Chapter 32

Stress and Infertility

Stress has become a buzzword today. It is one of the most over used words in our vocabulary – and one of the most poorly understood ones as well. Stress is defined as any event that a person perceives as threatening, and in order to protect itself, the body responds to stressors with a classic “fight or flight” response, which nature designed to allow survival. In response to stress, the hypothalamus produces a hormone called corticotropin releasing factor (CRF) which activates the hypothalamic-pituitary-adrenal (HPA) system, causing it to release neurotransmitters (chemical messengers) called catecholamines, as well as cortisol, the primary stress hormone.

The relationship between stress and infertility is still poorly understood today. While there is little doubt that infertility causes considerable stress, the question whether stress can cause infertility, and whether stress reduction can enhance pregnancy rates in infertile couples, is still very controversial.

Can Stress Cause Infertility?

Historically, infertility, particularly “functional” infertility, was attributed to abnormal psychological functioning on the part of one or both members of the couple. Preliminary work in the 1940s and 1950s considered “psychogenic infertility” as the major cause of failure to conceive in as many as 50% of cases. As recently as the late 1960s, it was commonly believed that reproductive failure was the result of psychological and emotional factors.

Psychogenic infertility was supposed to occur because of unconscious anxiety about sexual feelings, ambivalence toward motherhood, unresolved Oedipal conflict, or conflicts of gender identity. Fortunately, advances in reproductive endocrinology and medical technology as well as in psychological research have de-emphasized the significance of psychopathology as the basis of infertility, and modern research shows that there is little evidence to support a role for personality factors or conflicts as a cause of infertility. This perspective unburdens the couple by relieving them of the additional guilt of thinking that it is their mental stress that may be responsible for their infertility.

Biologically, since the hypothalamus regulates both stress responses as well as the sex hormones, it’s easy to see how stress could cause infertility in some women. Excessive stress may even lead to complete suppression of the menstrual cycle, and this is often seen in female marathon runners, who develop “runner’s amenorrhea”. In less severe cases, it could cause anovulation or irregular menstrual cycles. When activated by stress, the pituitary gland also produces increased amounts of prolactin, and elevated levels of prolactin could cause irregular ovulation.

Since the female reproductive tract contains catecholamine receptors catecholamines produced in response to stress may potentially affect fertility, for example, by interfering with the transport of gametes through the fallopian tube or by altering uterine blood flow. However, more complex mechanisms may be at play, and researchers still don’t completely understand how stress interacts with the reproductive system. This is a story which is still unfolding, and during the last 20 years, the new field of pychoneuroimmunology has emerged, which focuses on how your mind can affect your body. Research has shown that the brain produces special molecules called neuropeptides, in response to emotions, and these peptides can interact with every cell of the body, including those of the immune system. In this view, the mind and the body are not only connected, but inseparable, so that it is hardly surprising that stress can have a negative influence on fertility.