If you, like me, live with anxiety, you know that it can be frustrating when even the most well intentioned of people tells you to "relax." For me, at least, this just adds to my anxiety, instead of de-escalating it. Navigating your fertility - whether that means trying to get pregnant for the first time, coping with fertility problems like secondary infertility, negotiating IVF treatment (and other assisted reproductive technologies) etc, is inherently stressful, and it's natural to feel anxious and overwhelmed. At the same time, stress and anxiety can cause challenges to one's fertility, and that can amplify what you're already experiencing as a result of the situation. Anxiety, stress, depression and other mental health challenges are notoriously bad at taking direction (going away) especially when you really need them to. So when we talk about stress-inducing situations like trying to get pregnant, it's important to understand the impact they have, and how to mitigate it.
When you're feeling anxious, your nervous system releases stress hormones, specifically cortisol, and those hormones manifest in things like increased heart rate, shallow breathing, and high blood pressure. People experience stress in other ways, too, such as sadness, irritability, insomnia (and the total opposite, stress napping), and headaches. Because of the fight or flight response that gets triggered when an extremely stressful situation arises, any system that isn't necessary for survival shuts down, including your reproductive system. (This is why your period can be late when you're experiencing high levels of stress for an extended period of time.)
Stress + Fertility = Trouble
The science backing up the relationship between stress and fertility is robust: A study published in 1993, comparing the psychological impact of infertility with those folks living with cancer, heart problems, chronic pain, and HIV, revealed that the symptoms of those coping with infertility were actual similar to those facing serious illness. In other words, the emotional component of having trouble getting pregnant is taxing on your body. Another study, published in 2014, suggests that when stress hormones are activated, they inhibit the release of both estrogen and testosterone, meaning that both male and female fertility suffer when anxiety is present. A 2010 study conducted by Oxford University and the National Institutes of Health indicates that the 25% of women with high levels of alpha-amylase, a substance that's secreted into the saliva and has been linked to stress response, have more trouble conceiving than those who don't. And, all this scientific evidence aside, let's be honest - if you're trying to get pregnant via intercourse (as opposed to IVF treatment), stress about whether or not it's going to work this time isn't exactly going to contribute to an atmosphere that makes you want to get it on.
How to take care of you
So now that you have the evidence, what can you do to manage the psychological side effects associated with fertility? Dr. Chris Meletis of Fairhaven Health recommends making lifestyle choices to help your stress levels return to normal, like regular exercise (but not over exercise) , a healthy diet, and talk therapy. "As stress hormone levels fall," he says, "the body returns to hormonal balance and reproductive health may be restored." Meletis cites the work of Harvard's Alice Domar, whose work has explored the relationship between the mind and one's fertility. In a blog post, Domar writes, "simply relaxing does not cure infertility"- it's a much more intricate matter, especially when you're enduring a process like in vitro fertilization. Domar's Mind/Body Program for Fertility includes training on good nutrition, exercise, and sleep, as well as cognitive behavioral therapy exercises, which help couples support one another. (The cost of the program is $495, not including the intake session with a psychologist to assess your stress levels. That session can be billed as a mental health expense, depending on your insurance.)
Yoga (I know, seems like we hear it's the answer for everything) has been found to improve reproductive functions in both men and women, and can reduce the stress response and the release of cortisol. In other words, it can restore the balance of your hormones when they get knocked off kilter by stress and anxiety. Teresa Biggs, an Acupuncture Physician and Doctor of Oriental Medicine, recommends three yoga poses to her patients coping with stress in regard to their fertility - child's pose, happy baby, and legs up the wall, along with meditation and visualization. "Many women I see have begun to distrust their bodies," Biggs says, "so I encourage them to do what they can to connect with the idea of conceiving and creating. Get details, picture your endometrial lining as being pink and healthy and ready to nourish, bringing in feelings of care and love." Biggs also suggests doing these visualizations with your partner, as a means of achieving and maintaining the emotional connection that can get lost when you're stressed and anxious.
"When your stress/anxiety is excessive (disproportionate to the situation), when it is preventing you from doing things you'd otherwise like to do, like avoiding a situation because of fear, impacting your relationships, affecting your physical wellbeing (think insomnia, heart palpitations, shortness of breath) and perhaps most importantly, when it is distressing to the individual, it's time to get help from a professional," says Julia Weigel Altman, a Psychiatric/Mental Health Nurse Practitioner in San Francisco. She also urges folks to evaluate their mental health before pregnancy. "Be honest with yourself about your stress levels and take steps to reduce stress. This may mean adding exercise or meditation to your regular routine; it may also mean seeing a mental health professional for an evaluation and possible treatment. Talk to your health care provider and get a referral if needed to seek mental health treatment which may include therapy, medication, support groups or all of the above."
The stigma of mental health and illness: How it impacts you
While more people are opening up about their experiences with depression, anxiety, and other mental health challenges, the stigma surrounding these conditions still has teeth. We might feel like we should be able to fix our mental health ourselves, that talking about it will be burdensome to others, or that we're being dramatic when we bring it up in public (or in private). These feelings, combined with the tenderness that comes with people asking us "how it's going" if they know we're trying to get pregnant, or speculating as to why we're not pregnant "yet," can drive us inside of ourselves, cause our self esteem to plummet, and result in cutting ourselves off from support systems, or not seeking them out at all. Don't let stigma get in your way - you deserve to feel your best.
If you know you want kids in the future (but not yet), now is the time to learn more about your reproductive health with Modern Fertility. Being proactive feels good!