The study of infertility and stress is controversial as well as important. Whenever a new study on infertility and stress comes out, you’ll start seeing headlines that say stress is the reason you can’t get pregnant, even when the study doesn’t really point out that stress causes infertility.
A lot of couples faced with fertility issues are worried about stress. Infertility itself causes emotional turmoil and distress. Could the stress of fertility issues worsen your situation?
Fertility specialists are also curious about the connection between stress and fertility. Could stress be the missing factor when a couple has unexplained infertility or when treatment fails due to unknown reasons?
The answers are very complicated. We don’t yet completely understand what effects stress has on fertility. Merely “relaxing” isn’t going to resolve anyone’s fertility problems, but that doesn’t imply that stress is harmless. Learn what studies have to say and what you should be aware of about this controversial topic.
Types of Stress
Before we take a look at research, it’s beneficial to understand why it’s tricky to study stress.
To be able to study something, we first need to agree on what it is we are studying. There are myriad forms of stress, and there are a lot of questions that emanate from how each type could affect fertility.
- Childhood stress: you may have come across an ACE score (adverse childhood effect score). This refers to stress that occurred during your prime growing years and isn’t necessarily occurring now. High ACE score has been linked to several long-term health issues. Could this link to fertility?
- Short-term everyday stress: if your vehicle breaks down, and it so happens to be your ovulation week, will this have an effect on your chances that month?
- Long-term stress or a cycle of stressful events: you just discovered that you can’t pay your credit card bill, your mom is in the hospital, you’re running very late for an important meeting at the office, and your car just broke down. You may be experiencing long-term stress if your life looks like this every month. Tests, diagnosis, treatments, unsuccessful cycles, and high medical bills are all fractions of infertility that often result in long-term stress.
- “Good” stress from your lifestyle: what if you flourish under stress? Your job is demanding, you work long hours and sometimes run shifts for others, and frequently encounter conflict in your day. Your day may include intense psychological and physical demands. You’re still living a stressful life even if you love your lifestyle.
- Significant life events: moving to another city or country, job loss, divorce, and losing a loved one can all result in a great deal of stress.
- Living under stressful conditions: those living in poverty, without regular employment, or without access to primary health care and healthy foods live in stressful situations all day every day.
When researches enquire if stress causes infertility or if stress amplifies the time it takes to get pregnant, it’s essential that we know what form of stress is actually being examined.
This aspect of research is complicated. Once it is decided what kind of stress is being discussed, one must decipher how to measure it.
There are two principal ways examiners attempt to calculate stress levels: by using psychological stress measuring tools or by measuring stress-related chemicals in blood or saliva. There are benefits and detriments to both.
When evaluating biochemical stress signals in blood or saliva, we can’t precisely pinpoint if it’s caused by a disease process or by a stressful life.
For instance, let’s assume someone is diagnosed with endometriosis. Let’s assume that her biochemical test results for stress are high. Can we say the stress chemicals are high because she lives under stressful conditions and this lifestyle resulted in endometriosis?
Or does her endometriosis triggered biological stress on her body, and this results in higher levels of stress hormones?
Conversely, it could be that endometriosis symptoms triggered emotional distress, and that amounts to her higher stress hormone levels? As you can see, providing answers to these questions is difficult.
The issue with psychological measurement tests is that people bodies respond differently to stress.
Two persons can score high on a psychological stress measurement test but have totally different biological reactions. Another issue is that people have different perceptions of stress. This will alter how they answer questions on a stress questionnaire.
With psychological measurement, the coordinator of the study must also rely on the supposition that the respondent’s answers are sincere. Majority of these tests are developed to reduce the chances of insincere responses, but the tests aren’t perfect.
When does stress matter?
The timing of a research is as crucial as determining the kind of stress. For example, a study could examine stress levels before the beginning of a cycle, midway into the cycle, or just before ovulation.
It could look at stress during the two-week wait (the time between ovulation and period), or record the average stress levels within a period of weeks, months, or even years.
All of these factors contribute to the outcome of tests. It’s enormously challenging to capture this in one or even a series of studies.
Another reason why studying the effect of stress on the body is complicated is that it’s hard to differentiate between a stress problem and a poor-coping-mechanism problem. People experiencing stress usually turn to unhealthy habits to cope.
They may sleep too much or too little, may eat more junk food, may exercise too much (or not exercise at all). Some may turn to alcohol, smoking, or drugs.
We are aware that poor nutrition, smoking, and excess alcohol consumption all harm fertility. If someone is coping poorly, has high-stress levels, and his or her fertility depletes, can we say that the problem is caused by stress or is it the poor coping choices?
The biological connection
There is a biological reason as to why emotional stress may cause fertility issues. It all boils down to the hypothalamic-pituitary-adrenal axis (HPA axis)
Whenever your body senses stress, the hypothalamus gland in your brain sends impulses to the pituitary gland – the signal indicates that you’re experiencing stress and need assistance. The pituitary responds to this call for help by sending its own signal to the adrenal glands, informing them to release the stress hormone cortisol.
Cortisol is good—in healthy amounts. Among numerous things, this hormone helps adjust your blood sugar so that you have enough energy through the emergency. The issue is that when your body is flooded with cortisol for an extended period of time or all the time, this is when it can harm your health.
The pituitary and hypothalamus don’t only regulate stress hormones; they are also in charge of controlling reproductive hormone signals. The hypothalamus secretes gonadotropin-releasing hormone, or GnRH.
GnRH sends signals to the pituitary gland to release luteinizing hormone (LH) and follicle stimulating hormone (FSH). LH and FSH stimulate sperm growth in men and egg growth in women.
So in theory, if the HPA axis is busy dealing with stress, this could change or throw off how it regulates reproductive hormones. We also have to consider how stress hormones like cortisol may affect sperm cells, embryos and oocytes.
Studies finding a relationship
Some studies have been able to find a possible link between stress and fertility. A survey carried out in the United Kingdom included 250 women who were trying to get pregnant naturally over a period of six months.
On day six of every month, the participants provided saliva samples to test the cortisol and alpha-amylase, two stress-associated hormones.
During the six-cycle period, they also used ovulation monitors to give every participant of the study the best chances of conceiving and observe the timing of their sex for the most fertile days.
The research found that women lower concentrations of alpha-amylase conceived faster than women with higher levels of stress hormone. However, it’s crucial to note that this study also found women lower levels of cortisol (another stress hormone) took longer to get pregnant when compared to those with higher levels. In other words, the relationship is unclear.
Another study carried out in research centres in Texas and Michigan also wanted to examine whether the hormones cortisol and alpha-amylase in saliva might be connected to the time it took to conceive. The study included 400 participants (women) trying to conceive.
The study discovered that the women with the highest alpha-amylase levels had a 29% decline in their overall fertility, taking longer to get pregnant than those with the lowest alpha-amylase levels. This study found no connection between cortisol levels and the time of conception.
Stress related to socioeconomic situations may also negatively affect fertility. One study found that women who experience socioeconomic stressors had poorer ovarian reserves.
Another separate study discovered that women with higher ACE score (they suffered more trauma in childhood) were more likely to experience absent or irregular menstrual periods as well as infertility in adulthood.
Stress may also affect male fertility. A meta-analysis of 57 different pieces of research, which saw the participation of about 30,000 men, discovered that stress could slow sperm movement, lower sperm concentration, and the percentage of normal-shaped sperm.
However, the study didn’t examine whether this impacted time to conception for their female partners.
Another research found that a man’s semen analysis results may fall below the standard World Health Organization (WHO) set guidelines when they experience two stressful life events.
Other studies had found that when men who experienced psychological stress had lower testosterone levels. It’s difficult to know what comes next though – do stressful event cause a drop in testosterone levels? Or does increased sensitivity to stressful events result in decreased testosterone?
Studies with no relationship
Not all studies found a link between decreased fertility and stress. Research carried out in the United Kingdom had about 340 women fill out daily diaries over a period of six cycles or until they conceived. For each cycle, the participants had biomarkers of stress measured.
They also filled out questionnaires designed to evaluate their stress levels. This study controlled for the age of the woman, how much caffeine she consumed, whether she smoked and how frequently she had sex with her partner.
This research didn’t find a relationship between anxiety, depression levels, or self-reported stress levels with the time to conception.
In another study, that included just over 200 women, investigated whether IVF success rates (in vitro fertilisation) may be negatively impacted by stress. Their stress levels were examined via questionnaires and interviews that were administered before IVF began and four, 10, and then afterwards.
Women who were anxious or depressed before they started IVF treatment were more likely to experience failure in the IVF procedure than women with less depression or anxiety score.
However, it’s no surprise that the study failed to find a connection between significant psychological distress and IVF failure.
Self-care for stress
We still need to care about stress whether or not it decreases fertility. For one, it doesn’t feel good to be anxious or stressed. Whatever we can do to cope or feel better is going to be worthwhile.
Secondly, even if your odds for IVF success can’t be directly impacted by stress, it does have a relationship with your likelihood of continuing treatment. A lot of couples prematurely drop out of IVF treatment. The most paramount reason for dropping out: emotional distress.
Most physicians agree that you should IVF at least six cycles for the greatest odds for conception success. One study discovered that in countries where IVF is covered by health insurance, the rate of dropout after just one cycle was 40 percent. However, after four cycles, the rate of drop was 62 percent.
The top two reasons couples came up with when asked why they dropped out were the perception of poor prognosis and emotional stress. Theoretically, if couples had felt psychologically healthy enough to try for one or even two or more IVF cycles, their odds for live birth would have increased.
We all agree that infertility causes stress. However, whether stress causes infertility or not is debatable. Studies have proven that stress affects reproductive hormones and may elongate the time it takes to conceive, but so far, no one has been able to prove that stress alone can cause infertility.
Whether you’re in the middle of fertility treatments or you’re just trying to get pregnant, know that “trying too hard” isn’t going to cause infertility problems, and your stress around conception won’t stop you from conceiving.
Nevertheless, stress doesn’t feel good. Seek support from family members and those who understand and take good care of yourself.