Psychological distress, but not single-time endocrine stress markers, is associated with unexplained infertility: a prospective case–control study

Category	Detail
Condition	Unexplained Infertility
Key Mechanisms	Psychological distress interacts with neuroendocrine stress pathways affecting reproductive function.
Target Population	Women with primary unexplained infertility and age-matched fertile controls.
Care Setting	Tertiary gynecology outpatient clinic.

Higher prevalence of psychological distress in women with unexplained infertility (76.0% vs. 42.3%).
No significant differences in cortisol and DHEAS levels between groups.
Psychological distress was independently associated with unexplained infertility (adjusted OR 3.907).
Single-time endocrine stress markers showed limited discriminatory performance for identifying psychological distress.
HADS is a validated tool for assessing anxiety and depression in infertility populations.

Use HADS to assess psychological distress in women with unexplained infertility.

Increased emotional burden may affect treatment outcomes in unexplained infertility.

Women with primary unexplained infertility.

Psychological distress may complicate infertility treatment and should be addressed.

Incorporate psychological evaluations in infertility assessments.
Recognize the limitations of single-time endocrine stress markers in evaluating chronic stress.

Clinical Scorecard: Association of Psychological Distress with Unexplained Infertility, Independent of Single-Time Endocrine Stress Markers: A Prospective Case-Control Analysis