The role that stress plays in reproductive health and fertility is controversial, and scientists continue to look for answers. The results so far are much more complicated than, “Just relax and you’ll get pregnant.”
Gina McGillick was into her eleventh year of trying to get pregnant and “completely stressed out.” Every morning before getting out of bed, she popped a thermometer in her mouth to chart her basal body temperature. She monitored her cervical mucus religiously, and performed the usual acrobatics after intercourse, thrusting her hips high into the air until she felt as if her feet were hanging from the ceiling, hoping to get a boost from gravity.
Then there was the arsenal of drugs and procedures. She and husband Michael “did Clomid, timed intercourse, Clomid with intrauterine insemination, Lupron shots with an HCG trigger shot, then more intrauterine insemination. None of them was effective,” says McGillick, 35, a life insurance examiner in Nashua, New Hampshire, who drives all over the state for work. Worse, she worried that the chronic stress she was under would make it harder for her to conceive.
Then, in December 2006, McGillick transferred to a new fertility practice, Boston IVF, where she learned about a 10-week mind-body program at the adjoining Domar Center for Complementary Healthcare. When she read that half of the participants became pregnant within one year of completing the course, she signed up—and diligently practiced the yoga, meditation, and relaxation exercises she learned in class.
Before and after her first IVF (in vitro fertilization) cycle in January 2007, she underwent acupuncture and felt surprisingly relaxed, both during the procedure and up until her blood test two weeks later. The results seemed too good to be true. One of the two implanted embryos took, and after more than a decade of trying, Gina was pregnant.
“When I look back, the only thing that seems different is that when we did IVF I was very relaxed,” she says. “If I was still under all the stress I used to be, do I think the procedure would have been effective? Probably not.”
Patients as well as doctors know that infertility causes stress, but there’s a paucity of hard data on the effects of stress on natural conception and fertility treatments, such as IVF. “We don’t know what comes first, the chicken or the egg,” admits Courtney Lynch, Ph.D., of the epidemiological branch at the National Institute of Child Health & Human Development. Does stress cause fertility problems or is it the other way around?
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Research suggests that there's a complicated link between psychological distress and pregnancy rates. Studies have found that women who experience certain types of stresses in their personal lives or related to their fertility are less likely to get pregnant or carry a pregnancy to term. They also take longer to conceive compared with their less distressed counterparts. “We can’t explain why this relationship exists,” says Jacky Boivin, Ph.D., a senior lecturer at the School of Psychology at Cardiff University in Wales, who has been studying the topic for more than a decade. “We know, on a purely biological basis, that the different systems that regulate our moods and behavior interact with the systems that regulate reproductive functioning. From animal work we can say conclusively that stress applied during various parts of the menstrual cycle suppresses or inhibits conception.”
But the data on humans is less clear, although research is beginning to answer some basic questions. For instance, “what kind of stress is bad?” says Dr. Boivin. “Is it stress at work, or stress in one’s personal life or marriage?” Is it chronic or acute stress? “Maybe it’s not stress per se that’s the culprit but the kinds of behaviors that often go with it, such as smoking or poor dietary habits.”
Furthermore, no one knows “to what extent stress compromises your fertility over the long term,” she says. “Just because we can generalize a relationship doesn’t mean an individual woman’s stress is going to cause her fertility to be arrested. We know that millions of women all over the world give birth in harsh conditions of war, poverty, and famine,” suggesting that many us have buffers to modulate the reproductive effects of stress.
Stress-Related Problems When Trying To Get Pregnant
The link between stress and conception is biologically plausible, since both processes begin, and interact with one another, in the brain. One example: The hypothalamus, located in the base of the brain, secretes gonadotropin-releasing hormone (GnRH), which signals the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH), triggering ovulation. Under stress, however, the hypothalamus pours out a protein called corticotropin-releasing hormone (CRH), which can reduce or block the GnRH signal to the pituitary, which reduces LH and FSH. “This can lead to not ovulating and irregular or absent menstrual periods,” says Sarah Berga, M.D., professor and chairman of the department of gynecology and obstetrics at the Emory University School of Medicine in Atlanta. Women with a medical condition known as stress-induced anovulation, for example, have a dysfunction in their GnRH signaling system.
Stress has other reproductive ramifications. It “can increase the frequency of uterine contractions, which may interfere with implantation, says Sherman Silber, M.D., director of The Infertility Center of St. Louis at St. Luke’s Hospital in Missouri and author of How to Get Pregnant (Little Brown & Co., 2005). And it may also affect sperm quality.
But biological possibility does not prove cause and effect. Studies, however, are gleaning information about the women most likely to have stress-related problems getting pregnant. A 1999 Danish study of 393 childless couples ages 20 to 35 who were preparing to start their families, found that the women who had high scores of emotional distress on a standardized survey and had menstrual cycles longer than 35 days were less likely to conceive: 12.8 percent per cycle compared with 16.5 percent for less stressed women with shorter cycles. The researchers speculated that the women less likely to conceive were distressed over their longer cycles. A follow-up study in 2000 found that the most distressed women were also more likely to suffer early embryo loss.
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