Stress and Fertility
Photo by Joshua Woroniecki on Unsplash
The journey to start a family is not always an easy one; it can be filled with anxiety, frustration, and unmet expectations. If you're struggling to get pregnant, please know that you are not alone.
In the U.S., about 1 in 5 women (heterosexual, aged 15 to 49, with no prior births) are unable to get pregnant after one year of trying. Also, about 1 in 4 women in this group have difficulty getting pregnant or carrying a pregnancy to term (4).
There is an incredible amount of stress that comes along with subfertility. Women (and men) may battle depression, anxiety, isolation, grief, hopelessness, and loss of control.
But which came first, the chicken or the egg?
Infertility undoubtedly causes higher stress, but does stress also cause infertility? Studies have shown that stress is higher in less fertile women, but have they found a causal effect? What exactly is the relationship between fertility and stress?
What does the research say about stress and fertility?
Exactly how stress might affect fertility is still considered largely inconclusive. While many studies have found a link between the two, other studies have found little or no association between stress and infertility (2, 17). This could be because most studies so far have been small and have relied on self-reported data from participants, which is notoriously unreliable (13).
Although researchers have been hesitant to confirm a definitive causal relationship between stress and infertility, there have been a number of recent studies that have found a connection:
In a study of 45 couples undergoing IVF, female and male stress levels were associated with anxiety, depression, and a lower likelihood of clinical pregnancy and live birth (12).
A study of 457 couples found that high levels of alpha-amylase in saliva, known to be an indicator of high stress, increased the risk of pregnancy failure in infertile couples undergoing IVF (26).
Another study of 401 women found that those with the highest amount of alpha-amylase had a 29% reduction in fecundity (longer time to pregnancy) and a greater than 2-fold increased risk of infertility (16).
In a review of 39 studies on stress reduction and fertility, researchers found that psychosocial interventions (i.e. cognitive behavioral therapy) could both reduce psychological distress and improve clinical pregnancy rates for couples undergoing infertility treatment (9).
In a study of 184 women who had been trying to get pregnant for 1-2 years, researchers found a higher rate of conception for women who participated in a group psychological intervention (i.e. a cognitive behavioral group or support group) for stress reduction compared to women who did not receive any intervention for stress (6).
There are also immediate effects of stress on ovulation and menstruation.
High stress can cause problems with ovulation and irregularities with the menstrual cycle (25). Women under stress may experience irregular or missed periods and/or hormonal imbalances, which can increase the time it takes to get pregnant. Once the stressor is gone, the menstrual cycle will likely return to normal.
One study found that higher daily stress levels in healthy, premenopausal women were associated with lower concentrations of reproductive hormones (estradiol, LH, and luteal progesterone), higher concentrations of FSH, and increased odds for sporadic anovulation (19). This means that the women in the study were more likely to have menstrual cycle irregularities and occasionally not ovulate if they experienced higher levels of daily stress.
Other ways that stress may impact fertility
Certain habits that may become more common when you’re stressed (like grabbing fast food or losing sleep) can also reduce your fertility (11).
When you’re stressed, you may be more likely to:
Eat less healthy foods. When you’re busy and stressed it’s all too easy to reach for fast, processed, and less healthy foods. Studies have found that healthy dietary patterns (i.e. the Mediterranean diet) can improve embryo yield and oocyte quality and increase the chance of conception (22). Conversely, diets high in refined grains, sugar, processed meats, and fried foods can reduce fertility and increase the time it takes to get pregnant (22). Furthermore, what you eat can actually affect your stress levels. Diets emphasizing whole foods have been related to lower levels of depression, anxiety, and stress, whereas unhealthy eating patterns have been linked to an increased risk of poor mental health (10).
Sleep too little. Sleep quality and duration are incredibly important for fertility. Sleep deprivation can alter reproductive hormones and reduce fertility (15).
Gain or lose weight. Proper body weight is a key component of fertility. Being either over or under weight can increase the time to pregnancy, cause ovulatory disorders, and lead to a higher risk of miscarriage (23).
Skip your usual exercise routine. Not only is exercise important for maintaining a healthy weight, it can also improve fertility by helping to balance hormones, improve blood sugar balance, and reduce stress (3). However, too much exercise can actually impair your fertility. Increased frequency, intensity, and duration of exercise has been found to decrease female fertility and increase time to pregnancy (20). It’s important to talk to your provider to see how much exercise is right for you.
Drink more caffeine. High caffeine intake has been found to increase a couple’s time to conception and also increase the risk of pregnancy loss (20, 23). Caffeine also stimulates your central nervous system and consuming too much may worsen your feelings of stress and anxiety and negatively impact your sleep (14).
Drink more alcohol. While it’s not clear exactly how much alcohol will affect your fertility, there is a definite link between alcohol intake and female fertility. Studies have found a connection between alcohol intake and time to pregnancy, implantation rate, miscarriage, luteal phase disfunction, and anovulation (20). Limiting alcohol intake is a safe bet while trying to conceive.
Smoke cigarettes. Smoking has been “associated with a rapid decline of ovarian reserves, delayed conception and heightened risk of spontaneous miscarriage, as well as a lower success rate from ART (23).”
Lose interest in sex. This has obvious ramifications on fertility and time to conception, as you can’t get pregnant without it!
Whether or not chronic stress definitively causes subfertility, there does appear to be a connection between the two. It certainly couldn’t hurt to lower your stress levels while trying to conceive, and it may even improve your chances.
How to reduce your stress levels
Don’t stress out about being stressed! It isn’t possible to eliminate all stress in your life, nor would you want to. A little stress can be normal and healthy for your body. But if you feel like your daily stressors are getting the better of you, you may benefit from some stress reduction techniques.
In addition to the above mentioned lifestyle modifications, here are some of the top ways to reduce your stress levels.
Yoga. Studies have found that yoga can reduce stress, anxiety, and depression (5). Yoga also encourages deep breathing, meditative movement, relaxation, and focus on the present moment, all of which may reduce stress levels.
Meditation. No surprise here, meditation is an incredible way to reduce stress and feel more calm, centered, positive, and patient in your daily life. It can also to lower your blood pressure, lower your resting heart rate, and improve your sleep (18). If you’re new to meditating, there are plenty of apps available that can walk you through short, guided meditations. Or you can just sit quietly for a few minutes and focus on the feeling of your breath moving in and out of your body.
Alternative ways to meditate. If you’ve tried meditation before and had a hard time sitting still, check out this article about alternative ways to meditate. Some ideas include walking, practicing yoga, journaling, expressing gratitude, and practicing mindfulness (21).
Deep breathing. It’s normal when you’re stressed for your breathing to become more shallow. Deep breathing exercises can activate your parasympathetic nervous system, which controls your relaxation response (14). There are lots of different breathing exercises that you can do, but a good place to start is to just take a moment to sit still and focus your attention on your breath, making it slower and deeper as you feel your chest and belly expand. Your body and mind will relax as your breathing slows.
Exercise. Moderate exercise has the ability to both lower stress levels and improve fertility. Exercise has been found to reduce stress, improve mood, balance female hormones, improve blood sugar balance, and encourage a healthy body weight, all of which are crucial to fertility (1, 3, 7).
Diet. As mentioned earlier, stress, diet, and fertility are linked in a number of ways. Make healthy eating easier by meal prepping for the next few days, writing a detailed shopping list, planning meals for the week, and prepping quick healthy items to grab on your way out the door. When possible, always opt for whole foods rather than packaged and processed snacks.
Spend time in nature. Even short excursions outside (think 15 minutes away from your desk) can have huge impacts on your mood and stress levels. Spending time outside has been found to reduce stress, boost happiness, reduce the risk of depression, and improve attention and focus (24). And although a hike in the woods is great, you’ll see benefits from time spent in a city park as well.
Self-care. Take a little extra time to take care of yourself. Too many busy women see this as unnecessary or, worse, selfish. Take a break from the busy bustle to do whatever makes you feel relaxed and happy: read a book, take a bath, go for a walk, call a friend, get a massage, garden, drink a cup of tea, light some candles, etc.
Stay positive. It’s really easy to have negative thoughts when you’re struggling to conceive. Many women are quick to blame themselves or lose faith that they will ever get pregnant. Recognize negative thoughts when they come up and challenge their validity. Focus instead on positive affirmations like (8):
“I am grateful for my body and what it can do.”
“I become more fertile every day.”
“My womb is a healthy place that will nourish my baby.”
“I feel safe, supported, and loved.”
The takeaway
While the scientific research hasn’t definitively found that stress causes infertility, many studies have found a correlation between the two. It certainly couldn’t hurt to lower your stress levels while trying to conceive, and it may actually improve your chances. Stress can also affect your menstrual cycle and cause hormone imbalances, cycle irregularities, and anovulation. There are many lifestyle changes that you can make to reduce your stress levels and improve your chances of conception. In addition to improving your fertility, a healthy and wholesome diet can also help to reduce your anxiety and improve your mental health. Other stress reduction techniques include yoga, meditation, breath work, moderate exercise, time spent outside, self-care, and a positive mindset.
Looking for more info about holistic fertility?
Check out these other articles on how to naturally improve your fertility:
References
Basso, J.C. & Suzuki, W.A. (2017). The effects of acute exercise on mood, cognition, neurophysiology, and neurochemical pathways: A review. Brain Plasticity. Retrieved from: https://content.iospress.com/articles/brain-plasticity/bpl160040#ref151%20ref197%20ref198%20ref199%20ref200
Boivin, J., Griffiths, E., & Venetis, C.A. (2011). Emotional distress in infertile women and failure of assisted reproductive technologies: Meta-analysis of prospective. British Medical Journal. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043530/
Carolinas Fertility Institute. (2021). The relationship between exercise and fertility. Retrieved from: https://carolinasfertilityinstitute.com/the-relationship-between-exercise-and-fertility/
CDC. (n.d.). Infertility FAQs. Reproductive Health. Retrieved from: https://www.cdc.gov/reproductivehealth/infertility/index.htm
Cronkleton, E. (2021). Here’s how to use yoga for stress reduction. Healthline. Retrieved from: https://www.healthline.com/health/fitness/yoga-for-stress#how-it-works
Domar, A.D., Clapp, D., Slawsby, E.A., Dusek, J., Kessel, B., & Freisingen, M. (2000). Impact of group psychological interventions on pregnancy rates in infertile women. Fertility and Sterility. Retrieved from: https://www.fertstert.org/article/S0015-0282(99)00493-8/fulltext
Ennour-Idrissi, K., Maunsell, E., & Diorio, C. (2015). Effect of physical activity on sex hormones in women: a systematic review and meta-analysis of randomized controlled trials. Breast Cancer Research. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635995/
Fertility Centers of Illinois. (2019). 30 Affirmations to power happiness and positive thinking. Retrieved from: https://www.fcionline.com/fertility-blog/30-affirmations#:~:text=15%20fertility%2Dfocused%20affirmations%3A&text=I%20am%20ready%20to%20conceive,order%20to%20welcome%20a%20baby
Frederiksen, Y., Farver-Vestergaard, I., Grønhøj Skovgård, N., Ingerslev, H.J., & Zachariae, R. (2015). Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis. BMJ Open. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316425/
Graber, E. (2021). Nutrition and stress: A two-way street. American Society for Nutrition. Retrieved from: https://nutrition.org/nutrition-and-stress-a-two-way-street/
Gurevich, R. (2022). 7 Stress-related factors that can make it harder to get pregnant. Very Well Family. Retrieved from: https://www.verywellfamily.com/can-stress-keep-you-from-getting-pregnant-1959951
Haimovici, F., Anderson, J.L., Bates, G.W., Racowsky, C., Ginsburg, E.S., Simovici, D., & Fichorova, R.N. (2018). Stress, anxiety, and depression of both partners in infertile couples are associated with cytokine levels and adverse IVF outcome. American Journal of Reproductive Immunology. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/29528174/
Hutter Epstein, R. (2020). Does stress actually affect fertility? The New York Times. Retrieved from: https://www.nytimes.com/2020/04/17/parenting/fertility/conception-stress.html
Kubala, J. & Jennings, K.A. (2022). 15 Simple ways to relieve stress. Healthline. Retrieved from: https://www.healthline.com/nutrition/16-ways-relieve-stress-anxiety
Lateef, O.M. & Akintubosun, M.O. (2020). Sleep and reproductive health. Journal of Circadian Rhythms. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7101004/
Lynch, C.D., Sundaram, R., Maisog, J.M., Sweeney, A.M., & Buck Louis, G.M. (2014). Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study—the LIFE study. Human Reproduction. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984126/
Matthiesen, S.M.S., Frederiksen, Y., Ingerslev, H.J., & Zachariae, R. (2011). Stress, distress and outcome of assisted reproductive technology (ART): A meta-analysis. Human Reproduction. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/21807816/
Mayo Clinic. (n.d.). Meditation: A simple, fast way to reduce stress. Retrieved from: https://www.mayoclinic.org/tests-procedures/meditation/in-depth/meditation/art-20045858
Schliep, K.C., Mumford, S.L., Vladutiu, C.J., Ahrens, K.A., Perkins, N.J., Sjaarda, L.A., Kissell, K.A., Prasad, A., Wactawski-Wende, J., & Schisterman, E.F. (2016). Perceived stress, reproductive hormones, and ovulatory function: a prospective cohort study. Epidemiology. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315337/
Sharma, R., Biedenharn, K.R., Fedor, J.M., & Agarwal, A. (2013). Lifestyle factors and reproductive health: Taking control of your fertility. Reproductive Biology and Endocrinology. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717046/
Shuey, N. (2021). Alternative ways to meditate: They don’t involve just sitting still. RND4IMPACT Inc. Retrieved from: https://medium.com/@rnd4impact/alternative-ways-to-meditate-d42819ee62ec
Shuey, N. (2022). Does diet affect fertility? Timberline Nutrition. Retrieved from: https://www.timberlinenutrition.com/holistic-fertility/does-diet-affect-fertility
Silvestris, E., Lovero, D., & Palmirotta, R. (2019). Nutrition and female fertility: An interdependent correlation. Frontiers in Endocrinology. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6568019/
Weir, K. (2020). Nurtured by nature. American Psychological Association. Retrieved from: https://www.apa.org/monitor/2020/04/nurtured-nature?fbclid=IwAR2Qi-4vWhGoIjBGKYyisfIrgh30pW9N8yyLQHDNfhsVtKwusgitvA4LVOE
Winderlich, M. (2010). Stress and your menstrual period: A cycle that you can break. Everyday Health. Retrieved from: https://www.everydayhealth.com/pms/managing-stress-during-pms.aspx
Zhou, F.J., Cai, Y.N., & Dong, Y.Z. (2019). Stress increases the risk of pregnancy failure in couples undergoing IVF. Stress. Retrieved from: https://www.tandfonline.com/doi/full/10.1080/10253890.2019.1584181