Stress and Fertility

A Little Bit About Stress

The human response to stress is a highly evolved reaction ideal for short term physical crises. When humans were hunter-gatherers living on the savannah and a lion attacked, the "fight or flight" stress response was very beneficial. In the "fight or flight" response certain biological changes take place allowing humans to most effectively fight or flee predators. These include an increased heart rate and faster breathing so that the muscles can work harder and allow humans to run faster, the constriction of blood vessels to reduce potential blood loss if attacked, and the opening of sweat glands to cool off the hard-working body. In order to maximize the energy allotted to fighting or fleeing, some systems in the body are effectively shut down. These systems include the immune system, the digestive system, and the reproductive system. The body will stop expending energy on growth or reproduction choosing, as Robert Sapolsky, Professor of Biology and Neurology at Stanford University explains to "thicken the uterine wall at some other time" and flee from the lion right now (Sapolsky 2004). Today, being attacked by a lion is something few of us need to worry about, but we experience the same biological changes in response to social and psychological stressors. Losing a project for work, nearly avoiding an auto accident, or receiving a complicated medical diagnosis all provoke the fight-or-flight stress response in humans. Like our ancestors, when we are stressed our bodies use their energy to physically prepare us for fleeing or fighting. We feel this in a racing heart, faster breathing, and increased perspiration.

When our bodies respond to stressors that are not truly life threatening too often, we may begin to suffer from stress-related illnesses such as heart disease, high blood pressure, immune system disorders, migraine headaches, or insomnia. Research in non-human primates indicates that frequent stress may impair fertility through poor ovarian function (Shively 1998), fewer menstrual cycles (Shively 1998), low levels of progesterone (Wasser 1995, Shively 1997), and increased rates of miscarriage (Altmann et al. 1995). We look to studies on non-human primates because, due to the ethical and other considerations, few studies of pregnancy and reproductive outcome manipulate stress in humans. However, human studies are able to assess naturally occurring stress in women, and find many of the same results as animal models. High stress levels have been associated with reduced rates of implantation (Gallinelli et al. 2001), longer menstrual cycles (Hjollund et al. 1999), and miscarriage after 11 weeks of pregnancy (Boyles et al. 2000).

The link between stress and fertility becomes even more complicated when we realize that not only can stress impair fertility, but many of us also find the diagnosis of infertility profoundly distressing in itself. In fact, the majority of women with infertility report that it is "the most upsetting experience of their lives" (Domar 2002, 15). Women with infertility report equivalent levels of anxiety and depression as women with cancer, HIV status, and heart disease (Domar et al. 1993). Men also suffer fertility related stress, though they frequently keep their anxiety to themselves for fear of adding to their partner's burden. For both men and women, much of the stress of infertility comes from feeling as though they have lost control over their bodies and their plans for the future. Feeling as though you lack control is what biologist Robert Sapolsky identifies as the "foremost amongst psychological stressors" (Sapolsky 1994, 262). And the knowledge that the stress response, adaptive in other contexts, may impair fertility does little to help anyone relax. However, educating yourself about stress and the ways that it may affect your fertility is one of the most important and empowering steps you can take to reestablish control over your life.

Recent studies have highlighted the success of integrative medicine in decreasing stress and treating infertility. A 1999 study of women diagnosed with infertility found that 55% of women using a mind/body approach were pregnant within one year as were 54% of women attending a weekly support group. The rate of conception for women who did not use mind/body approaches or attend a support group was only 20% (Domar et al. 2000a). Furthermore, women learning the mind/body techniques and those in support groups reported significantly less distress than the group receiving no treatment for stress (Domar et al. 2000b). In other words, the women in the support and mind/body groups were both more likely to conceive and less likely to feel depressed, anxious, isolated, or stressed. Like support groups and mind-body therapy, acupuncture has been shown to reduce stress and increase conception rates. A 2006 study revealed that clinical pregnancy rates after embryo transfer were 10% greater in the group of women that received acupuncture than in the group that received no treatment (Benson et al. 2006).

As a reproductive endocrinologist, a medical acupuncturist, and a practitioner of integrative medicine, Dr. Kim can provide a variety of treatments to reduce stress and enhance fertility. Together, you and Dr. Kim will design a plan to address the various factors influencing your ability to conceive. You may choose meditation, relaxation therapy, centering prayer, or other proven stress-reduction techniques in order to get your body ready for conception. Feel free to look at our list of services detailing the many health and fertility-promoting techniques offered in our clinic.

References

Altmann J, Sapolsky RM, Licht P. Baboon fertility and social status. Nature 377: 688-689 Scientific Correspondence, 2002.

Boyles S, Ness, RB, Grisso JA, Markovic N, Bromberger J, CiFelli D. Life event stress and the association with spontaneous abortion in gravid women at an urban emergency department. Health Psychology. 19(6): 510-514, 2000.

Domar AD, Clapp D, Slawsby EA, Dusek J, Kessel B, Freizinger M. The impact of group psychological interventions on pregnancy rates in infertile women. Fertility and Sterility. 73(4): 805-811, 2000a.

Domar AD, Clapp D, Slawsby E, Kessel B, Orav J, Freizinger M. The impact of group psychological interventions on distress in infertile women. Health Psychology. 19(6): 568-575, 2000b.

Domar AD, Kelly AL. Conquering Infertility: Dr. Alice Domar’s Mind/Body Guide to Enhancing Fertility and Coping with Infertility. Penguin Books, 2002.

Domar AD, Zuttermeister P, Friedman R. Distress and Conception in Infertile Women: A complementary approach. Journal of the American Medical Women's Association. 54(4):196-199, 1999.

Domar AD, Zuttermeister P, Friedman R. The psychological impact of infertility: a comparison with patients with other medical conditions. Journal of Psychosomatic Obstetric Gynaecology. 14: 45-52, 1993.

Gallinelli A, Roncaglia R, Matteo ML, Ciaccio I, Volpe A, Facchinetti F. Immunological changes and stress are associated with different implantation rates in patients undergoing in vitro fertilization–embryo transfer. Fertility and Sterility. 76(1): 85-91, 2001. Hjollund NHI, Jensen TK, Bonde JPE, Henriksen TB, Andersson A, Kolstad HA, Ernst E, Giwercman A, Skakkebæk NE, Olsen J. Distress and reduced fertility: a follow-up study of first-pregnancy planners. Fertility and Sterility. 72(1): 47-53, 1999.

Sapolsky, RM. How stress affects your health. Talk of the Nation, National Public Radio. 10 September 2004. Listen to story.

Sapolsky, RM. Individual differences and the stress response. Neurosciences 6: 261-269, 1994.

Shively CA. Social subordination stress, behavior, and central monoaminergic function in female cynomolgus monkeys. Biological Psychiatry. 44(9):882-91, 1998.

Shively CA, Laber-Laird K, Anton, RF. Behavior and physiology of social stress and depression in female cynomolgus monkeys. Biological Psychiatry. 41(8): 871-882, 1997.

Wasser SK. Costs of conception in baboons. Nature. 376: 219-220 Scientific Correspondence, 1995.