Learn about research on the complex mind-body relationship between stress and fertility, and get science-backed recommendations to reduce stress.
Managing issues like anxiety, stress, and depression can be challenging. These issues can become even more difficult to navigate when combined with the complexities of fertility. Research suggests that high levels of stress and anxiety can negatively impact fertility, adding to the challenges of conceiving.
However, the relationship works both ways: fertility problems can also affect one's mental health. Infertility may lead to high levels of anxiety and depression, comparable to the chronic stress experienced by individuals with illnesses such as cancer, heart disease, and HIV.
Unfortunately, due to a lack of awareness, infertility is often wrongly seen as a personal failing. This false perspective may add further stress. Despite its prevalence, people who are experiencing infertility may choose not to share their stories with family or friends, which can make them even more psychologically vulnerable.
In this article, we explore existing research on the complex mind/body relationship between stress and fertility, along with science-backed recommendations to reduce stress.
What are the different types of stress?
Stress is different for each person. What may be stressful for one person might not be stressful for someone else. Stress may occur suddenly (also referred to as acute stress) or it can be ongoing (chronic stress). Stress can be brought on both by traumatic situations, such as experiencing a natural disaster or abuse, and seemingly normal events, like feeling anxious about public speaking or exams.
Beyond events, stress can also be tied to identity and relationships. For example, the loss of a loved one or dealing with a diagnosis can lead individuals to adjust how they see themselves and their roles.
What happens when you get stressed?
When a person feels stressed, their body goes through specific changes. This happens because of a mechanism called the hypothalamic-pituitary-adrenal axis (HPA). The HPA axis involves three body parts: the hypothalamus, the pituitary gland, and the adrenal glands.
When the body activates the stress response process, it releases cortisol and corticotropin-releasing hormone (CRH). These stress hormones can cause various physical effects:
- The heart rate increases
- Breathing becomes shallow and difficult
- Blood pressure rises
- The person may feel tired and fatigued
- Sleep problems may occur
- Muscles may ache
- Headaches may develop
- Chest pains may be felt
- Dizziness may be experienced
- The mouth may become dry
- Sweating may occur
- Digestion problems, like indigestion, may arise
- Rashes may appear on the skin
- Panic attacks may happen
- Changes in the menstrual cycle and ovulation may occur
How does stress affect your behaviour?
Feeling stressed can impact your life physically, emotionally, and socially. If you are stressed, you might:
- Have difficulty concentrating
- Respond more slowly
- Constantly worry or have a feeling of dread
- Have a tight jaw or shoulders
- Grind your teeth
- Bite your nails
- Not exercise or exercise more than usual
- Withdraw from people
- Be easily irritated
- Experience sexual problems, such as losing interest in sex or being unable to enjoy sex
- Smoke or drink alcohol more than you usually would
How does stress impact infertility?
The connection between stress and fertility is still being researched. While it has not been established that stress causes infertility alone, many studies have associated it with an increased risk of infertility. Here are some of the ways this could happen.
When you're in a stressful situation, your body goes into fight-or-flight mode. This means that it starts a process that helps you survive. Your body stops doing things that aren't necessary for your survival and instead focuses on sending glucose to your brain, heart, and muscles.
When you feel stressed, your body's nervous system produces catecholamines. These substances also cause the release of an enzyme called alpha-amylase, which is a sign that you're experiencing stress. A study found that 25% of women with high alpha-amylase levels had trouble becoming pregnant. Another study revealed that high stress levels among women resulted in slightly lower odds of conception.
Several studies have looked at how stress can affect sperm in different situations. Research has shown that sperm can change during times of war, when people are experiencing high stress in their jobs, or when they are grieving. These stressful circumstances can have an impact on various aspects of sperm. For example, one study reported that stress during the exam period may negatively affect sperm concentration and the speed at which sperm move.
Another study explored the potential physical impact that psychological stress may have on fertility. This study focused on 500 men involved in their partners' IVF treatment. Among these men, 14 experienced a decrease in sperm quality, going from normal to problematic levels during the IVF process. Additionally, 21 men had significant changes in their semen characteristics, deteriorating from normal to severely problematic throughout the IVF treatment. Although an association was found, these results do not prove that stress directly impacts fertility.
How does infertility cause stress?
Dealing with infertility can be a tough and emotional journey for both partners. People commonly experience various feelings and reactions, such as surprise, sadness, depression, anger, frustration, and a loss of self-esteem and confidence.
Additionally, undergoing fertility treatments can bring about stress for both men and women. A study on men and women seeking infertility treatment discovered that 76% of women and 61% of men displayed anxiety symptoms. Additionally, 57% of women and 32% of men showed signs of depression. This is supported by another study which found that mood disorders such as depression and anxiety were highly prevalent among women seeking assisted reproduction treatments. A study in Sweden found that the majority of these psychiatric disorders were left untreated.
Can managing stress improve your fertility?
Although it's not yet clear whether psychological interventions and mindfulness practices can improve the chances of conception, there is various research that positively supports the idea:
- A 2002 study showed that pregnancy rates improved with psychiatric interventions.
- A 2015 meta-analysis found that couples experiencing infertility had better chances of getting pregnant when participating in specific psychological treatments such as cognitive behavioural therapy or mindfulness.
How can I manage stress?
Since the path to parenthood looks different to everyone, the way you experience stress may also differ. Your stressors might range from the disappointment of not being able to have a child, to the financial costs of treatments, to dealing with failed cycles, to the pressure of balancing fertility treatments with work, to the grief of pregnancy loss.
Managing stress is an essential part of life that may look different for each individual. To manage infertility-related stress, consider the following:
- Practising relaxation techniques: Exercise, yoga, meditation, massage, and time in nature can help you control your emotional states and de-stress.
- Prioritizing mental health: Taking care of your mental health is crucial, especially when dealing with infertility, which often leads to feelings of depression and anxiety. Cognitive behavioral therapy, group therapy, or practising mindfulness can help address these challenges.
- Aiming for work-life balance: Try to find a better balance between work and personal life by making time for your loved ones, and strengthening your relationship if you're in one.
- Telling your spouse/partner how you want to be helped. Everyone has a different way of coping with stress, so seek out what works for you.
- Staying connected with your support system. Talking to your partner, family, and friends can benefit your well-being.
- Giving yourself permission to cry and be angry. Don't try to shut off your feelings.
- Giving your partner permission to feel and cope differently than you.
- Connecting with others. Seek out support groups that can help you connect with others who understand.
- Getting more information. One of the worst aspects of stress is uncertainty about the future. You can't get a crystal ball, but you can reduce some of your uncertainty by seeking information.
What else should I know about the science behind stress?
The relationship between stress and fertility is challenging to research in the field of reproductive medicine. In particular, many existing studies have small sample sizes. This makes it challenging to come up with concrete conclusions about the subject.
These smaller studies also make it difficult to rule out other factors that could impact fertility, such as age, the health of reproductive organs, and the use of various assisted reproductive technologies. For example, most of the research is focused on in vitro fertilisation (IVF treatment), which gives us limited insights into the effects of stress on other fertility treatments.
The research also has some limitations regarding diversity, which means we don't fully understand how stress affects different groups of people. There is also no consistent way to measure stress and its effects on reproductive health, making the findings more complicated.
Although stress may impact fertility, it is normal to feel stressed, especially during struggles with conception. Any changes in the body due to stress are a natural protective mechanism.
It is a good idea to monitor your stress levels. Exercise, mindfulness practices, therapy and support from loved ones can all play a role in helping you feel more in control. Additionally, improving your work-life balance and strengthening relationships can positively impact your well-being and quality of life. For couples, seeking support and incorporating psychological interventions has been associated with reduced stress levels and improved pregnancy outcomes.
If you find these stress reduction techniques helpful, try them out. However, don't force yourself if these activities make you more stressed. Instead, consult your fertility healthcare team if you have irregular cycles and high-stress levels. Lastly, remember that feeling anxious while trying to start a family is normal, and you are not alone in feeling this way.
If you are facing difficulty conceiving or want to learn more about stress management techniques for infertility, contact Cada’s compassionate team of fertility specialists.