Anyone who’s struggling to conceive knows that the entire experience can be extremely stressful. It’s not surprising that anyone finding it difficult to start a family feels a lack of control that fosters anxiety and potential depression.

One study found that women who are grappling with infertility show similar levels of depression to women who are fighting cancer. Another study found that women who were undergoing IVF treatments and had higher signs of stress (both self-reported and clinical) were less likely to get pregnant after their first IVF cycle.

It doesn’t help that some of the medications that are used to increase fertility, like clomiphene, leuprolide, and gonadotropins, have side effects that include increasing anxiety, depression, and irritability.

So it’s not surprising that stress and infertility go hand in hand. The big question is: does infertility cause stress, or does stress reduce fertility?

It’s not an easy question to answer.

Stress is difficult to measure

The easiest way to measure stress is to ask the people involved to rate how stressed they feel (self-reported stress levels). The trouble is, this measure is not objective and could therefore be under- or over-reported.

It’s more scientific to measure levels of stress hormones. Stress triggers the release of two hormones:

• Alpha-amylase, which is triggered by noradrenaline released by the adrenal glands
• Cortisol, produced by the hypothalamic-pituitary system

The challenge here is that cortisol is released in pulses throughout the day, so levels can fluctuate significantly from hour to hour, making it tough to be sure of an individual’s long-term cortisol levels.

Alpha-amylase is more constant, but scientists still aren’t confident about its reliability in representing stress levels.

Most studies try to measure both self-reported stress levels, and at least one stress hormone level.

What does the science say?

So far, studies haven’t been conclusive. 2010 saw the first study to find a link between stress levels and fertility outcomes. It tracked both cortisol and alpha-amylase levels and concluded that women with higher levels of alpha-amylase saw a 12% drop in their chances of becoming pregnant. However, this isn’t a statistically significant difference.

A later study in the US found that women with the highest levels of alpha-amylase took 29% longer to get pregnant than those with the lowest levels, but it didn’t take sufficient measurements to be confident of the results. Another one in China found that couples with higher levels of the enzyme had more difficulty conceiving than those with lower levels, but it didn’t rule out the impact of other factors on the delay in conception.

In case you might think that stress only affects women’s fertility, some studies have shown that stress could affect sperm production. The amount of sperm produced, their shape, and how fast they can swim all affect chances of conception. Unfortunately, however, the evidence isn’t clear cut for male fertility, either. A study from 2014 found that life stress affected the speed and shape of sperm, but not sperm concentration, while an earlier study found that men with 2 or more recent stressful life events showed lower sperm concentration and lower sperm motility (speed), but that sperm shape wasn’t affected.

An analysis of scientific studies from 1978-2014 discovered that couples undergoing fertility treatment who also received mindfulness training or Cognitive Behavioral Therapy were more than twice as likely to get pregnant than those receiving no such therapy. The study concluded that the more anxiety was reduced, the greater the improvement in pregnancy rates.

Stress hormones may interfere with sex hormones

Although the jury is still out about whether stress really does affect fertility, it is thought that alpha-amylase and cortisol could interfere with the production of GnRH (gonadotropin releasing hormone), which is responsible for the release of sex hormones.

In this way, it could affect the menstrual cycle and ovulation in women, and the quality and count of sperm in men. Stress may also increase amounts of steroid hormones called glucocorticoids, which control the secretion of testosterone and thus affect sperm production.

It’s not your stress levels, it’s how you deal with it

Many doctors agree that stress on its own isn’t likely to affect fertility levels. What matters is the ways that you respond to feeling stressed.

For a lot of people, high stress levels lead them to:

• Consume more alcohol and caffeine
• Smoke or vape more
• Engage in “emotional eating” which can lead to being overweight or obese
• Avoid eating, which can cause low body weight and affect menstruation and ovulation
• Sleep badly, which affects hormone production
• Have sex less often

all of which can lower your chances of getting pregnant.

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.