Fertility Week 2020

In the third installment of our Fertility Week 2020 series, MFC Clinic Director Prof Mary Wingfield discusses a frequently asked question: Does stress cause infertility?

From ‘The Fertility Handbook’ (Gill Press) by Prof Mary Wingfield.

How often are couples struggling to conceive told to ‘just relax’ or ‘take a holiday’ or ‘think positively’ and it will happen? Nothing upsets people more, even though they know it has been said with good intentions. And most people wish, ‘if it were only that simple’.

This is an old-fashioned concept that originated in the 1930s and was based on a small number of cases and inadequate information. Certainly there are couples who have had infertility for many years, who end up adopting a child and subsequently conceive unexpectedly. At our clinic, and every other fertility clinic, we see couples who have been trying to conceive for years, who have IVF, which may fail, and then unexpectedly conceive naturally. Or they are just about to start IVF and they get pregnant naturally. But sadly, for each of these couples, there are many more who never conceive naturally – so it is simplistic to say that ‘stress’ is the cause.

Couples with fertility problems prior to attending for treatment have not been shown to have higher levels of depression or psychiatric problems than the general population. They are more stressed and anxious, but this seems to be a result rather than a cause of the infertility.1 We also know that people reproduce despite very harsh conditions of war, famine, rape and poverty, so stress in itself does not cause infertility.

However, the relationship between psychological stress and fertility problems is complex. Some studies show a correlation between stress levels and subsequent fertility problems,2 but others don’t.3

We do know, however, that psychological stress can affect a couple’s relationship and libido, which may impact on their chance of conception if they are not having sex often enough. A higher frequency of male sexual disturbances including loss of libido and a decrease in the frequency of sexual intercourse has been observed in couples undergoing fertility investigations and treatments. Severe stress, eating disorders and depression can affect ovulation in women, but these are extreme cases.

What most couples wish to know is the impact of mild or moderate stress on fertility. My feeling is that most of us in modern western society are stressed due to work, money, travel, social media, the internet, constant messages and emails, etc. Any stress undoubtedly affects our health. It is unlikely that fertility is any different, but the effect is going to be different in different people and getting stressed over being stressed is certainly not going to help. Recent evidence seems to indicate that stress can reduce fertility but only if it interferes with the frequency of sex or if it stops people going for treatment when they need it.

References:

  1. Verhaak, C. M., Smeenk, J. M. J., van Minnen, A., Kremer, J. A. M. and Kraaimaat, F. W. (2005) ‘A longitudinal, prospective study on emotional adjustment before, during and after consecutive fertility treatment cycles’. Human Reproduction 20(8): 2253–60.
  2. Rooney, K. L. and Domar, A. D. (2016) ‘The impact of stress on fertility treatment’. Current Opinion in Obstetrics and Gynecology 28(3): 198–201.
  3. Boivin, J., Griffiths, E. and Venetis, C. A. (2011) ‘Emotional distress in infertile women and failure of assisted reproductive technologies: metaanalysis of prospective psychosocial studies’. British Medical Journal 23, 342: d223.

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