Myth busting: does stress affect fertility?

Myth busting: does stress affect fertility?

Struggling to get pregnant can bring on feelings of inadequacy, as some of my friends have told me. Both males and females experience the stress of dealing with infertility " when you can't get pregnant after a year of trying. If you're a man, the signs are hidden. But it's very visible when a woman isn't pregnant. Even having a period can become anxiety-inducing. On top of feeling flawed, my not-yet-expectant friends worry that worrying too much makes it even harder to conceive.

But breathe easy " or as easy as your anxiety will let you. If you're ovulating on schedule, stress doesn't really make it harder to get pregnant, says Dr. Eve Feinberg, an OBGYN who specializes in reproductive endocrinology and infertility at Northwestern Medicine in Chicago.

"I feel like people stress that they're too stressed out, but there's really no data to say that stress affects fertility," says Dr. Feinberg.

Dr. Feinberg explained that one way stress might affect fertility is by interfering with ovulation. At the start of the menstrual cycle, the brain sends out a signal to the pituitary gland to produce follicle stimulating hormone (FSH) and prepares a new egg. Studies show that chronic stress can suppress these signals and disrupt ovulation, resulting in functional hypothalamic amenorrhea (FHA). It's hard to say exactly how many people experience an occasional disrupted cycle from stress, but research shows FHA causes 20-25 percent of secondary amenorrhea cases " three consecutive cycles of missed periods " and at least 3 percent of primary amenorrhea.

"When women are very stressed out, they may not secrete FSH and so they may not release an egg every month or the timing of that release may be altered," says Dr. Feinberg.

If you're ovulating regularly " you can take a test at home to find out " then the direct effect of stress on your ability to get pregnant, at least according to recent research, is probably negligible. However, much of infertility is unexplained, and there are some byproducts of worrying that can impede your reproductive success. Here are some ways to think about fertility that might help you conceive without having to quit your job in order to avoid stress.

Performance anxiety

Since there is so much pressure placed on sex around the time of ovulation, patients who have trouble with infertility often have performance difficulties, says Dr.Feinberg. This can make either party less interested in sex " which you have to engage in to get pregnant. But in males, this can lead to erectile or ejaculatory dysfunction. "Obviously for a male, you have to have an orgasm in order to ejaculate, to get the sperm in the right place," says Dr. Feinberg.

It has been hypothesized that a female orgasm can lead to higher conception rates because the uterus contracts, sucking the sperm in like a vacuum. But there's no data to really support this, so don't panic if you're not climaxing every time. What having an orgasm can do is make sex more enjoyable, which can encourage a couple to do it more often, increasing the opportunities for the egg and sperm to meet.

Throwing in the towel too soon

Patients who continue their infertility treatments are the ones who are the most likely to get pregnant, says Dr. Feinberg. Treatments that increase the likelihood of conception include intrauterine insemination, where a doctor places sperm inside the uterus, and in-vitro fertilization, when a doctor extracts an egg, fertilizes it, and places it back in the uterus. Unfortunately, some frustrated couples stop treatment too early.

"Stress can make people feel helpless and hopeless," says Dr. Feinberg. "Therefore, life's stress can impact their ability to get pregnant because they're not following through with their treatments."

When to test your fertility

Unfortunately, you can't just go in and get your fertility evaluated in one fell swoop. There isn't one specific test that will tell you whether or not you can conceive. So you'll have to try for at least a year " six months if you're over 35, when natural fertility rates start to decrease " before you're considered infertile.

The fertility "levels" that are then measured mostly relate to ovarian reserves and function in females and sperm concentration or motility in males. Other female tests involve making sure estrogen and FSH levels are where they should be, the thyroid is working properly, and figuring out if there's an anatomical problem like a blocked Fallopian tube or endometrial adhesion.  

If you're having trouble conceiving, make an appointment with a board certified endocrinologist or a certified infertility specialist to figure out what's going on, says Dr. Feinberg. But even if you're stressed " and let's face it, we all are "it's not likely the major cause of your struggles.

"A lot of people place the blame on the woman, saying "˜Oh, relax and you'll get pregnant,'' says Dr. Feinberg. "As long as a woman is ovulating every month, the impact of stress on fertility is really negligible."

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