Maternal Psychological Distress and Repeated Implantation Failure: A Mini Review : Short title: Maternal Distress and Implantation Failure.

Repeated implantation failure (RIF) is one of the most stressful and distressing experiences for women undergoing assisted reproductive technologies (ART) [1]. Despite progress in identifying physical and physiological factors affecting RIF, such as embryo selection, endometrial preparation, and laboratory techniques, there has not been much progress in understanding the psychological factors associated with RIF in infertile women. Compared with a single failed ART cycle, RIF is associated with repeated in vitro fertilization (IVF) failures, and repeated cycles of hope and disappointment exacerbate anxiety, depression, and emotional exhaustion in patients [2] (Table-1). According to theories by scientists such as Sigmund Freud and Wilson [3], psychological trauma, including fear of pregnancy, is considered a cause of female infertility. Psychological stress in women with RIF leads to endocrine dysfunction and increased endometrial contractions, negatively affecting IVF success rates and embryo implantation rates [4]. Additionally, women with RIF face psychological stresses such as delayed childbearing age and various financial, social, and family problems during different stages of treatment (before starting, during, and after treatment failure) [5]. These stresses contribute to feelings of hopelessness, decreased self-confidence, marital problems, and the end of relationships [6] (Figure-1 A-C) . Therefore, this review aimed to stimulate reflection on the psychosocial burden of RIF in infertile couples undergoing ART, explore when distress is most intense, consider contributing factors, and discuss implications and gaps for clinical practice and future research.