On Fertile Ground

There's intriguing evidence that stress can influence a woman's chances of getting pregnant. Welcome to the conception conundrum.

By Lori Oliwenstein, published on November 01, 2005 - last reviewed on March 10, 2008

Patricia and Derek couldn't have chosen a worse time to begin trying to conceive. Derek's sister had just died, completely unexpectedly. Still, it was that event that pushed them to make up their minds in the first place.

Though stressful, "it was a crystallizing moment for both of us," Patricia recalls.

But after nine months of trying, the couple sought out a fertility specialist and began a regimen of treatment that millions of women are currently undergoing, many in its most high-tech form, in vitro fertilization (IVF).

"Each month was another cycle of stress and depression," Patricia recalls. "Do the meds, do the drugs, do the blood tests, have the ultrasound, have sex, wait for test results, do the meds, do the drugs... Then you get your period, and it is like a death. But you only have a few hours to grieve before you have to start the pills and the needles and the tests again."

After three months, Patricia was both literally and figuratively sick and tired of the process—and more stressed than ever. When their physician suggested the couple take a break before considering the next step, Derek and Patricia knew it was the right thing to do.

"After two months of being off any treatments, I was still feeling sick: weak, fatigued, nauseated," Patricia says. "I was pretty frustrated, so I called my doctor to ask when we might resume treatment. She asked when my last period was, and I told her I still hadn't gotten a period since our last failed treatment in early June."

Andy—Patricia and Derek's son, conceived during their very first "off-treatment" cycle—was born in April of 1997.

Patricia and Derek's story is the kind that will likely make anyone wince who has wrestled with fertility issues. If you've tried to become pregnant and had even the slightest hint of trouble, you've probably been told one or two—or a dozen—similar tales, most of which end with the cliched assertion that if you want to get pregnant all you have to do is stop trying so hard and relax. It's enough to make you want to strangle someone.

According to the American Society for Reproductive Medicine, well over 6 million Americans—about 10 percent of those of reproductive age—struggle with infertility, which is defined as not being able to achieve a pregnancy after trying for 12 months (six, if you're a woman 35 or over). Those aren't the most encouraging numbers, but what is perhaps most disturbing about them is that you rarely know ahead of time whether they do or don't, will or won't, apply to you.

For many couples who have decided to try to begin or expand their family, that means each month's hastily unwrapped negative pregnancy test brings with it a little more stress, a little more disappointment, a little more guilt—and maybe a lot more depression. But a growing body of evidence suggests that those feelings may tip the mind-body balance so that the next test is negative again. The question is, just how vicious is this particular cycle?

As Patricia discovered, a low mood is linked to low fertility. "Research shows that a woman who has a history of depression is twice as likely to subsequently experience infertility as a woman with no history of depression," says Alice Domar, of The Domar Center for Complementary Healthcare, in Waltham, Massachusetts.

It's no better at the other end of the street. Domar cites surveys showing that women who are infertile are as stressed-out as those who suffer from cancer, AIDS or heart disease.

Widely considered the preeminent expert on the relationship between mood and fertility, Domar has herself conducted studies showing that the more stressed a woman is, the less likely she is to achieve pregnancy with the higher-tech infertility treatments, like IVF. Even more compelling, she's demonstrated that when women are taught a meditative practice known as the "relaxation response" along with visualization, yoga and participate in support groups, the likelihood of pregnancy rises sharply.

Others have highlighted a link between the stress of infertility treatment and the outcome of that treatment. Depression, for example, is associated with high rates of dropout from infertility treatment.

In fact, emotional stress is the second-most frequently cited reason for dropping out of infertility treatment, trailing only financial constraints. It's not that the treatments are difficult, but that the people undergoing them simply can't take the conception-related pressure for long. In one Swedish study, a group of couples having trouble conceiving was offered three free cycles of IVF. Fifty-four percent dropped out of the program before completing all three cycles. The reason most commonly given was psychological stress. In an Australian study, couples offered six free IVF cycles completed only 3.1, on average; again, stress and mood effects were the top reasons cited for dropping out.

When treatment and its attendant stresses stop, pregnancy occurs often enough to be a documented phenomenon. A 2004 study from the Netherlands found that 26 percent of women who chose to drop out of fertility treatment after their first cycle went on to become pregnant without further treatment. Thirteen percent of women who dropped out after the second treatment cycle also became pregnant afterward.

Exactly how perceived stress results in reduced fertility is still sketchy, but the links in the chain of causation are becoming clearer. Negative emotions can kick stress hormones like cortisol into overdrive. Those stress hormones, in turn, alter physiology in ways that can be at odds with conception—by lengthening the menstrual cycle, for instance.