FERTI-PET: A Conceptual Protocol for Personalized Animal-Assisted Therapy in Reproductive Medicine

Background: Stress-induced dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis represents a well-documented pathophysiological mechanism in infertility, particularly in women undergoing assisted reproductive technology (ART). Elevated cortisol levels have been shown to suppress the hypothalamic-pituitary-gonadal (HPG) axis, reduce oocyte yield by up to 45%, and decrease clinical pregnancy rates to 8–10% in high-anxiety cohorts. Concurrently, animal-assisted therapy (AAT) has demonstrated robust evidence in cortisol reduction, oxytocin elevation, and autonomic nervous system modulation across multiple randomized controlled trials (RCTs) and systematic reviews. However, no standardized protocol currently exists for integrating AAT into reproductive medicine workflows. Objective: To present the first conceptual protocol — FERTI-PET (Personalized Animal-Assisted Therapy for Reproductive Optimization) / REPRO-CALM (Canine-Assisted Reproductive Neuroendocrine Modulation Protocol) — for the systematic integration of canine-assisted therapy into personalized infertility treatment, with specific emphasis on HPA axis downregulation, oxytocin-mediated endometrial optimization, and alignment with the Reproductive Pause Syndrome (RPS-SCORE) stratification system. Methods: This conceptual framework synthesizes peer-reviewed evidence from reproductive endocrinology, psychoneuroimmunology, and human-animal interaction (HAI) research, including systematic reviews encompassing 129 physiological studies and RCTs with biomarker endpoints. The protocol delineates six phase-specific intervention points across the IVF cycle, with defined biomarker targets (salivary cortisol, heart rate variability, oxytocin), session parameters (duration, frequency, canine selection criteria), and expected clinical outcomes. Results: The proposed mechanism integrates dual neuroendocrine pathways: (1) HPA axis suppression via cortisol reduction (documented in RCTs with p < 0.05), and (2) oxytocinergic modulation of endometrial receptivity, uterine quiescence, and luteal function. Expected outcomes include improved oocyte yield (+10–15%), enhanced endometrial perfusion (+15–25%), reduced uterine contractility (–20–30%), and absolute pregnancy rate improvement of +5–8%. Conclusion: FERTI-PET represents the first evidence-informed, phase-structured protocol for animal-assisted therapy in reproductive medicine. Its integration with the RPS-SCORE system enables personalized stratification of intervention intensity, offering a non-pharmacological, emotionally supportive modality with a predictable neuroendocrine impact on ART outcomes.