The Weak Link Between Stress and Infertility

Despite inconclusive evidence, the idea that stress harms conception persists—and it’s stressing women out.

Stressed-out women have a harder time getting pregnant? The message persists despite a lack of evidence.

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If you’re a woman in America trying to get pregnant, you’ve probably heard about that long contentious list of all the things you’re not supposed to do that might hurt your chances of conceiving: Smoking. Drinking. Exercising too much. Not sleeping enough. Weighing too much or too little. Consuming too much caffeine or too many carbohydrates.

But the one getting a lot of media attention lately? Stressing out. Doctors and grandmothers alike have long suspected that a woman’s inability to relax is to blame for her infertility troubles. The theories range from the more scientific (stress might mess with a woman’s delicate hormonal balance and ovulation timing) to the homespun (stress isn’t nature’s best aphrodisiac and results in couples having less sex).

However, the hype around stress as a cause of infertility isn’t warranted. Firstly, stress research is notoriously problematic, since it’s hard to pinpoint what causes what: Was a patient stressed to begin with or did she become stressed after being diagnosed as infertile? Also, it’s hard to objectively assess stress levels, considering that some studies rely on self-reports or don’t take into account how people experience stress differently. In fact, it seems as if for every study supporting an association, another refutes it. A recent study that appeared in Fertility & Sterility found a connection between stress and lower fertility by measuring a stress biomarker in women’s saliva, yet another article pointed out that the link isn’t so clear, since caffeine, food intake, and exercise can also make that biomarker rise.

When Danish researchers reviewed 31 studies on whether stress, anxiety, and depression played a role in whether infertility treatments worked, their conclusion was that the influence of psychological factors appeared to be “somewhat limited.” If the data are so spotty, why does the message persist that stress is bad for fertility?

For starters, it’s convenient. Infertility, like autism, remains one of modern medicine’s greatest mysteries. Fertility doctors know why a 45-year-old woman can’t get pregnant, but they don’t know what’s wrong with up to one-third of their patients who are struggling to conceive—causing them to diagnose them with “unexplained fertility.” As a society, we wonder if we’re suffering from lurking environmental toxins or secret sexually transmitted diseases. But stress is an easy explanation. And it fits nicely with the cultural imperative that stress is something that we can—and should—manage at all times. Aside from sex, weight loss, and the Kardashians, it seems to be the next most popular subject in magazines these days.

For a woman trying to conceive, the idea that she can do something proactive—practice yoga, meditate, pop fish-oil capsules—is wonderfully appealing. It gives her a sense of control over a process that is frustratingly uncontrollable. The problem, of course, is that no one can control her stress levels all the time. We are going to get annoyed at delayed traffic, inconsiderate partners, and unrealistic bosses. We are going to carry tension in our shoulders and feet. And women who are trying to get pregnant experience a whole other level of misery: Scheduled sex is stressful. The cost of infertility treatment is stressful. “It’s living in the whole fertile world where you don’t fit in. Baby showers or meeting other people’s newborn babies compound stress,” says Carol Fulwiler Jones, an Atlanta-based infertility counselor and author of Hopeful Heart, Peaceful Mind: Managing Infertility.

However, all this focus on enforced relaxation often just makes women feel worse. “When women hear things in the press about the causes of infertility, they feel guilty that they’ve done something that prevented them from getting pregnant,” explains Sharon Covington, a psychologist at Shady Grove Fertility Center in Washington, D.C., who reminds patients that many women who have endured severe trauma, such as the Holocaust or rape, still got pregnant. “There is nothing worse than hearing a family member say, ‘You’re way too stressed out’ or ‘You’ve just got to relax.’ It’s not something they can turn on and off.”

The message can also set a woman up to be blamed for her infertility. It’s not a far stretch to imagine husbands and partners accusing her of “not really making an effort” if she lets herself get worked up while trying to get knocked up. (Researchers are discovering that stress may harm men’s sperm, too, but that headline doesn’t get as much attention!) More insidiously, society may adopt a standard about how such women should behave. It’s bad enough how certain people feel it’s OK to glare at some poor pregnant woman sipping a single light beer (even though the jury is out on that issue, too). Will we now start the policing even earlier?  If we see a friend whom we know is “trying” screaming into her cell phone, should we feel compelled to confront her or quietly slip her some chamomile tea and aromatherapy candles?

Women generally feel bad enough about not being able to get pregnant. They already feel enough shame about their malfunctioning bodies and disappointed partners. Last month, Redbook magazine and Resolve: The National Infertility Association launched the “No Shame Campaign: The Truth About Trying” video series featuring celebrities, including Padma Lasksmi and Sherri Shepherd, sharing their stories about the emotional pain of infertility. Adding to a woman’s burden of being told to “chillax isn’t clearly helpful—to her cause or emotional well-being.

Stress researchers admit that even if came up with overwhelming evidence that stress causes infertility, they are at a loss how to design a proven stress therapy that helps women get pregnant. Currently, fertility clinics are increasingly offering “mind-body” programs, consisting of stress management and cognitive behavioral therapy exercises, such as breathing or visualization. But administrators say the main goal is simply to help women feel better—not necessarily improve their chances of conception. At the very least, the meditation might be a nice break from thinking about making babies.