Background <p>Infertility poses a significant emotional burden on couples, leading to increased stress levels. This study aimed to investigate the effectiveness of cognitive-behavioral stress management training in reducing infertility-related stress among infertile couples.</p> Methods <p>A randomized clinical trial was conducted involving 20 infertile couples (40 individuals) who sought treatment at the Saboohi Infertility Center of Mahdieh in Tehran, Iran, between May and June 2018. Participants were selected using convenience sampling and randomly assigned to either the control group, which received routine infertility counseling, or the intervention group, which received cognitive-behavioral stress management training in addition to routine counseling. Independent <i>t</i>-tests and analysis of covariance (ANCOVA) were used.</p> Results <p>In the post-time period, the intervention group demonstrated a significant decrease in total stress scores compared to the control group for both men (B =  − 15.07, <i>p</i> &lt; 0.001) and women (B =  − 2.82, <i>p</i> = 0.003), controlling for pre-time values. Subscale analyses revealed that the intervention group had lower scores in social concern, sexual concern, communication concern, rejection of childfree lifestyle, and the need to be a parent compared to the control group, for both men and women (<i>p</i> &lt; 0.001).</p> Conclusions <p>In conclusion, our study highlights the effectiveness of a behavioral-based stress management intervention alongside infertility counseling in controlling infertility-related stress. These findings support the inclusion of this comprehensive counseling approach in the care package for infertile couples, enabling healthcare professionals to reduce stress and improve overall well-being.</p>