Backgrounder: Infertility, Stress & the Mind/Body Connection

Maybe you’ve heard the cliché advice often given to women struggling to get pregnant: “Relax and it will just happen naturally.” Well, that advice is unproven and often counterproductive, says Eugenia Gullick, PhD, a licensed clinical psychologist at Reproductive Endocrinology Associates of Charlotte (REACH).

“Infertility is a medical condition, not a problem that’s ‘all in your head,’ as some people might say,” says Gullick, a subspecialist in the evaluation and psychological management of infertility. “Stress does not cause infertility, but infertility can certainly cause stress.”

Helping to manage that stress can go a long way in supporting medical treatment for infertility, says Jack Crain, MD, reproductive endocrinologist of Reproductive Endocrinology Associates of Charlotte (REACH). Among the variety of methods that patients often use to manage stress are yoga, massage and acupuncture.

However, Crain cautions, “It’s wrong to think that any of these methods will cure infertility. There has not been a lot of scientific studies of such therapies, there is still a lot of skepticism in the medical profession about their individual effectiveness. At this time, it’s better to think of them in a complementary, supportive role to conventional medical treatments.”

Nonetheless, fertility experts do agree that reducing stress is key for many infertility patients, with potential for both physical and mental health benefits. Stress signals the pituitary gland that the body is in trouble, Crain notes. “This can slow the release of the luteinizing hormone, which in turn triggers ovulation.” Even if ovulation occurs, a shortage of the luteinizing hormone could mean a lower level of progesterone, a hormone necessary to nourish and sustain an embryo’s implantation and early development.

Another example of how stress affects infertility is found among women who suffer from serious depression that causes appetite loss and subsequent weight loss. This can cause women to become annovulatory, a condition in which women do not produce eggs each month, which creates infertility.

For these and other reasons, REACH patients have supplemented medical treatments with acupuncture, massage, breathing techniques, meditation and yoga. In addition, REACH offers psychological counseling as part of its program.

There is an emphasis on counseling at REACH, Gullick says, because both men and women struggle with the stress of infertility and the strains it places on their relationship – in sexual as well as non-sexual ways. But it can be hardest on women who consider it is their life mission to be a parent. When a woman must “revise the dream,” many psychological issues arise that add to the intensity and complexity of the stress and disappointment of infertility.

“Especially for ambitious, high-achieving women,” Gullick says, “infertility doesn’t conform to the standard recipe for success on which they have relied in the past – that is, identify a goal, select an appropriate strategy, and then complete the action.” For women with tendencies toward perfectionism, excessive worry, or obsessive/compulsive behavior, facing a condition such as infertility can be daunting when it is outside of a patient’s and possibly her doctor’s control. Even the best possible medical treatment doesn’t guarantee a positive outcome.

Fertility success depends on many complex factors such as the body’s delicately timed release of four reproductive hormones, Crain notes, as well as variables such as too little iron in the blood, too much or too little body fat, or too much exercise – which can may disrupt the delicate synchronization of pituitary – ovarian hormonal communication.

"The fertility equation is complex, and small things can make a big difference,” says Crain. “That’s why we generally don’t rule out a variety of influences such as stress, body weight, diet, and physical activity.”

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About Reproductive Endocrinology Associates of Charlotte (REACH)

REACH is led by a nationally recognized team of five physicians who offer comprehensive, state-of-the-art assistance for infertile couples and women with reproductive endocrine problems. REACH physicians, all long-time practitioners in Charlotte, are widely respected for their superior pregnancy success rates – one of the highest in the region -- and for the finest patient care. REACH is a member of IntegraMed, an exclusive network of fertility practices nationwide. For more information, visit www.REACHdrs.com.