The link between emotional stress and infertility is well established but, for a couple struggling to conceive, the unwelcome advice of “just relax and it will happen” is more likely to raise blood pressure than induce relaxation.

“You’re trying too hard.”

“Don’t think about it too much.”

All of these statements send an inadvertent negative message of blame: if you were better at relaxing and not so worried about your fertility, then you would be pregnant.

When a couple is trying without success to get pregnant, it is impossible not to feel stress. As difficult as it is to relax when the months pass without the reward of a little blue line, new research has confirmed that reducing stress levels can more than double a woman’s chances of getting pregnant.

The study, published by the American Society of Reproductive Medicine, found that women undergoing certain infertility treatments are more likely to become pregnant if they take part in a simultaneous stress reduction programme.

A significant 52% of the women participating in a special mind/body programme for infertility became pregnant, compared with 20% of the control group.

This will come as welcome news for more than one in 10 couples of childbearing age who experience infertility. 

“The intersection of stress and fertility is a controversial one, but we do know that stress can reduce the probability of conception,” said principal investigator Dr Alice Domar, who developed the pioneering mind/body programme for infertility at Harvard Medical School. 

“Several studies conducted within the past three years support the theory that psychological distress can have a significant adverse impact on success rates of in vitro fertilisation (IVF). Mind/body treatment of infertility patients has been shown to both increase pregnancy rates as well as reduce psychological distress,” Dr Domar maintained.

About 2% of children in the Western world are born through IVF, and with increasing maternal age that figure is expected to rise to 5-10% over the next generation. The modern couple coping with an infertility diagnosis faces numerous stressors, including the difficulty of balancing a career, marriage and highly invasive and time-consuming infertility treatments; the financial burden of treatment; the struggle to maintain romance in a relationship characterised by timed intercourse; highly personal questioning by healthcare providers; and the recurring cycle of hope, anxiety and disappointment that accompanies each attempt to conceive.

Managing stress and infertility

Ann Bracken, cognitive behavioural psychotherapist at Sims IVF clinic in Dublin, spearheads a new integrative mind/body programme based on Dr Domar’s research. She says that couples who are dealing with issues relating to infertility can experience a roller coaster of emotions before and during treatment, and the stresses reverberate within their relationship, social and work environment.

“Infertility has far-reaching implications on a physical, psychological, familial and social level and therefore integrating a healthcare approach that reflects this is important when considering duty of care to the patient,” she suggests.

Ms Bracken explains that stress may have a multi-level impact on the individual and their fertility.

“There are two aspects of stress and its inter-relationship with fertility. Firstly, it can adversely affect fertility itself. Stress can affect the gland in the brain that regulates your appetite and emotions as well as hormones – the hypothalamus, which tells your ovary to release eggs – so a woman experiencing severe stress may ovulate later in her cycle or not at all. Stress can affect our hormone balance and stress generally contributes to extreme muscle tension, which is unhelpful in terms of implantation.

“Stress can also trigger anxious thoughts and feelings or negative predictions about the future. If a person is having difficulty conceiving or is stressed about the fertility treatment, they may have unhelpful self-beliefs about themselves or their partners following a negative outcome, such as ‘he can’t give me a child’ or ‘I can’t give him a child’,” she points out.

“The mind/body programme helps them to recognise and transform unhealthy thoughts and supports emotional and physiological balance throughout the challenging process of fertility treatment.”

Statistics show that female factors account for approximately 40% of all infertility cases and male factors account for a further 40%. In the remaining 20% of cases, infertility is unexplained.

“Financial circumstances, second relationships and career demands have meant that many couples delay starting a family until they are secure on these levels. However, at 35, women are half as fertile as they were at 25, and at 40, half as fertile as they were at 35. Therefore, time is an important factor after referral for treatment and this is reflected in the treatment received. 

“Coming to terms with this and the prospect of upcoming treatment often requires counselling support to ensure that relational well-being is factored into the overall treatment,” she adds.

The investigative pathway 

When concerns arise about potential fertility problems, the first port of call is usually the GP. If a couple is having regular unprotected sex for more than a year without conceiving (only six months if the woman is under 35 years old), the GP may refer them to a fertility clinic for a series of tests including anti-Mullerian hormone (AMH) testing to ascertain key hormone levels as well as auto-immune testing to improve the chances of implantation where reproductive immunology problems exist. Couples are also screened for infectious diseases and other major illnesses.

“Initial investigative procedures by the treating consultant include saline infusion sonography to identify the presence of hydrosalpinx – fluid in the fallopian tube – or polyps, fibroids or adhesions, which may impede implantation. Initial screening for men includes semen analysis, which may include DNA fragmentation testing and possibly genetic testing in cases of severe deficit of semen quality or non-obstructive azoospermia,” says Ms Bracken.

Investigative tests also identify if there are any issues around ovulation, whether the fallopian tubes are blocked or damaged or whether there are problems relating to the womb lining. A number of fertility problems encountered by women and men may be identified through testing.

Balancing mind and body

Increasingly, couples and their doctors are realising that in order to optimise their chances of getting pregnant, they must make sure that they are both physically and mentally equipped for the journey. Dr Domar found in her research that those who participated in mind/body programmes were more likely to ‘survive’ the gruelling process of IVF and other infertility treatments. Ms Bracken concurs: “Additional patient support may be required by individuals or couples undergoing treatment, particularly if they have experienced a negative outcome. Often couples suffer in silence, which can be incredibly stressful. They may experience anxiety relating to treatment or anxious thoughts and feelings relating to decision-making. 

“Often couples experience guilt, anger or envy relating to their situation and this has an impact on communication within their relationship and can also impact on interactions with medical professionals.”

The course integrates a number of mindfulness relaxation techniques, which aim to reduce the physiological impact of stress or anxiety. This is also supported with progressive muscle relaxation (PMR) and breath-work techniques. 

Ms Bracken said: “Patients are provided with dietary advice, an option to receive medical acupuncture, pre- and post-egg transfer as well as healthy lifestyle choices to enhance their overall experience. Our mind/body programme and CBT counselling service is aimed at patients who wish to reduce stress, promote conception and increase their well-being while going through the fertility treatment process.”