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Rationale Couples worldwide are seeking treatment for infertility in growing numbers. Both infertility and its treatment are stressful experiences that generate considerable emotional distress. There is speculation that women's distress is associated with poorer likelihood of pregnancy via assisted reproductive technology (ART) and plausible psychobiological mechanisms bolster this association, although prior reviews of existing evidence find little support. A rigorous, comprehensive, and up to date analysis of research on the association of women's distress with ART outcomes is imperative. Objective We systematically searched for and analyzed evidence regarding the association of women's distress before and during treatment with the likelihood of treatment success via ART. Method Meta-analysis using a random-effects model was conducted on prospective studies (k = 20) that compared levels of anxiety, depressive symptoms, or perceived stress before or during ART treatment in women who achieved successful pregnancy outcomes versus those who did not (total N = 4308). Results Anxiety, depressive symptoms, or perceived stress pre-treatment, and anxiety or depressive symptoms during treatment, were not associated with less favorable ART outcomes. Prior treatment experience, age, and duration of infertility were not significant moderators of these associations. No eligible studies examined perceived stress during treatment. Conclusion Results cast doubt on the belief that distress impedes the success of infertility treatment, offering hope and optimism to the many women who feel emotionally responsible for the outcome of ART and informing the evidence-based practices of their health-care providers. We also identify specific areas and research methods needed to corroborate and extend study conclusions, including study of factors that elevate or attenuate distress in women undergoing infertility treatment.

Rationale Favorable relationships with health care providers predict greater patient satisfaction and adherence to provider recommendations. However, the specific components of patient-provider relationships that account for these benefits have not been identified. The potential benefits of strong patient-provider relationships in pregnancy may be especially important, as care providers have frequent, intimate interactions with pregnant women that can affect their emotions and behaviors. In turn, prenatal emotions and health behaviors have potent effects on birth outcomes. Objective This study investigated whether pregnant women's relationships with their midwives predicted better self-care. Specific components of the patient-provider relationship (communication, integration, collaboration, and empowerment) were examined. We also investigated a mechanism through which these relationship components may be associated with salutary health behaviors: by alleviating women's anxiety. Methods In total, 139 low-risk patients of a university-affiliated midwifery practice in the northeastern United States completed well-validated measures assessing their relationship with midwives, state anxiety, and prenatal health behaviors in late pregnancy; state anxiety was also assessed in mid-pregnancy. Results Women's perceptions of better communication, collaboration, and empowerment from their midwives were associated with more frequent salutary health behavior practices in late pregnancy. Controlling for mid-pregnancy anxiety, lower anxiety in late pregnancy mediated associations of communication and collaboration with health behavior practices, indicating that these associations were attributable to reductions in anxiety from mid- to late pregnancy. Conclusion Results substantiate that benefits of patient-provider relationships in pregnancy may extend beyond providing medical expertise. Some aspects of patient-provider relationships may offer direct benefits to pregnant women in promoting better health practices; other aspects of these relationships may indirectly contribute to better health practices by alleviating negative emotions. The benefits of strong midwife relationships may derive from the reassurance, comfort, and warmth these relationships offer, as well as the information and education that midwives provide to their patients.