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The Relationship Between Stress and Fertility
A blog by Alice Domar, PhD, Executive Director of the Domar Center for Mind/Body Health, Director of Mind/Body Services at Boston IVF, May 16, 2014
It makes intuitive sense that stress should lead to decreases in fertility. It has certainly been observed in the animal model. If you stress animals by crowding them or limiting their access to food, their fertility rates decrease. When you put them in more comfortable surroundings or give them more food, they quickly begin to reproduce normally.
Until recently, there was less evidence about the relationship in humans. It isn’t really ethical to crowd humans or starve them in the interest of science. But a study published last month, by Courtney Lynch, Ph.D, and her colleagues at Ohio State University, for the first time documented that stress levels in women were in fact related to how long the women took to get pregnant. And the women who had the highest levels of a stress-related hormone when they began to try to get pregnant were twice as likely to go on to experience infertility as women who had the lowest levels.
What about women who are not simply trying to get pregnant but are already experiencing infertility (defined generally as a year of unprotected intercourse without a normal pregnancy)? Most of the research does show that the more stressed the woman is when she begins treatment, the less likely she is to conceive. It is a difficult field to research though, since there are so many contributing factors. For example, a 26 year old with normal hormone levels will likely report far less stress than a 42 year old whose hormone levels indicate that she is approaching menopause. The 26 year old is also more likely to get pregnant from treatment since in most cases, her eggs will be healthier. So if the 26 year old reports less stress and then gets pregnant, did she get pregnant because she was less stressed or did she get pregnant because she had more normal eggs? No way to answer that.
It doesn’t really matter, since reducing stress is a good idea for a number of reasons. The first is that infertility is incredibly stressful. Women who are experiencing infertility report the same levels of anxiety and depression as do women with cancer, HIV+ status, or heart disease. It is a very challenging time; the infertile couple is surrounded by fertile family and friends who get pregnant easily and talk nonstop about their pregnancies and babies. They likely don’t feel comfortable telling their boss(es) and so have to make up constant excuses to explain frequent work absences to make it to doctor’s appointments. Their sex life suffers since they are basically told by their doctor when they should and should not be making love, and many begin to associate sex with failure. Finally, infertility treatment is not covered by many insurance companies, is only mandated in a handful of states, and treatment can cost thousands of dollars per cycle. It is no surprise that most individuals feel sad and irritable.
Reducing stress not only can make the whole process more bearable, but may help couples cope far better with the rigors of treatment. Women who are depressed before they start infertility treatment are far more likely to drop out of treatment after only one cycle, thus limiting their chances of getting pregnant. In addition, there have been numerous studies which have shown that women who learn specific stress-reduction skills become less anxious and depressed, but also have far higher pregnancy rates.
So, there are numerous reasons to encourage learning stress management skills. They include:
- Decreasing the unpleasantness of feeling sad and anxious
- Decreasing the odds of dropping out of treatment
- Increasing the chance of getting pregnant
Some of the best ways to relieve stress during infertility are to increase social support and learn specific ways to cope. Because infertility can be so isolating, which tends to happen since most people don’t tell anyone they are going through it, connecting with other women in the same situation is incredibly helpful. One of the best ways is through Resolve, the National Infertility Organization. Resolve offers support groups throughout the US as well as an incredible amount of online support via their web site. If there is no support group in your area, speak to your infertility doctor about having one of his nurses offer an informal one in the waiting room after hours. It might stun you how much better you can feel after simply hearing someone else voice the feelings you thought only you were experiencing.
Another important way to feel better is to learn specific skills, designed to decrease stress and increase a sense of control. There is a lot of research on mind/body groups, which combine social support as well as very specific skills acquisition training on stress reduction. Research shows that women who attend a mind/body group not only see their level of depression and anxiety return to normal, but also double their chance of pregnancy. Ask your infertility doctor if there is an infertility mind/body program in your area. If not, consider seeing a therapist who specializes in infertility counseling (you can find one by going to www.asrm.org and looking for a mental health professional via the MHPG) and ask her or him to teach you these skills.
Finally, here are a few more things to keep in mind.
- Most couples don’t handle the emotional aspects of infertility in the same way. Don’t try to convince your partner to feel the way you do. You are each coping in the best way for you. Respect their coping style.
- If someone has not gone through infertility, they may well have no idea what is a hurtful comment versus a helpful one. Telling someone that they are trying too hard, or suggesting they adopt, might be intended as supportive. Memorize several “snappy comeback lines” to better protect you when someone says something and you don’t tend to think well on your feet. So the next time someone tells you to just relax, you can respond that in fact, infertility is a disease which is no more likely to be cured by relaxation than any other disease.
- Infertility is not a permanent crisis. Most people who receive treatment do indeed conceive a healthy baby. And if not, there are lots of ways to create a family. Infertility will not have a permanent negative impact on your quality of life, believe it or not.
Alice D. Domar, Ph.D, is the executive director of the Domar Center for Mind/Body Health at Boston IVF. She is an associate clinical professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and the author of “Conquering Infertility”. She is also on the Board of Resolve, the National Infertility Association.