The Stress Effect on Fertility Treatment
It’s possible that stress is most problematic for women undergoing fertility treatments. Dr. Boivin has been conducting her research on couples participating in the large Copenhagen Multi-Centre Psychosocial Infertility Research Programme in Denmark. In a 2005 study in Fertility and Sterility, Dr. Boivin reported on 818 infertile couples in their mid-30s who were preparing to undergo IVF or intrauterine insemination. She found that the women who said that fertility problems had caused stress in their personal relationships, particularly their marriages, were less likely to get pregnant. It took them three IVF cycles, versus two for the less-distressed women. “If you’re highly stressed, your marriage is under a lot of pressure, it takes an extra treatment cycle to get pregnant,” says Dr. Boivin. But, she emphasizes, “it wasn’t that they weren’t able to conceive, but that it took them longer to conceive.” Interestingly, couples in which the male partner said fertility-related problems had stressed their marriages were also less likely to have conceived over 12 months.
“At the time, this was a surprising finding,” says Dr. Boivin. “Maybe you can’t think about stress on an individual basis. These are two people trying to conceive together, and they have to deal with a lot of decision making: do we do more, do we stop, do we adopt, are we going to divorce, will you still love me if I can’t have babies. There’s a lot of stuff to think about, negotiate and agree upon. So it’s really a couple’s stress that predicts success.”
It’s important to note that not all studies have found an association between stress and treatment outcome. A Swedish study of 166 women published in Human Reproduction in 2005 found that a person’s perceived stress before or during an IVF transfer had no bearing on whether or not pregnancy occurred. So there may be other factors at play as well.
People with infertility-related stress, for instance, may quit treatment prematurely. “The maximum number of cycles people say they can put up with is three,” says Dr. Boivin. “The average number people do is 2.3 because they can’t handle the stress of treatment, the hormones, their life being on hold. It’s incredibly demanding.”
All of which speaks to the individual nature of stress. “How much stress anybody can put up with varies incredibly,” Dr. Boivin notes. “Some people have the tiniest bit of stress and they’re in bed. Other people do the most amazing things when they’re under stress: they run corporations, have a demanding social life, and never get sick. So I don’t want women to worry that they won’t conceive because they’re under stress, or that if they don’t become pregnant it’s their fault. The influence of stress on conception is smaller than people realize.”
In a given cycle, for instance, a woman has, on average, a 25 percent chance of becoming pregnant. Based on her studies, Dr. Boivin says the effect of stress might reduce her chances to 21 percent. “If you’re overweight it would reduce your chance of success to 15 percent,” she adds. “So stress might delay pregnancy, but I don’t think it will cause a person to never reproduce.”
{loadposition frboost} Does Treating Stress Improve Pregnancy Chances?
If stress plays a role in fertility, it would be useful to know if counseling or mind-body treatments can improve reproductive function. Alice Domar, Ph.D., executive director of the Domar Center for Complementary Healthcare at Boston IVF, believes it can. In her 10-week program, participants learn such stress-busting techniques as meditation, progressive muscle relaxation, diaphragmatic breathing, and yoga. They also receive nutritional counseling and learn cognitive restructuring. In other words, says Dr. Domar, “We teach them how to recognize the triggers or situations they know are going to push their buttons, and we give them ways to challenge automatic negative thought patterns. For example, ‘My infertility is all my fault,’ or ‘My husband is going to leave me for a fertile woman.’” The program also includes couples counseling and sessions with a male therapist for men.
But does reducing stress via a program such as hers improve pregnancy rates? Dr. Domar studied 120 women who had been trying to get pregnant for one to two years. One group participated in 10 cognitive-behavioral therapy sessions, another in a support group, and a third received no psychological treatment at all. After a year, the study (published in Fertility and Sterility in 2000) found that the women in the two treatment arms had significantly higher pregnancy rates than those in the control group.
Likewise, Emory’s Sarah Berga took 14 women who had stopped ovulating due to stress and, in 16 private counseling sessions, taught half of them how to de-stress using cognitive-behavioral techniques. “We talked to them about what constitutes a good healthy lifestyle, how to use food and exercise as a stress reliever, and how to be better problem solvers,” she says. The other seven women were not treated. After six months, 85 percent of the treated women showed evidence of a return of ovarian activity, while only one of the untreated women did.
Unfortunately, the majority of the studies on stress reduction and fertility have methodological flaws that make it impossible to generalize their findings. In a review of hundreds of these studies published between 1960 and 2001, Dr. Boivin found that while all of them recommended counseling, only six percent actually evaluated its effectiveness. Her conclusion: “Psychological interventions helped reduce fertility-related stress, anxiety, and sadness, but it didn’t do much regarding pregnancy rates. We just don’t know enough at this point.”
Nonetheless, asks Dr. Domar, “What is the downside of teaching mind-body techniques? Even if patients don’t get pregnant, they feel better. If we know from our clinical practice that the most distressed women have half the pregnancy rates of the least distressed women, I think it’s really important to intervene with infertility patients before they go on to high technology.”
Some clinicians agree. If a woman is stressed during an IVF procedure, for instance, it’s harder to get the catheter in. “A slight bit of blood on the tip of the catheter as a result of force can irritate the uterus and interfere with implantation,” says Sherman Silber of The Infertility Center of St. Louis. “A difficult embryo transfer gives you a lower pregnancy rate. That’s undisputed.”
Silber now guides all his patients through a relaxation exercise prior to doing transfers. “This is going to sound very Far Eastern, but if we can get patients to relax right in front of our eyes, what looks like a difficult transfer—because the catheter wasn’t going in on its own—suddenly becomes easy,” he says. “The catheter falls right in.”
The good news: Two new studies may help solve the stress-fertility puzzle. Dr. Domar plans to study 200 patients recruited right after they’ve been referred for IVF. Half will go through a mind-body program, the other half won’t. They’ll all get psychiatric interviews, and researchers will take blood samples to measure levels of stress markers, such as cortisol. Says Dr. Domar, “We should have a definitive answer to the question: What truly is the impact of stress, and can a mind-body program improve pregnancy rates and decrease treatment dropout?”
At the same time, the NICHD is in the process of enrolling 800 U.S. women in what is believed to be the largest controlled clinical trial on the effects of stress on fertility. Until these results are in, Dr. Boivin advises that if you want to improve your fertility, “sit down and have a really good look at your lifestyle, at how well you’re eating, whether you’re getting exercise or smoking or drinking. See where you can make changes, because that will significantly impact your fertility more than anything you can do about stress.”
Gina McGillick may beg to differ. “I firmly believe that the mind-body connection does make a difference,” she says. “You have to turn off the negative switch to let the positive energy come through. Do I think the program helped me? Yes.” In any case, she and husband Michael have other priorities. Their baby is due September 26. Says the ecstatic mom-to-be: “It’s nothing but sunshine and roses right now.”
A version of this article originally appeared in the Fall 2007 issue of Conceive Magazine.
Related Topics: Boost Fertility; Fertility Health; Stress and Fertility
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