Emotional and relationship assessments were completed by 144 couples at intake for in-vitro fertilization (IVF) and 6 months after either the identification of pregnancy or the discontinuation of treatment following three unsuccessful cycles. Women also completed emotional assessments at the time of pre-oocyte recovery and post-embryo replacement within each treatment cycle. At intake, women were more anxious than their partners and comparative norms, and were less positive than men about their marital and sexual relationships. Initial emotional assessments were not related to subsequent pregnancy, but at follow-up those who were pregnant were less depressed and more positive about their relationships. Within treatment cycles scores for women were higher after embryo replacement and the failure of pregnancy. First and last treatment cycles were associated with greater anxiety. High levels of confusion and bewilderment found during the initial cycle may indicate the need for better pretreatment information. Services must recognize the presence of high anxiety at intake and provide psychological care for those identified as particularly distressed. Emotional difficulties after failure of IVF treatment can be considered to be iatrogenic effects, and psychological services should be provided to minimize any negative psychological consequences of treatment.