All too many couples who are struggling to start a family have been given the unhelpful advice that they should “just relax.” Many people end up blaming themselves for their fertility problems, as though they are subconsciously stopping their bodies from conceiving successfully.

Fertility problems often go together with anxiety, depression, high stress levels, or all the above. A number of studies have found that couples struggling to conceive have higher levels of depression and anxiety. But it's not clear if the participants’ state of mind caused their fertility issues, or vice versa.

A 2011 meta-analysis of 14 studies into IVF success and women’s emotional distress covered more than 3,500 women. It concluded that depression, anxiety, or other emotional distress did not have an impact on the outcome of treatment.

But this is a topic that’s very hard to explore scientifically. Most studies examine couples who are undergoing IVF treatment, but by this point, most people will have been struggling with fertility issues for a while. It’s hard to say whether their difficulty conceiving was caused by their state of mind, or if having trouble getting pregnant caused anxiety, depression, and distress.

Does infertility affect your state of mind?

When you’re having trouble starting a family, it can affect your state of mind in many ways. A lot of people become isolated, because they avoid friends who are pregnant or have young children, and that can have its own impact on mental health. Fertility treatments can be expensive and lead to financial challenges. Some men and women feel a lack of control over their lives or bleak about the prospect of being unable to raise a family.

One study found that women who were receiving fertility treatments saw their symptoms of depression and anxiety get worse as their treatment progressed, which indicates that the treatment caused them emotional distress, and not the other way around.

It’s worth pointing out that fertility drugs can also affect the hormonal balance and cause emotional distress. For example, clomiphene citrate, a synthetic estrogen that can cause mood swings, anxiety, and insomnia in women, is often prescribed to increase sperm production and control ovulation. Other fertility medications can provoke depression, irritability, and mania.

Additionally, some medical issues that cause infertility also raise the risk of emotional distress, like polycystic ovary syndrome (PCOS) which can cause higher rates of depression and anxiety.

Stress and infertility

Stress has been found to correlate closely with infertility, but the jury is out about the cause and effect.

When you’re stressed, your brain produces two hormones, alpha-amylase and cortisol, which can interfere with the production of gonadotropin releasing hormone (GnRH). GnRH controls the release of sex hormones which govern women’s menstrual cycle and ovulation, and men’s sperm count and quality. Men who are stressed might also produce more steroid hormones called glucocorticoids, which affect sperm production by controlling testosterone secretion.

According to one study, women with higher levels of stress were less likely to get pregnant during IVF treatment than those with lower signs of stress.

Anxiety and infertility

There are a number of ways that anxiety levels could affect fertility:

• An anxious brain releases the stress hormones cortisol and alpha-amylase, which can affect sex hormone production.
• Anxiety can be caused by an imbalance in the sex hormones estrogen and testosterone, which could be the underlying cause of infertility.
• Hyperthyroidism (an overactive thyroid) can cause anxiety, and also disrupt the menstrual cycle in women and reduce sperm count in men.

A 2004 study from Iran that followed 370 women receiving fertility treatments found that women with higher levels of anxiety also saw longer periods of infertility, but that anxiety didn’t appear to cause infertility. It also concluded that higher levels of depression affected both the cause and duration of infertility.

When scientists carried out a metaanalysis of studies on Cognitive Behavioral Therapy (CBT) training and fertility treatments, they found that couples receiving CBT or mindfulness therapy were more than twice as likely to conceive successfully than couples without any therapy. The more couples were able to lower their anxiety levels, the bigger the improvement in pregnancy rates.

Depression and infertility

Depression might affect fertility in a number of ways:

• Depression can disrupt the regular functioning of the hypothalamic-pituitary-adrenal axis, which helps regulate the menstrual cycle
• Depression can disturb the regulation of luteinizing hormone which controls ovulation
• Depression and stress can affect the immune function, and that can have a knock-on effect on the reproductive function

One study found that women who are struggling to conceive and women who are battling cancer have similar levels of depression, while another reported a 38% drop in conception rates among women with severe depressive symptoms, compared with women with no or low symptoms.

Another study concluded that women with infertility had higher rates of depression than women without any fertility issues, but it didn’t rule out the impact that infertility may have had on the women's depressive symptoms.

Treatments that improve your state of mind can help

Although doctors are still not sure if depression, anxiety, stress, or other emotional distress can make it harder to get pregnant, they agree that the way that you deal with these disorders can be the most important factor.

People with mental or emotional health disorders can tend towards unhealthy habits which can provoke infertility and/or lower the sex drive, including:

• Eating disorders, which can cause obesity or low body weight
• Drinking too much alcohol
• Consuming too much caffeine
• Smoking or vaping
• Insomnia

Therapeutic treatments which help you relax, calm down, and improve your state of mind can improve fertility simply by helping you put an end to unhealthy habits that affect the reproductive system.

Some popular approaches to improving mental and emotional health as a way of increasing fertility include:

• Yoga
• Acupuncture
• CBT therapy
• Meditation and guided imagery
• Hypnosis

Your mental and emotional health always has a knock-on effect on your entire body, so it’s never a good idea to ignore it. Whether you’re trying to conceive naturally or beginning IVF, it’s clear that the more relaxed and positive you can be, the better. We hope you reach parenthood in an easy, smooth, and stress-free manner.

If you’re trying to get pregnant, whether you’re hoping to conceive naturally or starting IVF, it seems safe to say that the less stressed you are, the better your chances of conception. It’s never easy to relax, but take the time to do activities that calm you down. We hope your path to parenthood will be smooth and stress-free.