The effect of depression, anxiety, and cognitive flexibility on pregnancy outcomes in women with unexplained infertility.

OBJECTIVE: This study aimed to investigate the interaction between depression, anxiety, and cognitive flexibility in women with unexplained infertility and to evaluate the impact of these psychological factors on pregnancy outcomes following assisted reproductive treatments (ART). The study also sought to determine whether cognitive flexibility could serve as a potential neuropsychological determinant influencing reproductive success. METHODS: A total of 120 women aged 20-40 years were enrolled: 66 with unexplained infertility and 54 healthy controls with spontaneous conception. The infertility group underwent assisted reproductive treatments (ART) and was divided into pregnant (n=35) and nonpregnant (n=31) subgroups. Depression, anxiety, and cognitive flexibility were assessed using Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and the State-Trait Anxiety Inventory (STAI-I/II) and Wisconsin Card Sorting Test (WCST). RESULTS: Depression scores significantly decreased in women who conceived after ART (p=0.012), whereas both depression and anxiety levels increased in those who did not achieve pregnancy (p<0.001). No significant changes were observed in the control group (p≥0.050). Women who conceived demonstrated significantly higher WCST category completion scores compared to those who did not conceive (p=0.046), while no group difference was found in perseverative error counts. CONCLUSION: Cognitive flexibility may influence treatment success in unexplained infertility. Higher WCST category completion in women who conceived suggests that supporting psychological resilience and adaptive coping may contribute to improved emotional well-being and reproductive outcomes.