The role of psychological factors in IVF is complex. Psychological issues intertwine with physical ones, often with additive effects. The very diagnosis of infertility is likely to cause stress. In addition, the many investigations and procedures may have compounded distress. There are probably a small number of patients in whom psychological factors may induce infertility. But in the majority, psychological factors may exacerbate infertility and influence the patient's and partner's responses. Mental, sexual, marital and social adjustment may all be affected. The procedure of IVF is likely to have a further impact. A pilot study of couples entering an IVF programme revealed the women to be highly anxious and to conform strongly to feminine stereotypes. Many had received psychiatric help in the past. The idiopathic group appeared to cope less well with stress and had higher anxiety and neuroticism scores. Follow-up revealed that IVF had a profound impact on many of the women. Most had received no counselling in the interim. In those who completed questionnaires at follow-up, a differential effect was observed between the organic and idiopathic groups. State anxiety fell in the idiopathic group but so did marital adjustment. The clinician is advised to incorporate consideration of the psychological aspects of IVF into every aspect of the programme. The addition of a psycho-social team may assist the gynaecologist in this and help the couple to make an optimal adjustment.