Many couples that experience fertility challenges are worried about stress. Infertility itself causes distress and emotional turmoil. Could the stress of infertility make your situation even worse? Fertility experts are also curious about the stress-fertility connection. Could stress be the missing clue when a cause for infertility is unexplained or when treatments fail for unknown reasons? The answers are complicated. We don’t yet fully understand what impact stress has on fertility. Simply “relaxing” isn’t going to solve anyone’s fertility struggles, but that doesn’t mean that stress is harmless. Learn what the research has to say and what you should know about this controversial topic.
Types of Stress
Before looking at the research, it’s helpful to understand why studying stress is tricky. To study something, we need to agree on what it is that we’re studying. There are a variety of different types of stress, and there are many questions that arise in terms of how each type could relate to fertility.
Childhood stress. You may have heard of an ACE score (adverse childhood effect score). This refers to stress that isn’t necessarily happening now but occurred during your prime growing years. High ACE scores have been connected to several long-term health issues. Could this connect to fertility?Short-term everyday stress. If your car breaks down, and it happens to be the week you’re ovulating, will this hurt your chances that month?Long-term stress or a series of stressful events. Your car breaks down, you have a huge project due at work, your mother is in the hospital, and you just found out you can’t pay your credit card bill. If your life looks like this month to month, you may be experiencing long-term stress. Testing, diagnosis, treatment, failed cycles, and high medical bills are all parts of infertility that often cause long-term stress.“Good” stress from your lifestyle. What if you thrive under stress? Maybe you have a demanding job, work long hours, and frequently experience conflict in your day. Your days may include intense physical and psychological demands. Even if you love your lifestyle, you’re still living a stressful life. Big life events. Divorce, job loss, moving to another city or country, and losing someone you love can all cause a great deal of stress.Living under stressful conditions. Those living in poverty, lacking regular employment, or without access to healthy foods and basic primary care live in a stressful environment all day every day.
When studies ask if stress causes infertility or if stress increases the time it takes to get pregnant, it’s important that we know what kind of stress is actually being discussed.
Measuring Stress
This is a complicated aspect of research. Once it is decided what type of stress is being examined, one must figure out how to measure it. There are two primary ways researchers attempt to evaluate stress levels: by measuring stress-related chemicals in saliva or bloodwork or by using psychological stress measurement tools. There are advantages and disadvantages to both.
Measuring Chemicals
When measuring biochemical stress signals in saliva or blood, we can’t know for sure if it’s caused by a stressful life or by a disease process. For example, let’s say someone is diagnosed with endometriosis. Let’s say that her biochemical test results for stress are high. Are these stress chemicals high because she lives a stressful life and this lifestyle led to endometriosis? Or, does her endometriosis cause biological stress on her body, and this leads to higher levels of stress hormones? On the other hand, it could be that endometriosis symptoms cause emotional distress, and that leads to her higher stress hormone levels? As you can see, determining the answers to these questions is complicated.
Psychological Measurement
The issue with psychological measurement tests is that people perceive stress differently. This will change how they answer questions on a stress questionnaire. Another issue is that people’s bodies react to stress differently. Two people can measure high on a psychological stress measurement test but have completely different biological reactions. With psychological measurement, the researcher also must rely on the assumption that the respondent’s answers are honest. Most of these tests are designed to reduce the chances of dishonest responses, but the tests aren’t perfect.
When Does Stress Matter?
The timing of the study matters just as much as determining the type of stress. For instance, a study could look at stress levels before a cycle begins, in the middle of a cycle, or just before ovulation. It could examine stress during the two-week wait (time between ovulation and period), or take the average stress levels of a period of weeks, months, or even years. All of these variables factor into the results. It’s extremely difficult to capture this in one or even multiple studies. People under stress frequently turn to unhealthy habits to cope. They may eat more junk food, may sleep too little or too much, or may not exercise at all (or exercise too much). Some may turn to smoking, alcohol, or drugs. We know that smoking, poor nutrition, and excess alcohol drinking all harm fertility. If someone has high levels of stress, is coping poorly, and his/her fertility decreases, is it the stress that’s causing the problem or the poor coping choices?
The Biological Connection
There is a biological explanation as to why emotional stress may lead to fertility issues. It all comes down to the hypothalamic-pituitary-adrenal axis (the HPA axis). Whenever your body perceives stress, the hypothalamus gland in your brain sends a signal to the pituitary gland—the signal indicates that you are under stress and need assistance. The pituitary reacts to this call for help by sending its own signal to the adrenal glands, telling them to release the stress hormone cortisol. In healthy amounts, cortisol is good. Among many things, this hormone helps regulate your blood sugar so that you have energy through the emergency. The problem is when your body is flooded with cortisol all the time or for extended periods of time. This is when it can harm your health. The hypothalamus and pituitary don’t only regulate stress hormones. They are also responsible for regulating reproductive hormone signals. The hypothalamus releases gonadotropin-releasing hormone, or GnRH. GnRH signals the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH stimulate egg growth in the ovaries in women and sperm growth in men. If the HPA axis is busy dealing with stress, so in theory, this could throw off or change how it regulates reproductive hormones. We also have to consider what effect stress hormones like cortisol may have on oocytes, sperm cells, and embryos.
Studies Finding a Connection
Some studies have found a possible connection between stress and fertility. A study conducted in the United Kingdom included 250 women who were trying to conceive naturally over a period of six cycles. On day six of each cycle, they provided saliva samples to test the levels of alpha-amylase and cortisol, two hormones associated with stress. During this six-month period, they also used ovulation monitors to give every woman in the study the best chances of conceiving and monitor the timing of their sex for their most fertile days. The study found that women with higher concentrations of alpha-amylase took longer to get pregnant when compared to those with lower levels of this stress hormone. However, it’s important to note that this study also found women with higher levels of cortisol (another stress hormone) tended to get pregnant faster than those with lower levels. In other words, the connection is unclear. Another study conducted in research centers in Michigan and Texas also wanted to investigate whether the hormones alpha-amylase and cortisol in saliva might relate to the time it took to get pregnant. This study included 400 women trying to conceive. Researchers found that women with the highest levels of alpha-amylase had a 29 percent reduction in their overall fertility, taking longer to conceive than those with the lowest levels of alpha-amylase. This study found no relationship between cortisol levels and time to pregnancy. Socioeconomic-related stress may also negatively impact fertility. One study found that women facing socioeconomic stressors had poorer ovarian reserves. Another separate study found that women with higher ACE scores (they had more traumatic experiences in childhood) were more likely to experience infertility and irregular or absent menstrual periods in adulthood.
Male Fertility
Male fertility may also be affected by stress. A meta-analysis of 57 different studies, which included almost 30,0000 men, found that psychological stress could lower sperm concentration, sperm movement, and the percentage of normal-shaped sperm. The study didn’t look at whether this impacted time to pregnancy for their female partners, however. Another study found that experiencing two stressful life events increased the risk of a man’s semen analysis results falling below the normal guidelines set by the World Health Organization (WHO). Other studies have found that testosterone levels were lower when men experienced psychological stress. Though, it’s difficult to know what comes first—does decreased testosterone lead to increased sensitivity to stressful events? Or do stressful events cause testosterone levels to drop?
Studies With No Connection
Not all research has found a connection between stress and decreased fertility. A study conducted in the United Kingdom had almost 340 women complete daily diaries over a period of six months or until they got pregnant. For each cycle, the women had biomarkers of stress measured. They also completed questionnaires meant to evaluate their stress levels. This study controlled for the women’s age, whether she smoked, how much caffeine she drank, and how frequently the couple had sex. This study didn’t find a connection between self-reported stress, anxiety, or depression levels with the time to pregnancy. In a separate study, researchers investigated whether stress may negatively impact IVF success rates (in vitro fertilization). It included just over 200 women who were starting their first IVF cycle. Their stress levels were evaluated via interviews and questionnaires that were administered before IVF started and then four, 10, and 18 months afterward. Women who were depressed or anxious before starting IVF treatment were no more likely to experience IVF failure than women not scoring high on depression or anxiety. The study did find that IVF failure caused significant psychological distress, which is no surprise. Researchers for this study recommended that self-care and psychological interventions are aimed at help patients cope with treatment failure, instead of focusing on reducing stress to improving the success of the treatment. Perhaps most compelling was a meta-analysis study that included 14 studies and just over 3,500 women, looking at whether emotional distress was associated with success during assisted reproductive treatments like IVF. Researchers did not find a connection between pre-treatment emotional distress and IVF success rates. The researchers concluded, “The findings of this meta-analysis should reassure women and doctors that emotional distress caused by fertility problems or other life events co-occurring with treatment will not compromise the chance of becoming pregnant.”
Conflicting Findings
There are studies reporting that stress does have a negative impact on fertility. However, there are studies that report the exact opposite. Which is it? The truth is that both can be correct. It’s possible that stress extends the time to pregnancy, but that extended time is likely a period of weeks or, at most, months. This isn’t enough to cause infertility, which is defined as the inability to conceive after a year of trying. Several studies have found that IVF success, in particular, does not seem to be associated with stress. Given how stressful the IVF process can be and how emotionally distressing the experience of infertility is for many couples, this is very good news.
Self-Care for Stress
Whether or not stress decreases fertility, we still need to care about stress. For one, it doesn’t feel good to be stressed or anxious. Whatever we can do to feel or cope better is going to be worthwhile. Secondly, even if stress doesn’t have a direct impact on your odds for IVF success, it does have a connection to your likelihood of continuing treatment. Most doctors agree that you should give IVF at least six cycles for the best odds for pregnancy success. One study found that in countries where IVF is covered by health insurance, the dropout rate after just one cycle was 40 percent. After four cycles, the drop out rate was 62 percent. When asked why they dropped out, the top two reasons were emotional stress and perception of a poor prognosis. Had couples felt psychological well enough to try for one or even two more IVF cycles, theoretically, their odds for live birth would have increased.
A Word From Verywell
There is no doubt that infertility causes stress. Whether or not stress can cause infertility is debatable. Studies have found that stress impacts reproductive hormones and may increase the time it takes to get pregnant, but so far, no one has found that stress alone can cause infertility. Whether you’re just starting to try to conceive or you’re in the middle of fertility treatments, know that “trying too hard” isn’t going to lead to fertility problems, and your stress around conception won’t keep you from getting pregnant. However, stress certainly doesn’t feel good. Take good care of yourself and seek support from friends and those who understand.
