Infertility, affects 10-15% of couples of reproductive age worldwide. In recent years, the percentage of couples seeking infertility treatments has increased dramatically. Although infertility can stem from many different causes, studies have found that stress and reproduction are interrelated. Specifically, high stress levels are associated with an increased risk of infertility and difficulty getting pregnant.
Since infertility can be a stressful life experience in itself, it can negatively impact a couple’s psychological well-being and consequently, make reproductive outcomes even worse. Reducing stress and enhancing lifestyle choices could improve fertility in both men and women.
In this article, we discuss the impact of stress on fertility.
Stress and infertility: is there a real relationship?
The relationship between stress and infertility has been studied extensively. Women who are having trouble getting pregnant have elevated levels of anxiety and depression, so there is no doubt that infertility causes stress. However, it is less clear whether stress causes infertility because its impact on reproductive health is difficult to measure reliably. Nevertheless, one recent study found that mental health interventions are effective in lowering psychological distress as well as significantly increasing pregnancy rates.
Not surprisingly, couples who are dealing with infertility report high levels of distress, which increases the risk of developing psychological disorders and negatively impacts quality of life. A recent literature review showed that 25% to 60% of people experiencing infertility report psychiatric symptoms and that their levels of anxiety and depression are significantly higher than control groups experiencing no infertility. Other studies have found that increased stress levels can significantly alter a woman’s Hypothalamic-Pituitary-Ovarian Axis, impairing her reproductive hormonal balance and contributing to ovulatory dysfunction and subfertility. Women experiencing intense anxiety sometimes share their stories of ‘failure’ to give birth with family or friends, increasing their psychological vulnerability.
Furthermore, infertility treatments per se are associated with high levels of stress. Indeed, stress is a primary symptom of pregnancy complications and loss that might occur during infertility treatments. Psychological stress is also a potential clinical risk factor that may reduce male fertility. It has been shown that men who are receiving infertility treatment – and still failing to achieve pregnancy – experience frustration and disappointment. This can further exacerbate stress and adversely affect fertility levels.
Stress-related infertility and COVID-19
The coronavirus pandemic (COVID-19) has only added to the stress perceived by couples trying to conceive. In a 2020 online survey that asked women who were having trouble getting pregnant to identify stress factors, infertility (66%) and COVID-19 (63%) were identified as the two main stressors in their lives.
Assessment of stress-related infertility
Mental health professionals often use self-report questionnaires to assess the psychological state of couples experiencing infertility. This process is especially important before an individual with a history of anxiety and/or depression begins infertility treatment.
Among the questionnaires that have been developed to assess the psychological impact of infertility and its effects on intrapersonal and interpersonal relationships are: the 46-item Fertility Problem Inventory (FPI), the 36-item Fertility Quality of Life Tool (FertiQoL) and the Infertility-Related Stress Scale (IRSS). Two other questionnaires, the SF-36 and WHO-QOL, are mostly used for assessing quality of life in couples experiencing infertility.
Specific interventions
Recent research has explored the effectiveness of various psychological interventions in lowering mental distress and significantly increasing pregnancy rates. Psychotherapy has been shown to be effective in reducing detrimental effects such as anxiety, depression, and infertility-related stress, therefore increasing the chance of conception.
Even though individual counselling is always an option, couples therapy is highly encouraged as the problem of infertility should be viewed as a couple’s problem. In this way, each partner will have a better understanding of the demands made on the other and will be more likely to be supportive of his/her needs.
In order to be most effective, counselling should ideally begin before patients start any type of infertility intervention or treatment. Couples who undergo assisted reproductive treatment (ART) are at a particular risk of experiencing psychiatric distress, making psychological help especially important as they cope with the many issues associated with infertility diagnosis and treatment.
While professional help is important, there are also other measures couples can take to manage their stress level. For example, eating a balanced diet could help the body to manage the physiological changes caused by stress. Indeed, foods known for reducing inflammation in the body could also decrease cortisol levels, known as the “stress hormone”. That’s because cortisol is released both in mentally stressful situations and in the case of physical stress (such as inflammation). Moreover, foods naturally rich in Magnesium, Zinc and B vitamins have been linked to lowered anxiety. Keep in mind, a healthy diet is crucial to improving fertility.
In summary, couples planning a pregnancy should consider the impact of stress on the chances of conception. Reducing stress in everyday life could be a good starting point together with changes in lifestyle by following a healthy diet and exercising.
References
- Rooney KL, Domar AD. The relationship between stress and infertility. Dialogues Clin Neurosci. 2018;20(1):41-7.
- Palomba, S., Daolio, J., Romeo, S. et al. Lifestyle and fertility: the influence of stress and quality of life on female fertility. Reprod Biol Endocrinol. 2018; 16, 113.
- Ulrich-Lai YM, Herman JP. Neural regulation of endocrine and autonomic stress responses. Nat Rev Neurosci. 2009;10(6):397-409.
- Kiani Z, Simbar M, Hajian S, et al. The prevalence of anxiety symptoms in infertile women: a systematic review and meta-analysis. Fertil Res Pract. 2020;6:7.
- Lynch CD, Sundaram R, Maisog JM, Sweeney AM, Buck Louis GM. Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study–the LIFE study. Hum Reprod. 2014;29(5):1067-75.
- Naidoo U. Nutritional strategies to ease anxiety. Harvard Health Publishing, 2019.
- Donarelli Z, Lo Coco G, Gullo S, et al. Infertility-related stress, anxiety and ovarian stimulation: can couples be reassured about the effects of psychological factors on biological responses to assisted reproductive technology? Reprod Biomed Soc Online. 2016; 3:16-23.
To learn more about how stress can affect fertility, read the article.
