The question about if and how stress can influence fertility still isn’t fully resolved in the world of fertility. There are many different research projects in the space that have tried to identify the implication that stress can have on your body. In the case of physical stress a strong link to infertility could be established, but in other cases there is still some research to be done.
Unfortunately, research in this area is highly complex because of the variety of factors that must be taken into account. It is important to differentiate between the psychological and the physical effects of stress on the body. Physical stress is caused by external environmental factors or physical demands of the body such as heat, illness and dehydration. Psychological stress is created internally through cognitive or emotional factors such as anxiety or depression.
The insufficient distinction between these effects can be confusing to those of us who aren’t doctors or fertility specialists. When you read about a study that concluded that stress leads to infertility, read closely to discover exactly what kind of stress it should first be established what exactly is meant.
Physical stress can lead to anovulation
The link between physical stress and a woman’s menstrual cycle in the case of physical stress is well-established, and can lead to hypothalamic amenorrhea,1 a condition where menstruation stops during several months due to a problem in the hypothalamus, which is responsible for producing the hormones that cause you to menstruate and ovulate.2
Psychological stress decreases your odds of pregnancy
When talking about psychological effects an additional differentiation has to be made between direct and indirect effects of stress. An indirect effect is for example when a couple’s sexual activity changes because they feel stressed and hence are having less sex. In this case, stress is not the direct causation of the infertility, but the fact that the couple is not having enough intercourse or only has it at the wrong time. This type of cause of infertility is intuitive and in that regard it is clear that stress impacts infertility indirectly.
What still isn’t fully resolved is if and how psychological stress affects fertility directly. A recent US study was able to demonstrate a link between stress and time-to-pregnancy (TTP) as well as infertility. The women were divided into three subgroups of stress levels. The stress level was measured by the change in salivary alpha-amylase production which is produced by the parotid gland. When something is perceived as stressful the amount of salivary alpha-amylase increases. The results of the study showed that women in the group with the largest increase in salivary alpha-amylase had 29% decreased odds of pregnancy and had a longer time-to-pregnancy (TTP). Women in the middle stress group were 7% less likely to conceive.3
There are a few limitations to the study and the result should not be interpreted without questioning it. The study only collected two saliva samples of every woman participating in the study, one on the morning after enrollment in the study and one the morning following their first observed menses. What might have led to misleading results is that there is no research on changes of salivary alpha-amylase during a woman’s menstrual cycle that the researchers were aware of. Even though the study has shown a link between psychological stress and infertility, more research is required in order to a give a conclusive answer.4
Stress can also affect a man’s fertility
Male infertility is responsible for about half of all explained infertility cases, so if a couple is having difficulty conceiving, it’s important to take into consideration both parties’ fertility when trying to diagnose and address any issues that may arise.5
A research project by the Columbia University found that the sperm quality for men with two or more stressful events in the past year decreased compared with those who did not experience any stressful life events. They men experiencing stressful events showed a lower percentage of sperm movement (motility) and a lower percentage of sperm of normal shape (morphology), which are the two most important factors determining the fertility of a man.6
Stress impairs your chances of conceiving
It has been shown that stress can affect the female as well as the male sexual partner in different kinds of ways. Feeling stressed can have a negative influence on a couple’s sexual activity and it has also been established that physical stress affects a woman’s reproductive system by causing irregular menstruation. In regards to the effects of psychological stress on fertility no definitive conclusion could be drawn for the available research. However there is a clear tendency towards stress having a negative impact on a couple’s chances of conceiving and should hence try to be avoided while TTC.
- Chrousos GP, Torpy DJ, Gold PW. Interactions between the hypothalamic-pituitary-adrenal axis and the female reproductive system: clinical implications. Ann Intern Med 1998: 129:229-240 ↩
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NIH). (2013 March 03). “What causes amerorrhea.” “Retrieved November 15, 2015, from https://www.nichd.nih.gov/health/topics/amenorrhea/conditioninfo/Pages/causes.aspx ↩
- Lynch, C.D., Sundaram, R., Maisog, J.M., Sweeney A.M. and Buck Louis G.M. (2014). Preconception stress increases the risk of infertility: results from a couple-based prospective cohort- the LIFE study. Human Reproduction. Vol. 29 (5). pp-1067-1075. ↩
- Lynch et al: See above. ↩
- Mayo Clinic Staff. (2015 August 11). Male Infertility. Retrieved 2015 November 29 from http://www.mayoclinic.org/diseases-conditions/male-infertility/basics/definition/con-2003311 ↩
- Mailman School of Public Health. (2014 May 29). “Stress Degrades Sperm Quality”. Retrieved November 15, 2015, from https://www.mailman.columbia.edu/public-health-now/news/stress-degrades-sperm-quality ↩