Stress May Be a Factor in Women’s Ability to Conceive

“Just relax, dear.” The words are enough to incite even the mildest woman struggling with infertility into a fire-spitting rage. But those other purveyors of unsolicited childbearing advice may be onto something.

A growing body of scientific evidence is beginning to support the notion that stress indeed may play a role in the quest for a baby. The newest study, published in the October issue of Fertility and Sterility, found that women undergoing in-vitro fertilization who had higher levels of stress produced fewer eggs and so had fewer embryos to be transferred into their wombs than their more relaxed counterparts.

Conversely, women undergoing IVF who were the most optimistic about their chances of having a baby produced more eggs and had more usable embryos.

The finding surprised lead researcher Hillary Klonoff-Cohen, who expected to find that a woman’s anxiety about the procedure would be more important than her background stress level.

“Procedural stress is important, but I thought it would play more of a role,” said Klonoff-Cohen, an associate professor in the Department of Family and Preventive Medicine at UC San Diego. “It turned out that baseline stress was more important.”

Although the link between psychological distress and infertility remains controversial, studies have shown an association between depression and infertility. But the questions remain: Does depression hinder the ability to conceive children, or does infertility make women depressed?

“Most of these women were intact before infertility,” said Alice Domar, director of the Mind/Body Center for Women’s Health at Beth Israel Deaconness Medical Center in Boston. “The infertility destroys their coping mechanisms.”

To test the psychological connection, Domar looked at a group of women who had tried to get pregnant for one to two years. The women were divided into three groups: One set was enrolled in an infertility support group, one group was given other forms of psychological and emotional support and the third group was given fertility medication alone.

About half of the women in both types of emotional support groups got pregnant during the one-year study period, compared to only 20% of the women who got no emotional help.

Domar and her colleagues at the Mind/Body Medical Institute, which is affiliated with Harvard University, now run 10-week infertility support groups in which women learn skills that Domar says are vital for emotional health.

“If you are willing to change your lifestyle and work hard to get out of your depression, you will have a better chance of getting pregnant,” Domar said.

Relaxation is not a magic potion. Anatomical and biological problems are significant contributors to the inability to bear children and a full 40% of infertility is caused by problems with the male’s sperm.

And Klonoff-Cohen, who found lower rates of egg production in stressed-out women, said her research is only an early step in documenting the stress connection. But she said early psychological intervention with women struggling with infertility probably cannot hurt. “We’re realizing that a lifetime of baseline stress may play a role,” Klonoff-Cohen said. “With that information, as soon as a woman starts coming to the office, the clinician might want to start talking about that.”