Does Stress Actually Affect Fertility?
Mental health issues, including stress, depression, and anxiety, can profoundly affect your reproductive health and fertility. Although the relationship between stress and fertility has been difficult to decipher, several studies have provided valuable insight into the matter.
There is ample scientific evidence suggesting that stress and anxiety can hurt your ability to conceive. Things can get more complicated if you are having any fertility issues. Dealing with fertility issues can be stressful for many women and can affect their mental health as well.
This post will try to go over some of the scientific studies conducted to learn more about this tumultuous relationship between mental health and fertility. Before we go ahead, here are some points that you should keep in mind going forward-
- One of the immediate effects of anxiety and stress is an elevation of stress hormones such as cortisol in your blood. These hormones can precipitate significant physiological changes that can impact your fertility. Conversely, if you have stress resulting from any fertility issues, the release of these stress hormones can further negatively impact your fertility.
- There is credible evidence that the longer you have to wait to get pregnant, the more stress buildup.
- Although the studies looking into the impact of stress on fertility can be very complicated at times, there seems to be a consensus- stress can affect your menstrual cycle and hormone levels.
- The role of stress in affecting pregnancy rates, the success of IVF, and other fertility treatments have also been studied in great detail. However, the results have been mixed at best. While some studies have found that distress can cause a decrease in pregnancy rates after IVF treatment, some other studies have not found such a robust relationship after all.
- It is difficult to say with certainty at this point whether mental health intervention can positively impact your chances of getting pregnant. That said, there is merit in addressing your mental health issues whether they affect your chances of conception or not.
In the following sections of this post, we will take a closer look at some of the most crucial findings in recent studies relating to stress and fertility. Our goal is to help you manage your stress as you try to get pregnant.
First: A primer on stress and its physiological effects
Psychological distress can have a deep impact on your body’s physiology. When you are under stress, your body enters in what is called a ‘fight or flight response mode. It is accomplished by activating three endocrine glands- the hypothalamus, the pituitary, and the adrenal gland. These three glands release stress-induced hormones such as cortisol corticotropin-releasing hormone (CRH) in the blood in response to psychological stress. Once these hormones are released, they precipitate typical stress-induced reactions, including increased heart rate, the elevation of blood pressure, shallow breathing, and headaches. These physiological responses can act as biomarkers to detect whether you have any stress at all.
If your body switches to the ‘fight or flight mode, any system that is not essential for survival is shut down or downregulated. Several studies have shown that an excessive amount of stress for a long time can shut down what is called the hypothalamic-pituitary-gonadal axis- a system of endocrine glands that controls the reproductive system. What it means in simple words is that worry or anxiety can disrupt the connection between your brain and your ovaries. If such a thing happens, you might experience fertility issues such as irregular periods and anovulatory cycles. You might have observed this yourself; if you are stressed or depressed, your periods tend to come later than usual.
All this is happening as your body prioritizes the systems that can get you through a stressful situation. The goal in times like these is survival and not procreation. Consequently, getting pregnant is not on the list of things to do at this stage for the body.
Fertility distress is no different.
Infertility other fertility issues are known to precipitate stress. The stress that many women are going through this phase of life, trying to conceive, is no different than the stress that we just talked about. The worry or anxiety associated with infertility or any other fertility issues can be similar to those experienced by patients suffering from life-threatening diseases such as cancer.
Hence, it can be concluded that the fertility-related stress that most women experience is similar to other kinds of chronic stress. To make matters worse, women who find it difficult to get pregnant have increased anxiety. Here are some studies indicating how stress can impact fertility-
- According to a study that tracked 352 women undergoing some of the other fertility treatments, about 50% of the women reported being depressed, and over 75% reported being anxious.
- Another study conducted on 112 women found out that as many as 40% of them were facing other mental health issues, including depression and anxiety, throughout their treatment.
- There is also evidence that stress level increases in women who have been trying to conceive for a long time.
Many scientific studies have looked into the effect of being depressed or anxious while trying to conceive and how they relate to fertility itself. Although different teams of scientists have reported some conflicting results, it is becoming apparent that there is a relationship between stress and fertility.
How can stress impact your fertility?
Before we go into any further details of the available data on the impact of stress on fertility, let’s familiarize ourselves with the methods by which the effects of physiological stress are examined and how researchers reach a conclusion.
The most common way of evaluating stress in most studies has been through self-reported questionnaires, psych assessment by professionals, stress scales, or biomarkers. Some of the scales commonly used in these studies include the Perceived Stress Scale and the COMPI Fertility Problems Stress Scale.
Some of the biomarkers of stress commonly used include the level of hormones such as cortisol, CRH, and an enzyme called alpha-amylase present in the saliva.
As stated before, the relationship between stress and fertility can be very complicated; consequently, there are some limitations in the way scientists conduct this research. Some of the common issues include-
- One of the biggest problems with studies looking into the effect of stress on fertility is the lack of large-scale studies with proper sample sizes and control groups. Many studies have a relatively small number of patients, which makes these studies less reliable compared to studies conducted with thousands of participants.
- Smaller studies also make it hard to eliminate other factors such as the participants’ age and or reproductive health.
- Another issue with these studies is the lack of ethnic diversity. Most stress studies are conducted on white women.
- Another important thing that makes these studies less reliable and useful is that most of the studies come from women undergoing IVF. It means that the effect of distress on the egg’s movement, fertilization, or implantation can’t be studied.
More research is needed to ensure that a robust set of data is available to draw any useful conclusions.
With that being said, let’s move on to the available data out there and what it means.
Stress and menstrual cycle
Physiological stress can disrupt your menstrual cycle. Some of the studies have looked into the impact of stress on various aspects of the menstrual cycle.
- A study conducted in 2015 on women of reproductive age concluded that women having higher stress had a lower level of estrogen, LH, and progesterone. However, they had a higher level of FSH during the luteal phase of the cycle. It indicates that women under more stress have a higher chance of having an anovulatory cycle than women who had lower stress levels.
- As we saw earlier, an elevated level of distress causes an increase in cortisol levels in the blood, which can disrupt the maturation of ovarian follicles. The increasing cortisol levels can also disrupt the inflammatory process required to release the egg during ovulation. A study conducted in mice had established a connection between cortisol and ovulation. However, the number of such studies on humans is very limited, and we need more data to arrive at any logical conclusion.
Delayed ovulation or having anovulatory cycles is not the same as having chronic fertility issues. That said, if your cycles are irregular and if you have frequent anovulatory cycles, it can get difficult to conceive.
Distress also has an impact on the ability of the embryo to implant itself in the uterine lining. An abnormally high corticotropin-releasing hormone (CRH) can interfere with the uterine lining and consequently cause problems in implantation.
Stress, conception rates, and time to pregnancy
The data on the relationship between stress and conception rates or time to pregnancy is not very robust. While some studies did find a correlation, others did not.
- An Oxford study conducted in 2010 found out that 25% of women who had a high level of stress had more difficulties conceiving than women with a lower level of stress.
- A 2018 study out of Boston University concluded that women who have more stress had lower chances of getting pregnant.
- However, the results were not convincing in another study conducted on 111 women who kept a journal record of their stress levels. The study’s findings revealed no statistical correlation between the level of stress and the rate of conception.
Stress and IVF outcomes
The data regarding the effect of stress and IVF is inconclusive at best. While some researchers have found a link between increased stress and a decreased success rate of an IVF procedure, others did not.
- A 2018 study observed the stress level of 45 females undergoing IVF therapy. The study concluded that women who had higher stress levels (as indicated by an elevation of a protein called cytokine in the blood) had a lower success rate in the procedure.
- Another study conducted in 400 women undergoing IVF therapy in 2014 concluded that women with higher stress (as evidenced by an elevated level of salivary amylase enzyme) had a 29% lower success rate after one IVF cycle than women with lower stress levels.
- Another study conducted in 2019 concluded that the elevation of cortisol in women having a high level of stress was not associated with lower success rates of IVF cycles.
Other ways stress can impact your fertility
- It is a proven fact that having a high level of stress can decrease your sex drive considerably.
- Pressure and mental health can also mess up your immune system. A 2002 randomized clinical trial concluded that an increased level of stress is responsible for increased activity of Natural killer cells (NK cells) which can cause infertility.
- Another way stress can harm your chances of getting pregnant is by producing neurochemicals called catecholamines such as epinephrine and dopamine. Both these chemicals can decrease the blood flow to your reproductive organs, making it difficult for them to function optimally.
We still don’t understand how mental health impacts fertility
As we saw through this article, there are several technical limitations when it comes to many of the studies looking into the effect of stress on fertility. Furthermore, many conflicting findings make it difficult to arrive at any concrete conclusion.
That said, stress is never a good thing for your overall health. There might not be enough evidence to link it with infertility, and it is always a good idea to keep it under control. Talk to your healthcare provider if you have any distressing-related issues such as depression or anxiety, especially if you experience frequent irregular cycles.
If you feel anxious or depressed while you try to get pregnant, you are not alone. Talking about your worries with your partner and family members or friends can be a great thing. Always remember that you can reach out to professionals if the pressure becomes too much to handle.