Infertility & Stress

Increase your Stress Resilience
with The Fertility Concierge

Fertility treatments are expensive, time-consuming, invasive and stressful. Research indicates reducing psychological distress increases the chances of conception. The Fertility Concierge (TFC) will produce changes in your physiology that make you more stress resilient for your fertility journey.  

Stress & Infertility • What We Know Now

OTO is a human improvement company focused on innovation and quantifying the psycho-physiological impact of stress on medical & military clients and professional athletes for over 30 years. We have partnered with researchers and medical professionals around the world to spearhead the understanding of Stress & Infertility. We have developed The Fertility Concierge to address stress within infertility and help couples conceive.

Here are a few research backed facts that we know to be true:

Infertility Causes Stress

We know that infertility causes stress1. We have developed a unique program that helps you quantify your stress resilience so you can be proactive managing your daily activities and attempt to mitigate the physiological effects of stress.

Initial research indicates a connection between psychological stress and infertility

“The Mind/Body Program for Infertility was first launched in 1987 and there have been a number of RCT’s to examine its effectiveness (Domar et al., 2000 a,b, 2011). The 10-week group program includes relaxation exercises, cognitive strategies, lifestyle modification, as well as group support. Research indicates that participants experience significant reductions in psychological distress, stress-related physical symptoms such as insomnia and headaches, as well as increases in pregnancy rates. The clinical program is currently offered at numerous centers throughout the US, as well as internationally. Participants report improvements in all symptoms and approximately 55% conceive within 6 months.”

Stress Resilience Is the ability to adapt to the stressors in life

Stress Resilience has been proven to increase with a scientific application of controlled stressors like exercise volume and intensity. The cumulative effect of improving the function of your cardiac, nervous, musculoskeletal and hormonal systems with activity in a controlled manner allowing the body to adapt, is what we refer to as Stress Resilience or the ability to adapt to the stressors in your life.

1 Domar AD, Rooney KL,Wiegand B, Orav EJ, Alper MM, Berger BM, Nikolovski J. “Impact of a group mind/body intervention on pregnancy rates in IVF patients” Fertil Steril 2011; 95:2269-73. link to study

Our Vision For The Fertility Concierge

Our belief is that our technology should be part of the standard of care in fertility treatment. 

We are confident that our research-backed methodology and technology can play a significant role in your fertility journey.

We have partnered with leaders in fertility research to further define the relationship between stress and infertility. 


The Fertility Concierge

The Fertility Concierge will empower you to be proactive about your health when trying to conceive, managing your pregnancy and having a family.

You cannot control the stressors in your life, but you can build your Stress Resilience.

What is The Fertility Concierge?

The Fertility Concierge is powered by the OTO band, sensor and app that allow you to see what is happening inside your body by quantifying your Stress Resilience on a daily basis and monitoring it over time.

Our patented, science-based Adaptive Activity Plans will provide daily solutions to measure your progress, giving you peace of mind that you are doing your most to support having a baby.

Gain more insight of your fertility journey by utilizing The Fertility Concierge.

On-Going Research

Inception Study with Dr. Alice Domar

OTO has partnered with Dr. Alice Domar, Chief Compassion Officer at Inception Fertility ( to run an IRB approved study on stress and infertility using the OTO device.

Together we will build the scientific foundation of a psycho-physiological approach to the investigation of stress and infertility.

OTO has expanded use of its industry leading medical grade hardware and software to quantify stress in regard to infertility with a measure of Stress Resilience to empower the user to take control of health related decisions in preparation for their fertility journey.

Dr. Alice Domar is the Chief Compassion Officer at Inception Fertility and an associate professor of Obstetrics and Gynecology and Reproductive Biology part time at Harvard Medical School. We are delighted that she agreed to be the Chairperson of the OTO Scientific Advisory Board.


About Dr. Alice Domar

Dr. Alice Domar, or Ali as she likes us to call her, is the protagonist in our story of the relationship between stress and infertility. She is an industry leading expert that has helped many couples connect the dots regarding fertility with a career of rigorous scientific investigation.

A mother herself, Ali has been researching the mind/body connection to infertility since 1987. Known for her research but also highly regarded for her delivery and sense of humour, she continues to be a sought after expert and speaker at conferences and consultant to fertility clinics all over the world.

Her book, “Conquering Infertility” was brought to our attention at OTO and we found her theories about stress and infertility so compelling that we reached out to her to see if she was open to adding a measure of physiological stress to her research. We are excited about our new partnership and are hopeful to leverage her research and expertise into actionable solutions for our fertility clients.

She is a prolific researcher, author and speaker. Here is how she describes what she does in her own words:

How she spends her time:
“All of my time and effort toward research, teaching, and clinical contributions continue to be in the area of the application of mind/body medicine to women’s health issues. I spend approximately half my time in clinical activities, and the remaining time equally on research, administrative responsibilities, teaching, and educating the lay public through books and lectures.”

Her Area of Excellence:
“My Area of Excellence is the clinical application and research investigation into the relationship of stress and infertility, specifically how to decrease distress through psychological interventions for infertility patients. Through two NIMH and several industry grants, my research has shown that infertility patients experience significantly more depressive symptoms than fertile women and that the relief of these symptoms is associated with significant increases in pregnancy rates. I have been studying the reasons why insured women drop out of treatment as well as which interventions might allow these women to stay in treatment until a pregnancy occurs. I am also the director and founder of a clinical mind/body program for infertility patients. Thousands of women have attended the program over the past 33 years; significant improvements in physical and psychological symptoms are noted in the vast majority of patients and 55 percent achieve a pregnancy within six months. A graduate student I supervised showed through her Ph.D thesis work that the program is efficacious in an online format in significantly decreasing psychological distress as well as increasing pregnancy rates.”

What she does at Inception Fertility:
“I am currently the Chief Compassion Officer at Inception Fertility, the largest network of infertility clinics in North America. My responsibilities include providing stress management strategies for patients and employees, including in an electronic format, training the reproductive endocrinologists how to communicate empathetically, and training all patient-facing employees the best strategies for delivering bad news. I am also creating a new initiative in clinical research throughout their 79 clinics.”

Her career goal:
“Through my research, clinical activities, supervisory roles, administrative tasks, and public communications, the goal is the same: to teach women how to reduce the stress in their lives
and allow them to be healthier, both from a physical and psychological perspective.”


The Connection.TV
Harvard Catalyst Profiles
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Frequently Asked Questions

What is The Fertility Concierge (TFC)?

TFC is a medical grade hardware and software product that enables you to measure your Stress Resilience, which is an indication of your ability to adapt to the stressors in your life. This same technology is currently being used in an IRB approved study to quantify the impact of stress on infertility.

What Recommendations Will I Receive?

Once you complete your daily TFC assessment, you will receive a Stress Resilience Score and an activity plan that is adapted to your current score. Our Expert System adapts or modifies your activity based on what you are ready for on that day.

TFC will create an awareness of your physiological stress as a Stress Resilience Score. You can track your Stress Resilience daily and you can also track it as it trends over time.

Does The Fertility Concierge Support LGBTQ+ Couples?

Yes, the Fertility Concierge is an app inclusive of all people.

Does Infertility Cause Stress?

Yes, infertility has been shown to cause stress to couples trying to conceive worldwide.

“The inability to conceive a child is experienced as a stressful and traumatic situation by individuals and couples across the globe. It is estimated that 72.4 million women are currently infertile worldwide.[1] Of these, 40.5 million are currently seeking infertility medical care.[1] Approximately half of women undergoing fertility treatment rated infertility as the most stressful experience of their life.[2] The impact of infertility can have harmful social and psychological consequences on both the individual and couple. In the United States, specialists who study infertility have noted that infertile couple are one of the “most neglected and silent minorities.”[3]

Kristin L Rooney, Alice D Domar. Emotional and Social Aspects of Infertility Treatment

1. Boivin J, Bunting L, Collins J A, et al. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod. 2007;22(6):1506-12. 

2. Freeman EW, Boxer AS, Rickels K, et al. Psychological evaluation and support in a program of in vitro fertilization and embryo transfer. Fertil Steril. 1985;43(1):48-53. 

3. Domar AD, Siebel MM. Emotional aspects of infertility. In: Seibel MM (Ed). Infertility: A Comprehensive Text. Stamford: Appleton & Lange; 1997. pp. 29-44. 


Does Stress Cause Infertility?

Whether stress causes infertility has been the subject of controversy for years. Dr Alice Domar has been investigating the mind body connection to fertility since 1987 and has made significant progress in educating health care practitioners and clients about stress and infertility.

Read more here:

“The Mind/Body Program for Infertility was first launched in 1987 and there have been a number of RCT’s to examine its effectiveness (Domar et al., 2000 a,b, 2011). The 10-week group program includes relaxation exercises, cognitive strategies, lifestyle modification, as well as group support. Research indicates that participants experience significant reductions in psychological distress, stress-related physical symptoms such as insomnia and headaches, as well as increases in pregnancy rates. The clinical program is currently offered at numerous centers throughout the US, as well as internationally. Participants report improvements in all symptoms and approximately 55% conceive within 6 months.”


Alice D Domar & Kristin L Rooney © 2017. The Role of the Mental Health Professional in the ART Clinic Setting

Read more here:

“The relationship between stress and infertility has remained a subject of controversy for many years. Women undergoing infertility treatments exhibit high anxiety and/or high depressive scores at the start of treatment as well as over the course of treatment [1–4]. Stress may also have a negative impact on pregnancy rates in women undergoing in vitro fertilization (IVF) [5–8]. A recent large study [9] did not reveal a relationship between distress and IVF outcome, so it is possible that there might be differences among patient populations or cultural influences on emotional expression. A meta-analysis which included 14 relevant studies on this topic [10] also did not find a relationship between distress and outcome. However, patient distress in these studies was assessed only once, up to 3 months before cycle start, so the relationship between distress while actually cycling and subsequent pregnancy rates remains unknown. However, distress is the most common reason given by women who voluntarily terminate treatment [11–13], and baseline depressive symptoms can predict treatment termination after only one cycle [14].
A recent study on the impact of stress on fecundity indicated that distress significantly reduced the probability of conception in women just starting to attempt pregnancy [15].

Alice D. Domar, Ph.D., Kristin L. Rooney, B.A., Benjamin Wiegand, Ph.D., E. John Orav, Ph.D., Michael M. Alper, M.D., Brian M. Berger, M.D., and Janeta Nikolovski, Ph.D. Impact of a group mind/body intervention on pregnancy rates in IVF patients

1. Boivin, J., 2003. A review of psychosocial interventions in infertility. Social Science and Medicine 57, 2325–2341.

2. Boivin, J., Domar, A., Shapiro, D., et al., 2012. Tackling burden in ART: An integrated approach for medical staff. Human Reproduction 27, 941–950.

3. Boivin, J., Bunting, L., Koert, E., Ieng, U.C., Verhaak, C., 2017. Perceived challenges of working in a fertility clinic: A qualitative analysis of work stressors and difficulties working with patients. Human Reproduction 32, 403–408.

4. Chen, T.H., Chang, S.P., Tsai, C.F., Juang, K.D., 2004. Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Human Reproduction 19, 2313–2318.

5. Constable, J.F., Russell, D.W., 1986. The effect of social support and the work environment upon burnout among nurses. Journal of Human Stress 12, 20–26. De Berardis, D., Mazza, M.,

6. Marini, S., et al., 2014. Psychopathology, emotional aspects and psychological counselling in infertility: A review. La Clinica Terapeutica 165, 163–169.

7. Dill, J., Erickson, R.J., Diefendorff, J.M., 2016. Motivation in caring labor: Implications for the well-being and employment outcomes of nurses. Social Science and Medicine 167, 99–106.

8. Domar, A., Zuttermeister, P., Friedman, R., 1993. The psychological impact of infertility: A comparison with patients with other medical conditions. Journal
of Psychosomatic Obstetrics and Gynecology 14, 45–52.

9. Domar, A.D., Clapp, D., Slawsby, E., et al., 2000. The impact of group psychological interventions on distress in infertile women. Health Psychology 19, 568–575.

10. Domar, A.D., Clapp, D., Slawsby, E.A., et al., 2000. Impact of group psychological interventions on pregnancy rates in infertile women. Fertility and Sterility 73, 805–811.

11. Domar, A.D., Smith, K., Conboy, L., Iannone, M., Alper, M., 2010. A prospective investigation into the reasons why insured United States patients drop out of in vitro fertilization treatment. Fertility and Sterility 94, 1457–1459.

12. Domar, A.D., Rooney, K.L., Wiegand, B., 2011. Impact of a group mind/body intervention on pregnancy rates in IVF patients. Fertility and Sterility 95, 2269–2273.

13. Domar, A.D., Rooney, K., Rich, C., et al., 2016. Burden of care is the primary reason why insured women terminate IVF treatment. Fertility and Sterility 106, e62–e63.

14. Frederiksen, Y., Farver-Vestergaard, I., Skovgård, N.G., Ingerslev, H.J., Zachariae, R., 2015. Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: A systematic review and meta-analysis. BMJ Open 28, e006592.

15. García, D., Bautista, O., Venereo, L., 2013. Training in empathic skills improves the patient–physician relationship during the first consultation in a fertility clinic. Fertility and Sterility 99, 1413–1418.

What is the Benefit of Monitoring My Stress?

If you have been diagnosed as infertile – not able to conceive after 1 year of unprotected intercourse if you are 35 years old or less, or 6 months if you are over 35 years old, it may be beneficial to be aware of your Stress Resilience.

Quote from Dr Alice Domar:

“This is the way I explain things to patients….The vast majority of infertility has a physical cause, whether female factor, male factor, a combo of both, or unexplained. There are also many entities which can impair fertility such as weight, lifestyle factors such as smoking or alcohol, and environmental toxins. So one might be subfertile (ie: a little bit unfertile such as irregular ovulation or a low sperm count) but combine that with smoking or being obese, and one becomes infertile.

Stress is another factor which may well contribute to infertility. So if a couple tries to conceive and one or both is subfertile, the stress of trying over and over month after month may bump one or both of them into infertility.
And once they see a doctor and begin infertility treatment, even if the original physical problem is fixed by the treatment, the distress they are feeling by that time might hamper the efficacy of that treatment.”

“But there is also male factor which is 40-50% contributing. The issue is that IVF (In Vitro Fertilization) bypasses many of the actual diagnoses but not everyone conceives. Which is where I think stress comes in, with PGT (Preimplantation Genetic Testing) you are transferring a chromosomally normal blastocyst but about 40% don’t make babies. Stress?”

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