Is stress affecting your fertility?
For couples trying to conceive, the many well-intentioned comments calling for them to relax and let nature take its course only raises the stress levels. There is a nagging suspicion that the more we worry about conceiving the harder it gets. What makes this worse is that you cannot easily stop stressing and the cycle repeats.
However new research has shown that stress can affect fertility and that 'talking therapy' can help reduce stress and improve a woman's chances of becoming pregnant.
Research indicates chronic stress can lead to a drop in sex drive as well as a drop in fertility. This has become such a common issue that they have now named it: Stress Induced Reproductive Dysfunction.
Even the stress of infertility treatments can create issues with anecdotal evidence of couples conceiving children after the failure of assisted reproduction.
"It's becoming more and more important, in terms of what studies we do, to focus our efforts on the physiological effects of stress and how they may play a role in conception," Margareta D. Pisarska, MD, co-director of Center for Reproductive Medicine at Cedars Sinai Medical Center in Los Angeles and editor-in-chief of the American Society for Reproductive Medicine News told webmd.
The physiological effect of stress
Scientists know that stress boosts levels of stress hormones glucocorticoids such as cortisol that inhibit the body's main sex hormone, gonadotropin releasing hormone (GnRH), and subsequently suppresses sperm count, ovulation and sexual activity.
New research shows that stress also increases brain levels of a reproductive hormone named gonadotropin-inhibitory hormone, or GnIH, this puts the brakes on reproduction by directly inhibiting GnRH effectively suppressing reproduction.
"It's very adaptive to not be wasting resources on reproduction during times of acute stress, to just shut down reproduction for 24 hours or so until the stress is gone," said Daniela Kaufer, UC Berkeley assistant professor of integrative biology who looks at how stress affects molecular processes in the brain. "These functions go back in evolution a long way."
Research in the journal Human Reproduction compared pregnancy rates in couples who reported feeling stressed and those who were not and found pregnancy was more likely to occur in those couples feeling "good" happy and relaxed. It was less likely to occur during the months they reported feeling tense or anxious.
Research published in Fertility and Sterility in 2005 reported that stress may play a role in the success of infertility treatments, including in vitro fertilization (IVF). They found women who scored highest for stress ovulated 20% fewer eggs than those less stressed. Those who were most stressed were also 20% less likely to achieve fertilization success.
Recent advancements in infertility treatment do enable a much higher chance of conceiving. Yet there is an increasing number of women with unexplained infertility.
"Twenty years ago the rate of unexplained infertility was between 10% and 20%. Today I see up to 40%. Women's bodies aren't different, but their stress levels are, and combined with the ticking of the biological clock, I believe it sets the stage for infertility," Allen Morgan, MD, director of Shore Institute for Reproductive Medicine in Lakewood, N.J told webmd.
Stress reducing treatments
Whilst we do not yet fully understand the pathway between stress and infertility, what is known is that reducing stress levels seems to help. Many infertility clinics now offer a range of treatments from counselling to massage therapy, acupuncture, foot reflexology and even comedy as a means to reduce stress during treatment.
A research study in Europe found high levels of the hormone cortisol, which is linked to stress, in a sample of 16 women in their twenties and thirties who had not had a period for six months. Half of the sample of women received a 'talking therapy' treatment over a 20-week period and 80% were found to have started ovulating again, this compared to 25% in the group receiving no therapy. Two months later two of the women who received therapy became pregnant.
Professor Berga reported to the Australian Daily Mail "This population actually looks very well pulled together," she said. "They don't report stress. They say everything is just fine. It may be the fact that the people who say everything is fine are the most stressed. They have unrealistic attitudes about themselves and others and think they can get more done in the day than is realistic, and their sense of worth depends on achievement."
Professor Berga said that although the study involved women whose monthly cycle had stopped, the findings may apply to other women who have fertility problems which are harder to discover because they still menstruate.
"It is quite possible there are many individuals who could benefit from stress reduction in terms of infertility therapies," she said.
In my experience therapy helps by getting to the underlying causes of stress. There is not one simple answer or solution to be offered as each person differs. I have found taking the time to better understand and make sense of the feelings and thoughts raised can lead to beneficial shifts in mood, a better sense of perspective and a reduction in stress.
Pisarska commented to webmd that the effects of stress may be different for each women, "Stress may cause one set of reactions in one woman, and something else in another, so ultimately the reasons behind how or why stress impacts fertility may also be very individual."
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