At Modern Fertility, we're committed to making sure you have the most current information about your reproductive health available at your fingertips. Because mental health is reproductive health, and October is Mental Health Awareness Month, we're bringing you an update on an important subject: stress and fertility.
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)—is inherently stressful, and it's natural to feel anxious and overwhelmed.
At the same time, studies show that stress and anxiety can cause challenges to one's fertility (more on that below), 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 that stress.
Stress + fertility = trouble
When you're feeling anxious, your nervous system releases stress hormones such as 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.
The science backing up the relationship between stress and fertility is fairly robust. Here’s a timeline of some of the most relevant research:
- A study titled "The psychological impact of infertility" published in 1993 compared the psychological impact of infertility with those folks living with cancer, heart problems, chronic pain, and HIV. It 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.
- A 2006 review of an ever-growing number of studies show that stress can dampen or shut down activity of the reproductive axis (the hypothalamus, pituitary gland, and gonads).
- A 2009 study indicated that women with high amounts of stressful life events that negatively impact her quality of life may have less favorable IVF outcomes.
- A 2010 study conducted by Oxford University and the National Institutes of Health indicates that the 25% of women with highest levels of alpha-amylase, a substance that's secreted into the saliva and has been linked to stress response, have more trouble conceiving than women with lower alpha-amylase.
- In October 2018, a new study from Boston University's School of Public Health found that women who experienced higher levels of stress had lower rates of conception, but men who experienced the same levels did not.
Let’s dive into some of the most recent research: In the October 2018 study, researchers used information from the Pregnancy Study Online (PRESTO), which tracks couples for 12 months, or until they become pregnant. Using the perceived stress scale (PSS), they looked at the stress levels in 4,769 women and 1,272 men who did not have a history of infertility and hadn't been trying to conceive for longer than six menstrual cycles. PSS's questionnaire evaluates the degree to which the patient perceives her life circumstances to be overwhelming and uncontrollable.. The scale’s stress questions range from 0 (never feels her life is unpredictable) to 40 (she very often feels this way), and it also collects information about income, diet, sleep, behavior, frequency of intercourse, and race/ethnicity.
The researchers found that women with a PSS score of at least 25 were 13% less likely to conceive than women who had a score under 10. Women who had been trying to conceive for three of more menstrual cycles (before they joined PRESTO) and women over 35 were also more likely to struggle with conception.
For men, there was no association between a high PSS score and conception, but in couples, when the woman had a PSS score of 20 or higher, and the man a score of under 10, they were about 25% less likely to conceive. In other words, the study suggests that when one person is more stressed than the other (also known as "stress discordance"), getting pregnant could be difficult, because it can indicate poor relationship quality.
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 going to contribute to an atmosphere that makes you want to get it on.
A reminder: many factors influence your ability to get pregnant, including your age and the health of your reproductive organs. And not every study points to a sturdy link between stress and fertility challenges. A December 2019 study of 111 women who kept journals reporting their stress levels found no differences in conception rates among those who described their stress as high, moderate and low. Ultimately, this new suggests that moderate levels of stress in relatively healthy women doesn't adversely impact getting pregnant.
How to take care of you
What can you do to manage the psychological side effects associated with infertility?
#1: Think about your mental health holistically
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.
"Simply relaxing does not cure infertility"
"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.
#2: Connect with your body through yoga or meditation
Yoga (I know, seems like we hear it's the answer for everything) has been found to reduce stress in both men and women (and reduced stress = better reproductive function),which in turn reduces the stress response and the release of cortisol. In other words, it may indirectly help 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.
#3: Consider professional help
"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 healthcare 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).
Don't let stigma get in your way: you deserve to feel your best.
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.