Received November 15, 2025
Accepted November 25, 2025

This study aimed to investigate the influence of stress, anxiety, and cognitive flexibility on pregnancy rates in women diagnosed with unexplained infertility. Patients who failed to achieve pregnancy after at least one year of unprotected intercourse were included. Psychological evaluations were conducted using the Beck Depression Inventory, Beck Anxiety Inventory, and State-Trait Anxiety Inventory, while cognitive flexibility was assessed with the Wisconsin Card Sorting Test (WCST), Verbal Fluency Test, and Trail Making Test A-B. Patients subsequently underwent assisted reproductive techniques, and pregnancy outcomes were recorded. The results demonstrated a significant reduction in depression scores by the 12th week among patients who achieved pregnancy, whereas those who did not conceive showed no such improvement. Although no significant differences were found in anxiety or other psychosocial parameters between the groups, the analysis of WCST performance revealed an important distinction. While perseverative errors and total errors were similar across groups, the number of categories achieved was higher in patients who conceived compared to those who did not respond to treatment. This suggests that the ability to adapt to changing cognitive demands, reflected by greater category achievement, may serve as a predictor of treatment success. In conclusion, cognitive flexibility—particularly the number of categories achieved in WCST—appears to be associated with improved pregnancy outcomes in women with unexplained infertility undergoing assisted reproductive treatments. These findings highlight the potential value of incorporating cognitive and psychological assessments in the evaluation and management of infertility.