Why you should stop stressing about the stress of infertility

If you’re struggling with infertility, no doubt someone has said to you, “just relax and you’ll get pregnant”. Or they told you a story about how their friend was struggling to conceive but then went on a beach vacation and “presto, they were pregnant”. In fact, you’ve probably heard something like this so many times that you feel like punching the next person who says it!

Almost every woman I’ve spoken with undergoing fertility treatments has expressed frustration because she “knows” that stress is hurting her chance of pregnancy but the whole treatment process is so damn stressful!

So, what is the relationship between stress, fertility, and IVF? In this post, I’ll break this down and offer my perspective.

Does stress affect fertility?

Our body’s response to stress evolved long ago to protect us in situations of acute danger — think of an early human ancestor being stalked by a tiger while foraging for dinner. The knowledge of danger activates a tiny area in the brain called the hypothalamus. This triggers the pituitary gland, the “master gland” of the endocrine system, to kick off a cascade of signals that results in the production of cortisol by the adrenal glands. Cortisol, and other hormones created in this process, cause the “fight or flight” or stress response — an elevation in heart and breathing rates, an increase in blood sugar and blood pressure, and a decrease in digestion. This prepares the body to run like hell, which is great if you have a tiger stalking you. And, once you’ve made it to safety, the high levels of cortisol in your body cause the hypothalamus and pituitary to decrease their signaling so your body can return to its normal state. So, the stress response is very helpful in cases of acute stress.

However, in today’s world, we are more likely to be confronted by chronic stressors — toxic work environments, financial concerns, caring for a sick loved one. Chronic stress can result in prolonged elevations of cortisol. Since the hypothalamus and pituitary gland also regulate our reproductive function (see figure 1), chronic stress suppresses their normal functioning and can cause problems with both ovulation and the development of the uterine lining (1). So, yes, chronic stress can negatively impact fertility. And, as a result, people who are struggling to conceive and then remove a source of stress or invest in mind-body practices such as acupuncture, yoga, or meditation, sometimes do get pregnant.

But, does stress affect your chance of getting pregnant with IVF?

There is actually reason to think that that the answer is no. Many of the medications prescribed in an IVF cycle work by hijacking the reproductive functioning of the hypothalamus, pituitary, and/or ovaries. This, in theory, overrides any natural effects of stress or cortisol on the reproductive system (2). (Figure 2 shows where some common IVF medication work in the body to take over reproductive function.)

Unfortunately, studies over the two past decades investigating the relationship between patient’s stress, anxiety, and depression during IVF treatments and subsequent pregnancy rates don’t fully support this theory. Two recent meta-analyses — studies that combine data from previous studies on the same topic in order to find trends or patterns in the research — came to different conclusions. One found that depression and anxiety during treatment was significantly associated with lower pregnancy rates and the other found no association (1,3).

So, the best answer is, we really don’t know. However, it is likely, that any effect of stress on the chance of pregnancy with IVF is small or indirect.

Ahhh! Seriously? So then why should I stop worrying about this?

Because, it doesn’t serve you. I know that this sounds flippant but I truly mean it. Due to technical limitations in this area of research, we may never conclusively know if and how stress affects the chance of pregnancy with IVF. Worry about it won’t chance this.

But, this is not to say that finding ways to manage your stress and investing in self-care during infertility is not important. In fact, it is vitally important, just for a difference reason.

Research has clearly shown that infertility patients experience levels of stress, anxiety, and depression similar to those seen in cancer patients(4). So, for many, infertility itself is a source of chronic stress. And, our lives don’t stop for it. Often we start struggling with infertility at the same time that we are working to build key foundations for our career, our couplehood, and in our community. Symptoms of chronic stress like headaches, fatigue, digestive problems, irritability, nervousness, feeling out of control, and difficulty concentrating can affect how we show up in every aspect of our lives. Too often I hear people express anger that, not only are the treatments not working, but they are not proud of how things are going in the rest of their life either.

Investing in stress management and self-care can help mitigate this. I’m not saying you need to become a yogi or attend silent meditation retreats. If the idea of lying still while someone sticks needles in you makes you cringe, then don’t do acupuncture! If taking a vacation or some time off from your job doesn’t feel right or isn’t an option, then don’t do it! But do invest in things that help you feel less stressed, more positive, and proud. It could be walks in the woods, taking up a new hobby, volunteering for a cause you are passionate about, date nights with your partner, attending an infertility support group, whatever works for you. And, if infertility is starting to negatively impact other areas of your life, consider getting help from a professional such as a coach or therapist.

You will find your way to being a parent. But it can be a long journey. Investing in stress management and self-care can help you remain proud of how you show up throughout it and continue to build strong foundations for the future. It’s an investment in yourself today and the family you build in the future.

Please note: this article provides a synthesis of information and perspective and should not be taken as medical advice. Please discuss all concerns and treatment decisions with your physician.

References:

1. Nicoloro-SantaBarbara J, et al (2018) Just relax and you’ll get pregnant? Meta-analysis examining women’s emotional distress and the outcome of assisted reproductive technology. Social Science & Medicine (213), 54–62.
2. Park A (2011) Stress doesn’t hurt changes of success with IVF. TIME.com.
3. Purewal S, et al (2018) Depression and state anxiety scores during assisted reporductive treatment are associated with outcome: a meta-analysis. Reprod Biomed Online 36, 646–657.
4. Domar AD, et al (1993) The psychological impact of infertility: a comparison with patients with other medical conditions. Journal of Psychosomatic Obstetrics and Gynecology 14 Suppl, 45–52.