Stress, The Mind and Fertility

One of the most common experiences of men and women who face difficulties conceiving is stress. Infertility can have a big toll mentally as well as physically and it’s important to be aware that this is a normal response to very challenging circumstances. In this section, we look at:

• Infertility and stress
• You are not alone
• Does stress impact fertility?
• Stress and male fertility
• Navigating your fertility journey
• Manage life’s stresses
• Look after your mental health
• Deal with negative emotions and overthinking
• Be aware of addictions
• Work on a healthy mindset
• Practise yoga and meditation
• Protect your relationships
• Keep socialising
• Make a plan for better self-care
• Fertility counselling
• Keep going

Infertility and stress

The fertility journey can be a uniquely lonely and isolating experience because the feelings that come up are often not easy to share given the intensely private nature of what you face. It can be especially difficult knowing that many aren’t able to truly understand your pain. We know that the well-meaning but often thoughtless comments from those around you when it comes to the question of children or even passing a pregnant woman in the street can sometimes feel too much.

For those who have suffered the added burden of miscarriage or stillbirth, the loss and grief can be overwhelming. Many people who have fertility problems report feelings of guilt because of the emotions they experience including peaks of pain, anger, jealousy or even hatred with each passing pregnancy announcement. These are all things we hear from our patients.

When these feelings become overwhelming, many worry the stress will impact their fertility. It’s important not to deny or diminish these feelings, but having strategies to cope can help. Understanding how stress may affect you and then looking at practical things you can do to help yourself is important.

You are not alone

Being aware of these emotions as they pass through and seeking help where needed can make a difference, and there are many national and regional infertility groups including Fertility Network UK that can signpost you to support locally. Remember you are not alone. All the emotions you are experiencing are completely understandable and shared by many.

Does stress impact female fertility?

It’s natural to worry that all this stress will impact your chances of conceiving, and this is an area that has been the subject of intense debate over recent years. Though there is still controversy, one popular narrative in the fertility sector at the moment is that stress does not lead to difficulties conceiving either naturally or via IVF, rather that infertility causes stress.

This is based on high-quality research by psychologists who have not found an association between self-reported stress and IVF outcomes. One such meta-analysis of 14 studies concluded that emotional distress does not reduce the chances of pregnancy. A conflicting meta-analysis, however, found a small but significant association between stress and reduced chance of conceiving. Psychology-based studies do have limitations, however, so this isn’t conclusive evidence as there are biological consequences of stress that do have the potential to affect reproductive pathways.

One indicator of stress in the body is the hormone cortisol. Recent research from the University of Nottingham investigated cortisol levels laid down in hair grown in the three months prior to fertility treatment. Cortisol is secreted from the adrenal glands, which sit just above your kidneys and produce hormones that help regulate key bodily functions such as the stress response, metabolism, immune function, blood pressure and healthy gastrointestinal function. Cortisol production is stimulated by signals from the pituitary which in turn is controlled by the hypothalamus in the base of the brain – the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis acts as a kind of master switch of the body’s stress response and is very sensitive to stress. Researchers found that increased cortisol was indeed associated with reduced IVF success. It is also well known that the increase in cortisol levels triggered by stress can negatively affect many different aspects of health, including sleep quality.

The physical manifestations of stress can be explained by the evolutionary ‘fight or flight’ response to threat. In other words, human beings evolved in a world where they faced much greater physical threat from predators and, like other animals, they would have had to either fight the predator or run away in order to survive. When faced with threat, a number of changes are triggered in the body that are designed to maximise survival. A cascade of stress hormones initiates well-orchestrated physiological changes in response to a stressful incident. These include increases in breathing and heart rate, and blood flow directed to muscles and away from other organs (including reproductive ones) to maximise energy supply to power the escape, or to fight to defeat the threat.

The Nottingham research suggests that more long-term stress may impact fertility, perhaps contrasting to the more short-term stress reported around the time of IVF treatment in many studies conducted by psychologists. Again, conclusions from these studies are debated and other studies looking at more short-term measures of cortisol have yielded mixed results. This is because the interactions between stress and our individual’s body’s responses are complicated, and studies may not always be able to account for some of this complexity.

While the jury is still out on this, it’s important to remember that the effects of stress are temporary. Stress is part of everyday life and we can’t avoid it entirely and insulate ourselves from each and every source of worry and anxiety. We don’t need to eliminate all stress from our lives in order to improve our well-being. Remember it is likely that short-term stress around the time of IVF treatment does not have a significant effect. Whatever the reality, however, it’s helpful to devote time to things that can counter the effects of stress and focus on your well-being rather than being falsely reassured that you don’t need to do anything at all. This is important for a healthy pregnancy and your well-being as a new mother, too. In fact, some research shows that the ability to cope may moderate the impact of stress on your body including on the menstrual cycle, so taking care of yourself and taking steps to mitigate any stress you experience will always be helpful. We can’t exist in a bubble and there are many things that impact health in fertility in both men and women – accepting this and doing the best we can in a balanced way without blame is the key.

Stress and male fertility

Although teasing out cause and effect when it comes to male fertility is always difficult as it only takes one good sperm cell out of an ejaculate of millions to fertilise an egg, studies do show that psychological stress can impact semen parameters. Stress may affect spermatogenesis through the impact on testosterone secretion and the HPA axis can inhibit reproductive function in the testes. Whether this has a meaningful effect on fertility in men is hard to say but, as with female fertility, taking steps to alleviate stress will always be good for general health and in preparation for parenthood.

Navigating your fertility journey

Having a positive, proactive strategy to cope with your emotions and manage stress at what can be a very stressful time can make a big difference. There are some important steps we recommend to our patients that help.

Manage life’s stresses

While the impact of stress on fertility is debated, you will feel better if you take steps to mitigate against the effects of stress:

• Minimise avoidable or very significant stressors where possible. For example, if there is serious conflict in your wider family or friendships and contact depletes you emotionally, recognise the source of this stress and try to manage boundaries and contact so that you don’t feel this as a constant.
• Recognise the impact that chronic ongoing stress is having on your life. This is essential in protecting the long-term health of both men and women. If there are things that are a source of constant ongoing stress that you are able to change, prioritise doing so where this is possible.
• Allow more time to recover emotionally if you have experienced more than two or three significantly stressful events in the last year (e.g. moving house or serious illness of you or a close family member) or one major trauma (e.g. bereavement or serious accident). Trauma leaves a lasting impression physically as well as emotionally, so taking a mind–body approach is most effective. Many people are keen to have IVF treatment as soon as possible after being referred for treatment, but often pausing and giving yourself this time where needed can make all the difference.

Look after your mental health

Infertility can affect mental health and be a cause of depression and anxiety. A previous termination can rear its head psychologically, for instance, or a nagging anxiety, when explored, can point towards unresolved childhood trauma, perhaps revealing a lack of safety and security in a person’s upbringing such that they either consciously or subconsciously fear they will not be able to provide an emotionally safe environment for their own child.

It’s helpful to at least understand your own emotional landscape in order to be able to help yourself and prepare for the future that is so desired. That isn’t to say we should strive to be perfect or ‘fixed’ – nobody goes through life sanitised from pain and suffering – but that we should seek to heal what we can in preparation for pregnancy and parenthood.

By looking at these things, you can use the preconception period to think proactively about your mental and emotional well-being. Given one in three of us will suffer from mental health issues at some point in our lives, this is something we should all be taught from a young age but, in the absence of that, preparing for parenthood is an excellent opportunity and a way of laying the foundation for this work with your children. Support is always available and you can start by speaking to your GP.

Deal with negative emotions and overthinking

Feeling your feelings is an essential part of coping with them. However, a tendency to ‘ruminate’ on worries and negative thinking without processing feelings in a healthy way is a significant contributor to anxiety and poor mental health. Recognising a tendency to ruminate without repressing emotions is an important first step. It may be helpful to see a counsellor or therapist. Ask your doctor to be referred or see the British Association for Counselling and Psychotherapy (BACP) website. Every country will have its equivalent. Be aware of negative thoughts and don’t allow them to spiral out of control. Keeping a worry journal can also help: have a dedicated slot to write down any negative thoughts and emotions at the end of the day to get them out before you sleep. A healthy diet, regular exercise and getting out in nature are all positive strategies too.

Be aware of addictions

Many people believe addictions are restricted to alcohol, smoking, drugs and damaging behaviours like excess gambling. But we can use a whole range of things to soothe emotional pain, escape day-to-day reality or distract from confronting unwanted feelings. As well as drugs and alcohol, this can include addiction to work, money, status, power, sex, shopping, cosmetic procedures and cleaning. Also be aware of unhealthy habits and attitudes to foods: emotional eating, binge eating, starving, control or eating disorders. Food (or its restriction) can be used to soothe emotional pain. Seek help if there are things that you aren’t able to manage and start by speaking to your GP.

Work on a healthy mindset

Working on the way you think about your experiences can help you cope with your emotions as you navigate your fertility journey. Focus on what you can control: do your best with the things that are under your control and try to let go of and accept what you can’t. It’s so easy to allow tension to creep in and end up feeling knotted up inside with all that you are trying to manage. Often people aren’t aware of the tension they are holding in their bodies as they grasp tightly to what they want. Develop a routine that includes bodywork that helps release some of the tension: that could be a form of exercise including a regular yoga practice. Keeping a gratitude journal and remember each day the things you are grateful for can help balance out the intense focus on trying to conceive.

Practise yoga and meditation

There are studies demonstrating the physical benefits of yoga and meditation, including on inflammatory markers and stress hormones like cortisol, all things that may impact the ability to conceive. Having a regular practice can certainly help alleviate the negative aspects of stress so this is something we routinely recommend to our patients.

Protect your relationships

Another area that can come under strain when trying to conceive is our relationships. Infertility and IVF can be emotional and stressful, and this can spill over into how we relate to partners, friends and family. These can be difficult times for your most intimate relationship, with your partner, and it may affect each of you differently and at different times. Remember that simple kindness to yourself and each other will help you get through what is often a challenging time. Being supportive of each other also helps to maximise benefits of a preconception care period and turns it into a positive experience. One study showed that making lifestyle changes with a partner improved weight-loss outcomes, for instance.

Facing fertility problems can also impact sex and intimacy, especially when sex is scheduled month in and month out to coincide with ovulation, so it’s important to be aware of this. Making a conscious effort to maintain sex and intimacy will not only help in trying to conceive, it will help to de-stress, and remain happy and hopeful. Sex and intimacy are beneficial for emotional well-being, and sex also produces a bonding effect due to the release of coital oxytocin, the ‘cuddle’ hormone. Having spontaneous sex in the second half of your menstrual cycle when you are past the fertile window can help avoid intimacy becoming a chore intended only for procreation.

Relationships with wider family and friends, including parents, siblings and work colleagues, can all be put under strain and vary according to how open you choose to be with them about your circumstances. Some people find it easier to keep everything very private, which can mean those around you won’t always be as sympathetic as you would like when you’re struggling. Choosing to tell others about what you are going through can mean you have more support, but they will often say the wrong thing, hit a nerve when you don’t feel like talking about it or not ask how you are enough because they simply don’t know what to say. Be aware of all of these things and try to be forgiving of yourself and those closest to you.

Keep socialising

When facing fertility problems, it’s common to stop doing the things you enjoy as fertility treatment can be all-consuming. Some couples stop socialising and avoid occasions where they are likely to meet children or pregnant women. All of these things are completely understandable and you certainly don’t have to go to baby showers if they make you feel terrible. However, we always encourage our patients to try to enjoy and make the most of what they have now. Life has its phases and the things that you may take for granted now, you will miss later.

Make a plan for better self-care

Recognising the importance of self-care and proactively fostering good emotional well-being is the first step. The second is knowing what to do about it. In its simplest form, self-care is about being kind to ourselves and accepting ourselves as imperfect human beings. You can make a plan by addressing main areas of your life including body, emotions, work, relationship and so on. We go into more detail about making a plan for self-care in our Fertility and Preconception Care course.

Fertility counselling

All fertility clinics are obliged to have counsellors who are trained in all aspects of fertility therapy, so that they understand fully the social and legal implications of complex issues such as donation, fertility preservation and surrogacy. It is mandatory for you to have counselling when having these treatments and for donors and surrogates too, without any charge, whether through NHS or private clinics. In addition to implications counselling, you may benefit from support counselling, for support during treatment, after unsuccessful treatment or at other times, for example if you have experienced miscarriage or other complications. You may also need counselling to discuss options for moving from one treatment to another, such as using donor eggs rather than your own eggs, or the difficult discussion as to when to discontinue treatment altogether.

Genetic counselling is also essential if you carry the risk of genetic problems or need treatments such as pre-implantation genetic testing (PGT). These issues may be very complex and you may need several sessions in order to ensure you make the right decisions for you about which treatment to have and when.

If you choose to seek the support of other therapists, such as those who practise meditation, acupuncture, reflexology, yoga, etc, these can provide enormous comfort, support and therapeutic benefit. Detailed advice from a properly trained fertility counsellor can, however, be invaluable, so do use your local services to support you.

Keep going

When you’re in the middle of challenging circumstances, it can often feel like you’re stuck, but the simple capacity to keep putting one foot in front of another and reminding yourself to just keep going can help spur you on.

References

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