Studying stress can be complicated because the definition of stress is murky. Furthermore, for some people stress is a positive thing while it can be very destructive for others. We know that there is an association between low sperm quality and stress. In this article, we take a closer look at how stress can influence fertility and its impact on the ability to conceive.
The Science behind Stress and Fertility
It is still unknown precisely how stress can influence fertility or reduce fertility. Some experts have hypothesized that stress may reduce libido, leading to less frequent sex. Others have suggested that stress may dampen the immune system in a way that is bad for implantation in a female body.
In men, researchers have theorized that stress might reduce sperm concentrations by producing a rush of glucocorticoids, a class of steroid hormones that temper the secretion of testosterone from cells in the testes. Furthermore, stress can induce more oxidative stress in the sperm cells leading to lower sperm concentration and motility.
In women stress can disturb the balance in the sex-hormones and have an effect on ovulation.
Studies have suggested a link between stress and lower sperm quality, but the findings are inconsistent. Authors of one study from 2014 in the journal Fertility and Sterility interviewed 193 men between 38 and 49 and analyzed their semen samples. They found that life stress (but not work stress) was associated with reduced sperm concentration and motility, as well as higher proportion of abnormally shaped sperm. A 2010 study of 744 men published in the same journal, however, found that the 166 men who reported at least two instances of life stress had lower sperm concentration, but the same number of normally shaped sperm as those who reported less stress, so their fertility rates may not have been impacted.
A study published in the American Journal of Reproductive Immunology in 2018 found that among 45 couples undergoing in vitro fertilization (IVF), women who had higher blood levels of a specific kind of molecule that rises with stress were less likely to get pregnant after one cycle of IVF.
Other studies have also linked reduced fertility with increased concentrations of salivary alpha-amylase, an enzyme that’s secreted by salivary glands in response to stress. One study published in 2014 in the journal Human Reproduction, found that among nearly 400 women in the United States, those who had the highest levels of salivary alpha-amylase were 29 percent less likely to get pregnant after a year of trying — and more than twice as likely to be declared infertile — than those who had the lowest levels of the enzyme.
Another study, out of China and published online in the journal Stress in 2019, linked higher levels of this enzyme in both men and women undergoing fertility treatments with a lower chance of pregnancy.
Therapy to reduce stress
In 2015, psychologist and researcher Yoon Frederiksen and colleagues conducted a systematic review and meta-analysis of 39 studies published between 1978-2014. The objective was to evaluate the effects of psychosocial interventions on distress and pregnancy rates in couples undergoing fertility treatment.
The results indicated that that those couples who practiced cognitive behavioral therapy (CBT, a type of talk therapy) and mindfulness training were more than twice as likely to get pregnant than the couples who didn’t use such stress-reducing strategies.
This means that psychosocial interventions for couples in treatment for infertility, in particular CBT, could be beneficial both in reducing psychological distress and in improving clinical pregnancy rates. The effect was generally larger for women than for men.
What you should do
If you feel that infertility is a stress factor in your life, or that undergoing fertility treatment feels stressful, you are not alone. Many couples feel the same way. It is important to try to cope with the feelings you have and try some exercises to relieve the stress burden. If stress can influence fertility, make sure that you destress properly.
CBT is a psycho-social intervention that aims to improve mental health. As mentioned above, this can help couples go through fertility treatment, which can be emotionally taxing. The purpose of CBT is to develop personal coping strategies to solve current problems. In CBT, people learn to recognize and change negative thought patterns and apply different tools that help improve their negative self–talk to be more positive.
We recommend the following:
- Find someone in whom you trust (or someone with whom you feel safe) to confide your struggles with.
- If possible, try to de-stress with mindful-oriented apps.
- Try activities like exercise, yoga, acupuncture, massage, meditation.
- Communicate with your partner on how you feel.
- Write down your feelings and thoughts.
- Look for networks, for example online, where you can share your difficult thoughts and feelings – and be heard and understood.
- Seek professional counselling and advice. This could be your own general practitioner or a psychologist with specialized knowledge in fertility.
If you have tried a specific stress coping strategy before which worked, you might just start with that. For some people, doing something active like physical exercise, baking, working in the garden – or whatever their favorite hobby may be can have a great positive impact on their mental health.
This blog was co-authored with Yoon Frederiksen, Aut. psychologist and Ph.D., from the danish patient organization Fertility Care.