SEXUAL HEALING: How Intimacy and the Hormone Oxytocin Support Fertility, Emotional Wellbeing, and a Couple’s Resilience
By Sonia Gayete-Lafuente, MD, PhD, one of the CHR’s REI physicians, Associate Editor of CHR Publications, Director of Medical Education, Associate Scientist at the CHR
Today’s posting is made up of two distinct sections: In the first Sonia Gayete-Lafuente, MD, PhD, who recently joined the CHR’s senior physician team, demonstrates why the CHR for such a long time has been looking for a truly qualified female physician to join the CHR. To say it bluntly, none of the guys on the team could have addressed the subject of intimacy during infertility treatments the way she did, - offering solid and at times unexpected information with sensitivity as well as authority.
And then our posting switches straight into the recent infertility literature addressing three interesting papers, - though, as you will find out, - “interesting” for very different reasons.
Let us know what you think. We always try to say it as we see it, - well recognizing that nobody, including us – will always be right and, certainly, not everybody will always agree. But we try very hard to communicate common sense, humanity, and empathy and do it with as much transparency as is possible.
Our readers’ reactions and responses are, therefore, of great importance to us and we can’t wait for you comments to today’s posting.
The CHR’s Editorial Staff
When a couple face infertility struggles and reproductive treatments, their relationship often enters a new emotional and physical frame. What was once spontaneous desire, touch, and intimacy slowly shifts as medical routines take over. Sex becomes scheduled around ovulation, paused during procedures, or just deprioritized altogether. Hormones, injections, ultrasounds, and uncertainty can chip away at sensuality until closeness feels like another item on a long list of obligations. In some instances, it can even feel stressful, triggering, and painful. Yet beneath this clinical reframing of intimacy lies this truth: our bodies are wired for healing through closeness. Intimacy -whether sexual or not-, can soothe the nervous system, soften grief, and remind couples that their connection is still alive under the treatments. A central player in this biology is a small but potent molecule: oxytocin, often called “the love hormone”, maybe more accurately understood as “the safety hormone”.
We here explore not only the restorative chemistry of oxytocin and the neuroscience of pair bonding, but also the often-overlooked role of sexual healing: how closeness, in its many forms, can become a quiet but powerful source of resilience during fertility treatment, and why reclaiming intimacy on your own terms may be one of the most radical acts of self-care you can practice while cycling in treatment.
Why Fertility Treatment Disrupts Intimacy - and Why this Is Completely Normal -
Here’s what nobody tells you when you start IVF: your sex life is about to become collateral damage. Not because your relationship is failing or because you’ve stopped loving each other, but because your nervous system is doing exactly what evolution designed it to do under sustained threat – to prioritize survival over pleasure.
As your body becomes medicalized, monitored, injected, and hormonally manipulated, - it begins to feel more like a science trial than a source of sensuality. Physical discomfort from ovarian stimulation, egg retrievals, biopsies, or pregnancy loss can make even gentle touch feel unwelcome. Meanwhile, emotional baggage accumulates, - grief after failed cycles, fear of disappointment, the relentless uncertainty of what comes next.
Research confirms what you’re experiencing: Studies have shown that 60-80% of couples undergoing IVF report significant sexual dysfunction, with women experiencing decreased desire, arousal, and satisfaction, and men showing surprisingly high rates of erectile dysfunction - far exceeding rates in couples who conceived spontaneously.
Partners often respond differently to this stress. One may withdraw emotionally; the other may focus on staying “strong” or hyper-practical. Desire fades not because of relationship problems, but because chronic stress fundamentally rewires sexual responses. Studies using daily assessments showed that higher subjective stress directly correlates with lower sexual desire and arousal, with these effects particularly pronounced in women. But this does not only affect women: One striking study found that among IVF couples men demonstrated dramatically lower sexual function scores compared to controls not in IVF cycles, both before pregnancy and up to one year postpartum. Sex becomes scheduled, paused, or quietly avoided.
And as this shift is not pathological, but a predictable human response to prolonged emotional demand. What matters is understanding this change as part of the treatment experience and not as a failure of connection or love.
The Molecule of Love and Safety: How Oxytocin Builds Bonds -
Oxytocin is a nine-amino-acid long neuropeptide that acts as both a hormone and a neurotransmitter. It is best known for its role in motherhood, during labor and early bonding, but its influence stretches far beyond those moments. So calling it simply “the love hormone” underestimates its evolutionary sophistication.
Oxytocin is released during any affectionate touch, warm conversation, during kissing, orgasm, and even as a response to simple gestures like eye contact or holding hands. When it rises, the body and brain receive a clear message: You’re safe.
You’re held and you can let go, - with feedback into more oxytocin release, thereby further enhancing the connection. Through this message, oxytocin calms the stress response, lowers cortisol, eases anxieties. and promotes what researchers call “allostasis,” - the ability to adapt and recover from challenges.
This matters profoundly for couples navigating infertility, as it enhances trust and positive communications, reduces stress levels during conflict discussions, helps regulate sleep, reduces pain perception, and even influences the immune system – all notably important in a shared context of intense uncertainty.
The evolutionary story is fascinating. Research on prairie voles - one of the few mammalian species that, like humans, form lifelong pair bonds - revealed that oxytocin and its receptors are essential for partner preference formation and bond maintenance. Interestingly, species that don’t pair bond have different patterns of oxytocin receptor distribution in their brains; and it seems that our capacity for selective attachment, for choosing one person and staying connected through hardship, is neurochemically mediated by this single molecule.
During fertility treatment struggles, oxytocin’s calming and bonding effect becomes particularly valuable. Studies of couples in early romantic attachment show that higher oxytocin levels predict better interactive reciprocity (synchronized positive affect, affectionate touch, mutual gaze) and even predict which couples will stay together. And in stressful contexts, oxytocin reminds our nervous systems that connection itself is a form of care.
Sexual Intimacy Beyond Reproduction -
Many couples begin to see sex as losing its purpose once timed intercourse ends or IVF begins. Some couples report this as an irony of fertility treatment: the very act that brought them together becomes medicalized, scheduled, and stripped of spontaneity. Yet sexual intimacy has always served functions beyond conception. Erotic touch and orgasm produce some of the highest natural surges of oxytocin in the body, higher than almost any other naturally occurring stimulus. This is why sex can feel grounding, soothing, and connective even when it’s not tied to reproduction, although paradoxically a lot of couples may not feel like it at all in context of stress. However, the absence of sexual intimacy during treatment can feel like losing an essential coping mechanism precisely when you need it most.
The research on infertility and sexual function reveals a bidirectional relationship: infertility-related emotional and relational stressors predict lower sexual desire, arousal, and satisfaction in both partners, with effects crossing between partners (your distress affects your partner’s sexual function and vice versa). But here’s the hopeful finding: sexual desire and sexual activity are associated with lower subsequent stress levels, suggesting that intimacy - when it feels safe and is mutually chosen - can actually buffer against the emotional toll of treatment. So, how do we address this?
The Healing Power of Touch Without the Pressure
Not all couples feel ready or able to engage in sexual activity during fertility treatments. Pain, fatigue, grief, hormonal shifts, or recovery from procedures may make intercourse difficult or undesirable. For those who are ready after all, encouragement at the safe moments of the process (for example, avoiding the few days after egg retrieval or embryo transfer) is always welcome; and for those who aren’t, - here’s the good news: oxytocin is released through many forms of non-sexual touch as well.
As already noted, simple gestures such as a long hug, holding hands in the waiting room, resting together quietly, gentle stroking of the arm, etc., can raise oxytocin levels and reduce emotional tension. Recent ecological momentary assessment studies (where people reported experiences in real-time throughout their day) showed that even just an affectionate touch is, indeed, significantly associated with decreased anxiety and stress, and increases oxytocin levels with measurable effects by lowering the stress hormone cortisol and inducing higher happiness in individuals and between couples.
Our understanding of the neuroscience of oxytocin release through touch independent from sexual activity has recently come into more focus through quite elegant studies” Our skin contains specialized nerve fibers called C-tactile afferents, - unmyelinated, slow-conducting nerves, found only in hairy skin, which respond optimally to gentle, slow stroking touch (approximately 3-5 cm per second is the speed of a comforting caress). These nerves appear to have evolved specifically to signal the rewarding value of physical contact in nurturing and social interactions.
When activated, they trigger oxytocin release, reduce physiological arousal, and carry positive affective value. A groundbreaking 2023 study moreover showed that affectionate touch doesn’t just affect immediate oxytocin levels, but creates context-dependent adaptive responses, supporting that regular affectionate touch with your partner and may actually recalibrate your stress response system in general.
In fact, these small, consistent moments often matter more than grand romantic gestures. They help couples stay emotionally connected when words feel insufficient or energy is limited. During fertility treatments, intimacy is often rebuilt through repeated, low-pressure acts of tenderness rather than dramatic efforts at “fixing” lacking desire.
Reframing Intimacy as Care, - Not Performance –
As the “Inferto-Sex Syndrome” - a term coined by researchers to describe all constellations of sexual dysfunctions that can emerge during fertility treatments, affects both partners profoundly, many couples benefit from shifting their view of intimacy away from performance and toward mutual care. For you, this may mean:
- Spending intentional time together without expectation of having sex.
- Exploring slow and non-penetrative touching.
- Simply sharing physical closeness without a specific goal.
- Acknowledging that desire and sex may return gradually - or may not, - and even that is okay.
Most interestingly – and sometimes quite surprisingly - when pressures are removed and infertility-related relational stressors are navigated together, - intimate curiosity and tenderness often take over after all. Intimacy approached with kindness rather than obligation, supports both emotional resilience and relational stability during treatment, ultimately helping couples open up, maintaining more positive perspectives even during challenging times.
The Clinician’s Role: One Sentence That Can Change Everything –
Here is a final thought especially for clinicians: Although intimacy is profoundly affected by fertility treatments, it’s rarely addressed with patients by physicians in office settings. Yet a brief and compassionate acknowledgment from a clinician can have a powerful impact.
Research has demonstrated that couples want their sexual health addressed as part of comprehensive fertility care, while most report that it “never” has come up. Clinicians don’t need to offer sexual counseling to make a difference, but normalizing fluctuation in desire, acknowledging physical discomfort, and recognizing connection as part of healing opens space for patients to feel seen as a couple.
Short comments like, “partners frequently notice changes in intimacy during treatment,” - can immediately reduce shame, provide validation, normalize the situation or address the elephant in the room. Asking, “how are you two coping together?” signals that the relationship matters, not just the outcome. Couples may still not share intimate details with clinicians, but a comment like this could, at least, remove tension and open a door for couples to talk about it among themselves, and thereby reconnect.
On Valentine’s Day, the - perhaps - most radical act of love is simply holding your partner, touching each other with tenderness, releasing the pressure to perform, and trusting that your nervous systems - wired for connection across millions of years of evolution – knows very well how to find its way back to couple hood.
READING LIST
Amiri M, Khosravi A, Chaman R, et al. Sexual function and satisfaction in couples with infertility: the role of personal and relational characteristics. J Sex Marital Ther. 2021;47(2):110–123.
Bright K, Dube L, Hayden K, et al. Effectiveness of psychological interventions on mental health, quality of life and relationship satisfaction in infertile couples: a systematic review protocol. Syst Rev. 2020;9:25.
Carson SA, Kallen AN. Diagnosis and management of infertility: a review. JAMA. 2021;326(1):65–76.
Handlin L, Novembre G, Lindholm H, et al. Human endogenous oxytocin and its neural correlates show adaptive responses to social touch based on recent social context. eLife. 2023;12:e81197. doi:10.7554/eLife.81197.
Leeners B, Tschudin S, Wischmann T, et al. Sexual dysfunction and disorders as a consequence of infertility: a systematic review and meta-analysis. Hum Reprod Update. 2023;29(1):1–19.
Luk BH, Loke AY. A review of supportive interventions targeting individuals or couples undergoing infertility treatment. J Sex Marital Ther. 2016;42(6):515–529.
Sater M, Al-Kindi R, Al-Makhmari A, et al. Impact of assisted reproduction treatment on sexual function of patients diagnosed with infertility: a systematic review. Sex Med Rev. 2022;10(3):433–445.
AND NOW SOME PAPERS FROM THE FERTILITY LITERATURE
Does functional ovarian reserve affect miscarriage risk?
This is an interesting question which – somewhat paradoxically and likely because everybody believed to know the answer – has not been properly addressed in the literature. And – as not infrequently in medicine and in science in general – when everybody believes to know the right answer – this consensus then proves wrong.
This is – at least partially – the case here as well: everybody, of course, believed that the lower the functional ovarian reserve (FOR) of a woman is, the lower are her pregnancy chances with treatments and the higher, moreover, - once she does conceive – will be her miscarriage risk.
But, as a paper by British investigators now clarified the picture further.1 Using 16 retrospective studies involving 43,147 patients, they found in a meta-analysis that low AMH levels – as expected – were in principle associated with miscarriages in comparison to medium and high AMH levels. But once patient age was considered, this risk disappeared in women above age 35. And the same dynamics were observed when antral follicle counts were used to define FOR.
This, of course, then raises the question why this association is statistically lost after age 35 and the answer to this question is why we liked this paper so much: This paper points out what likely has been the most substantial error in IVF practice since its beginning - and still unfortunately lasting, - namely the failure to recognize that, especially in female fertility everything changes with advancing. The assumption that a 25- year-old woman can – or should be - be treated like a 35-year-old or even a 45-year-old woman is simply ridiculous. But that is, unfortunately, still what is happening in most infertility clinics, though, at least in some regards the IVF has recognized this fact: For example most clinics do consider a woman’s age in how they stimulate ovaries; but IVF clinics (except of course the CHR) then still trigger all patients at identical follicle sizes(overwhelmingly always between 18 and 22-23mm. This, of course, ignores the fact that all metabolic processes in follicles speed up with advancing female age. If this is not properly considered, the consequence with advancing female age will be larger and larger percentages of overmature oocytes which never produce pregnancies.
The authors try to explain the observed age-35 cut-off with increasing miscarriage rates with advancing female age due to increasing aneuploidy of embryos. But while statistically this, indeed, may be a contributing factor, the more basic message of this paper – at least in our opinion – is that female patient age must be considered in practically everything we do in treating female infertility.
REFERENCE
Kasavern et al., RBMOnline 2026; 52(1):105041
Can Ovaries Unlock Secrets of Aging and Longevity?
It seems that everybody has suddenly discovered the ovaries as research subjects for general aging and longevity studies. Articles on the subject are popping up everywhere, - the last one in TIME.1 And all of them are correct: The ovaries are, indeed, for several reasons amazing organs to study aging and longevity, - not the least because – as the TIME article noted – they age like all other organs in the female human body, - just ahead all other organs which, of course, offers an opportunity to study what produces this difference.
So much for general aging; but what about longevity? The two, of course, are related but they don’t have identical meanings. What recent research has demonstrated is that ovaries have many more functions than just being the “egg-factory” for fertility. Like we have learned by now in many areas of medicine, organs which we never associated with each other are connected in so many different ways that were unimaginable only a relatively few years ago. And ovaries in women are a terrific example for this interconnectivity, often revealed by what happens to women who go through menopause.
They, suddenly, are also seen as “testing organs” for potential general anti-aging treatments and the article, quoted an ongoing rapamycin study, - this time at Northwestern University in Chicago (we previously mentioned in these pages an ongoing rapamycin study at Columbia University here in NYC). The Chicago study was headed by Kara Goldman, MD, (years ago on the faculty at NYU). And , yes, the CHR also just announced a registered rapamycin study in women with low functional ovarian reserve (FOR) and we are inviting IVF treatment resistant women beyond ages 42-43 years to participate in this new venture.
The article offers no sensational news but provides an updated overview on the subject which, of course, is not only relevant for aging and longevity medicine but also for fertility practice. For the CHR this subject has been at the core of most research for over 15 years, when the CHR reached the conclusion that the aging ovary was the most essential subject in human fertility medicine and decided to make it a core subject of research as well as clinical practice.
One of the most important discoveries the CHR then made within this context as a consequence of this decision was the fact that – as women age - all processes within their ovaries speed up, explaining why menstrual cycles shorten as women get older. This discovery then led to a radical practice change at the CHR with the introduction of HIER (highly individualized egg retrieval), leading to progressively earlier egg retrieval with advancing female age, - a practice which nowadays dominates the CHR’s IVF practice and distinguishes IVF practice at the CHR from almost all other IVF clinics in the world, - even though the CHR’s investigators published this concept years ago in two publications and repeatedly discussed it in these pages and elsewhere.
And while there are general principles that apply to most women (who then have average menopauses at ca. ages 51), roughly 10% of women age their ovaries ahead of time, a process the CHR has given the name premature ovarian aging (POA).2 While so-affected women may still enter menopause around age 51, they, of course, have increased risk for early menopause and in 10% of the 10% (i.e., in 1% absolute) of so-called primary ovarian insufficiency (POI), - also often called premature ovarian failure (POF) when menopause occurs before age 40.
That with advancing age everything in the ovary is happening quicker, may very well be a general principle of aging,- well worth investigating.
REFERENCES
Mosbergen D. TIME. January 13, 2026. https://time.com/collections/the-age-of-longevity/7338546/ovaries-unlock-secrets-longevity/
Gleicher N, Barad DH. Fertil Steril 2006;86(6):1621-1625
On How Not to Do It - Another Totally Biased Expert Opinion Paper
If there is something that never should be in the title of a serious scientific paper these days, - then it is the phrase “expert opinion.” And the reason is not only because expert opinion is rightly considered the lowest levels of scientific evidence, - but because medical “experts” got a really bad name during and after the COVID pandemic. And how some of them have now become salesmen on television, does not improve their image. Yet this is exactly what two prominent female embryologists recently did in a Views and Reviews section in Fertility and Sterility (F&S), claiming in the process to having rethought embryology dogma.1
Really? We don’t think so!
So here is the context: We all by now know about the (in)famous opening section of every issue of Fertility and Sterility (F&S), the mother-journal of the ASRM, where one or more editors of the journal are assigned a theme and then go out to recruit other authors to provide articles, - usually covering different aspects of the targeted subject. The so-selected editors are, of course, chosen for the project based on being perceived as “experts” on the selected subject. And as such they, of course, have opinions which in one way or the other can be assumed to be - rightly or wrongly – biased. In selecting other authors to contribute. One can further assume that there, consequently, will be at least some selection bias at work in favor of opinions that are close to those of the editors.
Responsible editors will be aware of these concerns and will, hopefully, try to avoid them as much as possible. One of the best ways of avoiding such conflicts would be, of course, not to invite collaborators and not to invite yourself to contribute an article (nobody of course will be more biased toward the editors’ opinion than the editors themselves).
So what did these two editors do under the theme “rethinking embryology dogma.” They, first, - as is customary - wrote a brief introductory article as co-authors in which they made the point that in order to achieve progress in embryology, it was essential to learn lessons from the past (we of course fully agree!). But they then went on arguing that this makes opinions from experts in the field “indispensable” to transition from tradition-based technologies or dogma to new, evidence-based approaches and, here, we strongly disagree!.
But this is not yet the end of the story: They then went out and solicited only one article. From whom? From themselves, of course, - with one being the first and the other being the last author. Between the two senior authors, they then added three of the most prominent – if not the most prominent male embryologists, all known to have significantly contributed to embryology:2 Jacques Cohen, PhD, can be viewed as father of the concept of embryo selection and many other things, including PGT-A, David K. Gardner, D. Phil, is unquestionably the father of extended embryo culture to blastocyst-stage and an active proponent of many other things including elective single embryos transfer, and PGT-A, and Denny Sakkas, PhD, with 168 references in PubMed just under IVF is certainly also not missing contributions to the IVF field and is in addition a career-long proponent of embryo selection, PGT-A, etc. Nor can anybody doubt that they are really “experts” in embryology.
And if we sat the expectation that we will now here destroy their paper, we will disappoint because we actually liked their review, - especially their discussion of laboratory automation was insightful. But why we liked the paper most of all was because it confirmed our opinions about “expert bias:” Of course not a word about the questions that have arisen about current routine IVF practice (and since we are talking here about dogma), such as routine ovulation triggers at all ages at same follicle sizes, embryo selection beyond morphology, about routine culture to blastocyst-stage, about elective single embryo transfer and, of course – how could we stay away from it – how about PGT-A, - all clearly dogmas in so many IVF clinics, including the authors’. Shouldn’t all of these issues be addressed first before venturing out into hypothetical future automation chambers?
Just a thought!
REFERENCES
Rienzi L, Racowsky C. Fertil Steril 2026;125(1):1
Rakowsy et al., Fertil Steril 2026;125(1):2-12