Stress and Fertility

Stress

Stress can come from just about anything that you feel is threatening/worrying or harmful. Acute stress can make your heart beat faster and your blood pressure elevate. You might breathe harder, get sweaty hands, and/or your skin can feel cool and clammy. Chronic stress, which is when you are always stressed, can lead to depression, change in your sleep pattern, and decrease your chances of fighting off common illnesses. Stress makes many body organs work harder than normal and increases the production of some important chemicals in your body, including stress hormones. Sometimes stress is disguised as irritability, tiredness or a change in routines.

Our Stress and Fertility Fact Sheet can be downloaded from the bottom of this page.

Why is Infertility Stressful?

Most couples are used to planning their lives. They may believe that if they work hard at something, they can achieve it. So when it's hard to get pregnant, they feel as if they don't have control of their bodies or of their goal of becoming parents. With infertility, no matter how hard you work, it may not be possible to have a baby. Infertility tests and treatments can be physically, emotionally, and financially stressful. Infertility can cause a couple to grow apart, which increases stress levels. Couples may have many doctor appointments for infertility treatment, which can cause them to miss work or other activities.

Is there an Association Between Stress and Fertility?

Acute and chronic stress may affect fertility. In a study that Professor Bruce Dunphy conducted in the 1980s, he documented that women who attended a tertiary level infertility clinic for the first time experienced a significant boost in their pregnancy rate independent of any treatment. Bruce described this as a placebo response, and hypothesized that there were psychological factors linked to this boost in pregnancy rates most likely linked to the belief that attending such a highly reputable centre would improve their chances of becoming pregnant.

There have been a number of studies that examined a potential link between stress levels and in-vitro fertilization (IVF) outcome. IVF is often described as the most stressful event in the lives of a couple. There is increasing evidence that psychological factors, such as anxiety and depression, may have a negative impact on IVF outcome, however, at this stage the evidence is inconclusive.

Despite the known relationship between psychosocial stressors and the stress response of our bodies, little is known about the physical effect of stress in relation to IVF outcome. Some reports have shown that pretreatment levels of anxiety and depression are significantly related to treatment outcome in IVF. This could theoretically be mediated by stress hormones influencing such physical factors as uterine blood flow, and the immunological conditions needed for implantation.

Some studies have documented that women whose treatment was successful had lower urine concentrations of stress hormones at key points during treatment than those whose treatment was unsuccessful. Furthermore, levels of such hormones were related to depression scores in such women.

However, despite the possible negative impact of psychological variables on IVF outcome, the evidence remains inconclusive, and this may relate to the number and quality of studies that have been undertaken so far. The majority of related studies have reported early pregnancy as an end point, without providing information about pregnancy complications such as miscarriage and premature birth. Only two studies have considered live birth as an end point, both of which showed an association between stress and the possibility of a live birth. These findings are in keeping with studies undertaken in women who have experienced recurrent miscarriage, for whom there is evidence that stress reduction may reduce the chance of future miscarriages. Three studies have shown that for such women extensive counselling and emotional support throughout early pregnancy results in a significantly greater live birth rate than when routine care is given. Thus for women who have recurrent miscarriage, intensive psychological support appears to be very beneficial.

In summary, the precise impact of stress on fertility remains an open question. However, based upon current evidence, the reduction of high levels of stress before IVF is beneficial and is to be encouraged.

Counselling

The Role of Counselling:

Please visit Counsellor's Corner for examples of how counselling can be an important part of fertility care. Improving fertility outcomes is not the only reason to consider stress reduction counselling. There are a number of pressures associated with going through treatment including finances, the emotional highs and lows experienced during treatment, and relationship stresses. Fertility problems can be highly stressful including associated tests/investigations and treatments. The journey frequently evokes a range of powerful feelings such as anxiety, anger, grief, humiliation, denial, confusion, guilt, blaming and depression. Frequently, self-esteem suffers. Making good decisions in such a highly stressed state is often not easy. It can be difficult to continue one¹s normal social life and work. Partners often have different ways of coping with the stress of infertility, and for the sake of your relationship it is important to keep communication channels open and to understand how each other is responding. Infertility can test relationships to the limit. Consequently, counselling can be very beneficial in helping individuals/couples to cope with the journey of investigations and treatment for infertility.

In general, counselling is a process through which individuals and couples are given the opportunity to explore their thoughts, emotions, reactions and beliefs with an impartial and empathetic professional who understands the issues involved. Good counselling helps people cope better. It usually brings greater clarity, a broader perspective and some peace of mind. Decisions about what choices to make become more clear and are based on realism and self-knowledge. The process is strictly confidential.

The Law & Fertility Counselling:

In some Australian states such as Victoria it is mandatory to have counselling prior to IVF. This is not currently the case in Queensland. Consequently, you are not usually obliged to accept counselling, but for the reasons outlined above you may find counselling very valuable. There is one notable exception in Queensland where counselling for fertility treatment is compulsory: Australian federal legislation mandates that prior to any treatment involving donor eggs, donor embryos or donor sperm there must be a counselling process and the counsellor must be satisfied that a number of issues have been addressed/covered.

Types of Counselling

Implications Counselling:

The implications of treatment that you are considering will be explored with you. The course of treatment may have implications not just for you, but also for your wider family and any children born as a result. This type of counselling is aimed particularly at people thinking about using donated sperm, eggs or embryos. It may also include genetic counselling.

Support Counselling:

The aim of support counselling is to provide emotional support at times of particular stress. One example is when a treatment has failed to produce a pregnancy or the pregnancy ends in miscarriage. It¹s important to remember that high-tech fertility treatments such as IVF or ICSI may not succeed. There is the potential for a lot of disappointment connected with these procedures. Support counselling may also be helpful if you discover that you are pregnant with twins or triplets. Support counselling can also offer alternative strategies for dealing with wider social and family pressures related to falling pregnant.

Therapeutic Counselling:

This usually encompasses support counselling, but goes beyond it. Broadly speaking, it aims to help people cope with the consequences of infertility and fertility treatment. Sometimes, this may include helping people to adjust their expectations and to accept their situation. It may also help couples repair any damage to their relationship caused by the stresses of fertility problems and treatment, or offer a chance to explore underlying or wider issues that may be hindering a successful outcome or trigger other emotions/issues.

What Other Things can I do to Reduce my Stress?

Talk to your partner regularly
Realize you're not alone. Talk to other people who have infertility through support groups or on forums. However, always remember that what other people have been told about their condition or treatment may not be relevant to you, confusion about your treatment may be a source of stress, and so don't hesitate to clarify what you have heard with your specialist or other members of the team. The main value in joining a support group is to have other people to talk to who share your experiences.
When you read self-help books on infertility or surf the world wide web, remember that what you are reading has usually not been vetted by a peer review process and so can be inaccurate and a source of considerable confusion. Don't hesitate to check out what you have read with your specialist.
Consider learning stress reduction techniques such as meditation or yoga. There is some recent evidence that having acupuncture can improve IVF pregnancy rates.
Exercise regularly to release physical and emotional tension.
Take care of your general health including a balanced diet and cut our or reduce cigarettes, street drugs and alcohol.
Have a medical treatment plan with which both you and your partner are comfortable.
Learn as much as you can about your own situation and the treatment options that are available.
Find out as much as you can about your insurance coverage and if you are having expensive treatments make financial plans regarding your fertility treatments.

Counselling available through Monash IVF Brisbane

Monash IVF Brisbane believes that it is very important to provide all patients with easy access to accredited and high quality counselling. Consequently, once a patient commences treatment with Monash IVF, free fertility-related counselling may be accessed.

Other Sources of Support

Access is Australia's national infertility network for information, support and advocacy. Their URL and contact details are;

ACCESS Australia Infertility Network
Box 3605 Rhodes Waterside Rhodes
NSW 2138 Australia
T: 02 97370158
E: info@access.org.au
http://www.access.org.au/

Stress and Fertility Fact Sheet - 146 KB