive age group will be recruited to take part in the study. The second delimitation of the proposed study is that it will only focus on examining the impact of CBT on infertility among women; hence the impact of CBT on men’s infertility will not be considered.


These are situations and concepts which are considered to be true and, to some extent, are not within the researcher’s control. The first assumption for this study is that the collected primary data will be accurate and sufficient to address the research question. It will also be assumed that infertility among the selected women is not caused by underlying medical conditions.


Limitations are potential shortcomings and influences, and the researcher has no control over them. One of the potential limitations of this study is the small sample. It is anticipated that limiting the respondents to females in the reproductive age groups will restrict the sample size. However, this restriction will be important in the study as it will reduce the scope of the study and make it as specific as possible.


The proposed study will have significant value. Firstly, the study will uncover the impact of CBT Counseling on female infertility. If findings showcase that CBT contributes to improved fertility, the findings of the study will be used to emphasize the use of stress reduction techniques in improving the efficiency of infertility treatment procedures.

Consequently, this will assist in reducing infertility which is currently a significant health issue requiring to be dealt with. Also, the findings of this study will add to the scope of literature relating to fertility and stress and provide future scholars with rich literature to support their studies that relate to this area of research.


Bhardwaj, J. K., Mittal, M., Saraf, P., & Kumari, P. (2018). Pesticides induced oxidative stress and female infertility: a review. Toxin Reviews. https://doi.org/10.1080/15569543.2018.1474926Biringer, E., Howard, L. M., Kessler, U., Stewart, R., & Mykletun, A. (2015). Is infertility really associated with higher levels of mental distress in the female population? Results from the North-Trøndelag Health Study and the Medical Birth Registry of Norway. Journal of Psychosomatic Obstetrics & Gynecology, 36(2), 38-45.

Cheng, Y., Zhang, J., Wu, T., Jiang, X., Jia, H., Qing, S., … & Su, J. (2019). Reproductive toxicity of acute Cd exposure in the mouse: Resulting in oocyte defects and decreased female fertility. Toxicology and Applied Pharmacology, 379, 114684. https://doi.org/10.1016/j.taap.2019.114684Golshani, F., Hasanpour, S., Mirghafourvand, M., & Esmaeilpour, K. (2021). Effect of cognitive behavioral therapy-based counseling on perceived stress in pregnant women with a history of primary infertility: A controlled randomized clinical trial. BMC Psychiatry, 21(1), 1–11.

Hajela, S., Prasad, S., Kumaran, A., & Kumar, Y. (2016). Stress and infertility: A review. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 5(4), 940-943. http://dx.doi.org/10.18203/2320-1770.ijrcog20160001Khodakarami, B., Masoumi, S. Z., Shayan, A., Ahmadnia, H., Dastgerdian, F., & Rabiei, S. (2020). The Effect of Counseling on Stress in Infertile Women Admitted to an Infertility Center in Hamadan City, Iran. Current Psychiatry Research and Reviews Formerly: Current Psychiatry Reviews, 16(3), 220-226.

Patel, A., Sharma, P. S. V. N., Narayan, P., Binu, V. S., Dinesh, N., & Pai, P. J. (2016). Prevalence and predictors of infertility-specific stress in women diagnosed with primary infertility: A clinic-based study. Journal of human reproductive sciences, 9(1), 28. https://doi.org/10.4103%2F0974-1208.178630Rooney, K. L., & Domar, A. D. (2018). The relationship between stress and infertility. Dialogues in clinical neuroscience, 20(1): 41–47. https://doi.org/10.31887%2FDCNS.2018.20.1%2FklrooneySahraeian, M., Lotfi, R., Qorbani, M., Faramarzi, M., Dinpajooh, F., & Ramezani Tehrani, F. (2019). The effect of Cognitive Behavioral Therapy on sexual function in infertile women: A randomized controlled clinical trial. Journal of sex & marital therapy, 45(7), 574-584.

Simionescu, G., Doroftei, B., Maftei, R., Obreja, B. E., Anton, E., Grab, D., … & Anton, C. (2021). The complex relationship between infertility and psychological distress. Experimental and Therapeutic Medicine, 21(4), 1-1.