While women shoulder most of the burden of fertility-related stress, it is not theirs exclusively. Men experiencing psychological distress tend to produce fewer sperm and ejaculate sperm with lower motility. In a study of more than 800 couples followed over 12 months, researchers from the United Kingdom and Denmark showed that stress in men—in particular, personal and marital stresses—led to a lower likelihood of achieving pregnancy via infertility treatment.
Still, the impact of male stress on fertility is much weaker than is the impact of female stress. The external pressures placed on men to reproduce are significantly less than those placed on women, and their response to those stresses is correspondingly less intense.
An evolutionary perspective provides added logic. Stress creates an inhospitable environment for sustaining a pregnancy. Stress hormones signal the presence of some kind of external crisis—and a crisis does not supply the most advantageous conditions for sustaining a pregnancy for nine months. A body that is receiving a constant barrage of distress signals does not put its main focus on pouring time and energy into conception.
Men, as the Danish researchers pointed out, "contribute to conception but not to actual pregnancy, limiting the time interval in which their emotions can influence the biological event relative to women." While a woman's mood can influence everything from fertilization to implantation to fetal growth, a man's mood plays a role only in the production and delivery of sperm.
Just how important mood is in men and women is itself unclear: a fact that will frustrate some and buoy others.
A study in the journal Human Reproduction disputed Domar's findings that stress diminishes the effectiveness of IVF. It followed 166 women from before they began IVF to right before egg retrieval. The researchers searched for some factor that could discriminate between those who later conceived during that particular cycle and those who didn't. They found none.
Teasing out a link between mood and fertility is even more difficult when researchers look not at people undergoing high-tech infertility treatments but at the mass of humanity simply setting out to try to conceive a child the old-fashioned way.
"Do I think that mood plays a critical role in conceiving?" asks Kris Bevilacqua, a psychologist at New York's Montefiore Institute for Reproductive Medicine and Health. "Yes and no. No, because women who are raped conceive. And yes, because when couples are in a good mood, feeling positive and optimistic, it helps them go further, try a little harder."
Where does that leave you? Domar's studies suggest that mood influences the success of infertility treatment. But no data show that the treatment of psychological distress leads to any rise in pregnancy rates among the general population.
And as for all those people who tell you "just relax, you'll get pregnant in no time," they don't really have a clue what they're talking about, notes William Petok, chairman of the mental health group of the American Society of Reproductive Medicine. "Besides, I've never met anybody to whom you could say, 'Just relax,' and they'd do it. So it's bad advice."
And to whom does it even apply? "Most couples do not begin their reproductive efforts with feelings of depression and anxiety," observes Madeline Licker Feingold, director of psychological services at Alta Bates In Vitro Fertilization Program in Berkeley, California. "In fact, most people take fertility for granted—usually having spent many years guarding against an unplanned pregnancy—and begin the process of family building with hope, joy and excitement. Then they are shocked to learn of their infertility and often torment themselves for wasting time with birth control and waiting too long to try to conceive."
If you have a history of depression or anxiety, it would be wise to talk to a doctor, Domar advises. "I recommend that anyone who wants to get pregnant get their distress level under control before even trying to conceive ."
Lori Oliwenstein is a science writer and also the author of Taming Bipolar Disorder in the PT Here to Help series.
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