Stress and Fertility

Stress and Fertility

How Does Stress Affect Your Fertility?

By:  Dr. Lisa Doran ND

The longer I work with women in our Barefoot Health Fertility program the more I have seen a distinct pattern emerging.  Not only are women waiting longer to have their families but they are reporting much higher levels of stress in their lives. The modern woman is juggling more variables, is more time limited, is processing more information and facing increasing psychological demands.   Many women often feel that they are just barely coping with the demands in their life,  and that they are overwhelmed.  However they feel that they need to maintain the responsibilities of a work life and a home life and often their own sense of living their own personal life is diminished because they feel spread too thin.  As one of my patients recently said “Everyone else seems to be managing all right, why am I struggling so much with this?”     Many women are not aware of how much stress they are handling each day nor how to be sure that their stress response returns to normal after a stressful event.

Our Stress Response System

Our stress response system is a wonderful system that we have in place to ensure our survival.  It is meant for us to be able to run faster, fight harder and think more clearly when our lives are in danger.  When we are stressed our brain signals our bodies to shunt blood flow from our digestive tract to our muscles, our heart rate and respiration rate increases, we release stored energy to feed our working muscles, and our mental focus can become very clear.

The problem is of course that in today’s world we seem to be activating this emergency response system for everything from forgetting our favourite gloves in Walmart to being late for a meeting.  Neither one of those things are life-threatening but I can tell you from personal experience that both will activate your stress response.

It’s The Little Things that Add Up

Most people’s perception of the type of stress that would interrupt the production of fertility hormones or the process of conception are major life stressors like a car accident or a death in the family.  Often we don’t notice the little things that cause stress and the importance of the psychological responses to those stressors in our environment.  Noise, a never ending to-do list, bright lights, crowded supermarkets, a line-up at the bank, interrupted sleep, relationships that are strained, not taking holidays – all of these small items add up to enough stress to impact our fertility.  Research is very clear:  psycho-social stressors can change our fertility hormones and make it very difficult to conceive.

This is an exercise that I have taken from Depak Chopra’s wonderful book   Magical Beginnings Enchanted Lives and it’s simple and effective exercise to do.  Sit comfortably in your chair, hands folded in your lap and close your eyes.  Breathe deeply for a moment until you feel grounded.  Now read the following statements and note your body reactions.

Imagine hearing a shrieking ambulance go by

Imagine listening to a Bach violin concerto

Imagine being stung by a bee

Imagine holding a baby in your arms

Imagine witnessing an automobile accident

Imagine watching a dramatic sunset

Imagine tasting a bitter medicine

Imagine biting into a juicy, sweet mango

Imagine the smell of a skunk

Imagine the aroma of a Hawaiian flour

Each of these sensations, pleasurable or uncomfortable, imaginary or real, changes your body.  When sensory stimulation is soothing, your body releases hormones that create a sense of well-being and health.  When it is toxic or negative, stress hormones are released.  Remarkable, isn’t it?

Are You Stressed?

Keep a stress journal.  This is one of my favourite homework activities for patients.  I will discuss how to identify how stress “feels” in my patients body during our visit.  For example:  do you notice that your heart races, or that your become irritable or short tempered?  Do you notice that you may feel a tightness in your chest?  People can experience stress differently and different symptoms will manifest in response to stress.  Stress effects every area of the body and can cause a variety of symptoms including headaches, upset stomachs, muscular tension, decreased sex drive, teeth grinding, tightness in the chest, feeling dizzy, insomnia, and of course changes in the menstrual cycle.  If you start to pay attention then you can begin to track those body sensations and understand that your stress response has been activated.  Once you can start to identify when you feel stressed you can then work backwards and think about the things that were happening around you as your body began to feel that way.  I discovered that I find crowds distressing when I was on the subway one day and I found myself staring at the ceiling of the subway car and taking rather shallow breaths.  As I thought about that circumstance I realized that frequently when I am on a busy subway car I will look at the ceiling and not at the passengers around me.  This was my way of handling the stress I felt in that circumstance.

How Stress Affects Your Fertility Hormones

As I have explained above, the stress response equals short term survival from an immediate threat.  Therefore anything to do with long term planning such as digestion, bone building and most of all reproduction  is going to be decreased or abandoned.  Reproduction is too physiologically expensive to be spared during the stress response.  A variety of endocrine regulatory points exists where stress limits the efficiency of reproduction,  the entire  hypothalamo–pituitary–adrenal response is delayed.  We also have endocrine evidence to show that stressors interfere with precise timings of reproductive hormones release within the follicular phase of the female cycle.   In stressed individuals we see a reduction in gonadotrophin-releasing hormone and a resulting delay of the onset of the luteinising hormone (LH) surge.  The reduction of these hormones causes a cascade of effects which ultimately deprives the ovarian follicle of adequate hormonal support  leading to reduced estradiol production by slower growing follicles.  Uterine linings are thinner due to lower estrogen levels and Egg maturation does not happen, therefore FSH levels spike.  Stress effects our fertility hormones in a profound and complete way.

Cross Generational Effects of Stress

Epigenetics has become an exploding field of research and study.  We are learning that what affects mothers during their pregnancies can impact their daughters during their pregnancies through “programming” that happens in-utero.  The stress we feel today can affect our grand-daughters in a very real and physiological way.  There are good studies to show that our endocrine or hormonal systems are particularly vulnerable to this effect.  The way we cope with stress, our thresholds for feeling anxiety, our metabolic processes for insulin sensitivity and glucose metabolism  (read here how easy or difficult it is to loose weight) might be due to the stresses our mothers felt during their pregnancies.

The Stress of Assisted Conception

We work with many families who are undergoing IUI or IVF assisted conception attempts at Barefoot Health.  Stress management is most important in this group of people because they are particularly vulnerable to the stress that is caused by the assisted conception programs they are enrolled in.   Research is again very clear:  the process of cycle monitoring, frequent visits to the fertility clinic, blood draws, injections of drugs, timed intercourse, waiting those long two weeks to do a pregnancy test all take a toll on people.  Relationships are stressed, marital separations are increased,  intercourse is less pleasurable, sexual performance, ability and  identity is questioned.  Anxiety around conception, especially for women, can reach extremely heightened levels.  It is very important that couples who are undergoing assisted conception techniques seek support through counselling and therapy – weather they perceive they are under stress or not.

How Can You Lower Your Stress and Increase Your Fertility?

There are no easy answers when it comes to stress management because we all seem to have a real identity investment in the things that keep us busy and stressed.  Our jobs, our commutes, the extra courses we want to take, the marking we have to stay up until midnight to complete, the teams we coach, the committees we sit on.  In the end it really does take a major de-cluttering of the time in our lives in order to lower our stress.  Lowering stress means creating time in our lives for things like exercise, stillness and quiet, a nap.  I have had patients look at their stress, keep stress journals and realize that their commutes are too long or their jobs are too stressful to be sustainable and create happiness and they make big changes to their lives.  I have had patients who decide that the evenings are their own and they begin to say no to requests that would take up their personal time in the evenings.  I am sure if you began to look at your weeks that you would be able to find things that perhaps are not essential parts of your life and you can start to carve out time to nuture yourself.

Some ideas:

1.  Exercise is a great Stress-Buster.  30 minutes every day
2. Sleep.  Get 7-9 hours of sleep if you can.   Try napping in the afternoons if you are tired.
3. Getting outside in the fresh air has been shown to reduce stress response.
4. Loving touch with your partner that isn’t about baby-making will help you to lower your stress levels.
5. Learning to meditate or taking time to simply be still or prayerful
6. A gratitude journal – list 3 things each and every day for a month that you are greatful for – and then create more time in your life for those things
7. Adaptogenic Herbs such as Withania, Rhodiola, Polygonum, Eleuthrococcus or Holy Basil can be very useful.
8. Use healthy vitamins:  B vitamin Complex, Vitamin D and Omega 3’s can be useful.  Ask your ND for help in deciding which are appropriate for you.
9. Using Acupuncture or Massage to help with relaxation are wonderful tools.

Conclusions

Stress is an important and often over-looked issue with couples planning a pregnancy.  Identifying stressors, reducing stressors, coping with stress better are all aspects of preparing for a healthy pregnancy.

References

1.   Andrews FM, Abbey A, Halman, L   Is fertility-problem stress different? The dynamics of stress in fertile and infertile couples. J Fertility and Sterility [1992, 57(6):1247-1253]
2. Austin et al. Maternal trait anxiety, depression and life event stress in pregnancy: relationships with infant temperament Early Human Development  Volume 81, Issue 2 , Pages 183-190, February 2005
3. Harrison RF, O’Moore RR, O’Moore AM  Stress and fertility: some modalities of investigation and treatment in couples with unexplained infertility in Dublin. International Journal of Fertility [1986, 31(2):153-159]
4. Herrenkohl LR  Prenatal Stress Reduces Fertility and Fecundity in Female Offspring.  Science (New York, N.Y.) [1979, 206(4422):1097-1099]
5. Paris AL, Ramaley JA   Adrenal-Gonadal Relations and Fertility: The Effects of Repeated Stress upon the Adrenal Rhythm  Neuroendocrinology 1974;15:126–13