Is stress a cause or a consequence of infertility?

For years, stress and anxiety have been linked to infertility. In fact, data shows that approximately one-fifth of all sub-fertile couples seeking fertility treatment show relevant levels of anxiety, depression or distress. However, experts disagree in what comes first – does stress cause infertility or is infertility a consequence of being stressed?

And actually, there are arguments which could support both views… let’s talk about stress as a cause or a consequence of infertility.

Stress as a cause of infertility.

Some research has shown that stress is a cause of infertility. However, it is not only stress which affects the hormones in the brain in charge of your menstrual cycle, causing irregular periods or amenorrhea. There are other reasons for this:

1. When we are stressed, we tend to eat more. Does this happen to you? We get tempted by fast food or high-fat foods in general. Even our alcohol consumption might increase. This can make us put on weight and therefore, our cycles might become irregular because of the consequences that obesity has for fertility, and not only for women but also for men.

2. Stress increases smoking habits. Experimental studies showed that people under stress smoke more, and as you might guess… smokers have lower or worse reproductive outcomes. It can affect pregnancy rates, sperm and egg quality, and give a lower response to ovarian stimulation in assisted reproductive treatments. So, please do not smoke.

3. Stress increases depression: There is an association between stress and depression. Unfortunately, depression is related to poor reproductive outcomes. In addition, patients with depression are less likely to take up assisted reproductive treatments and become pregnant, or they simply delay starting treatment or seeking professional advice.

4. Stress might trigger giving up treatment. Some studies have revealed that stress is one reason why people quit fertility treatments. Depressed patients are five times more likely to give up trying. Stress could also cause problems with your partner and disruptions in your relationship. In fact, there is data which shows that couples who do not achieve pregnancy within three years of trying are more likely to split up.

Stress as a consequence of infertility.

On the other hand, despite these arguments supporting stress as a cause, experts have suggested that stress is not actually a cause and that really it is a consequence… let’s find out why.

1. An increase in stress hormones does not cause infertility. There are two main stress hormones – cortisol and salivary alpha-amylase. For cortisol, there is inconsistent data, but so far, no relation between levels of cortisol and pregnancy has been found. There are publications from 2014, which show that patients who had high levels of salivary alpha-amylase had a slight delay in conception. However, 87% of them were pregnant within a year, and so that theory was discarded.

2. There is no relation between relaxation techniques and pregnancy rates. There is no good evidence to support a relation between relaxation and pregnancy rates. However, if it makes us feel better, less stressed, happier… we will do more healthier activities, we won’t give up trying, and we will have more sex and those things do really help!

How much does it affect your chances?

There is no rigorous data which supports stress as a cause of infertility, but stress could have a non-biological role (e.g., increased risk of smoking, alcohol use, decreased sex, etc.). Therefore, seeking help to learn how to manage stress is beneficial for your mood and potentially for reproduction. Good counselling might be useful to help you cope with your TTC journey or a failed attempt at fertility treatment. Even though stress has not been shown to cause infertility, it can affect us emotionally, so finding techniques that help you cope with your stress could be key in your journey.