Both physical and psychological or emotional stress affect the body in all kinds of ways, not the least of which is fertility.
THE FIGHT-OR-FLIGHT RESPONSE
You’re probably already familiar with the fight-or-flight stress reaction—the increases in heart rate and blood pressure and the reduced blood flow to any part of the body not absolutely essential for staying alive. In the face of mortal danger, the body marshals all its resources in the interest of one thing: survival. This is an excellent plan for when we are indeed facing mortal danger.
The problem is, our bodies (and minds) are very bad at determining what’s “mortal danger” and what isn’t. We are likely to go into some variation of this emergency mode for the more everyday problems of today’s world. The truth is, most of us live with at least some level of chronic stress, and not just as a result of the big things such as grief and unemployment but also from the ordinary pressures of deadlines and traffic jams and misbehaving children. Then, too, we stress ourselves in many ways without even thinking of it as stress, such as when we don’t get enough sleep or we go on a crash diet. Wherever the stress comes from, if we don’t know how to manage it, it takes its toll.
The familiar physical reactions to stress stem from the way it activates the adrenal glands, which overproduce adrenaline and cortisol and give us the butterflies, sweaty palms, galloping heartbeat, and other symptoms of stress. The excessive doses of adrenaline and cortisol also interfere with the production of other hormones, including FSH and LH, in both men and women. The decreases in FSH and LH in turn lower testosterone, estrogen, and progesterone, all of which are crucial in conception and implantation. In this way, chronic stress can stop ovulation (and menstruation) or decrease the production of sperm. Stress compromises the immune system as well—the cortisol again, which suppresses immunity. This can, among other things, leave you open to other fertility problems, from infections to inappropriate immune reactions.
While science is still sorting out all the whys and wherefores of the stress-conception connection, one thing is clear: people who are highly stressed have lower rates of conception. Stress decreases women’s fertility in part because it can stop ovulation and menstruation altogether. Short of that, women under stress are less likely to get pregnant in any given cycle than are women not experiencing any particular psychological distress. Stressed women also face a higher risk of very early miscarriage.
Consider the study in which researchers “psychologically” stressed monkeys: 10 percent stopped menstruating. When the stress let up, the monkeys began menstruating again. Then the researchers created physical stress for the monkeys, either by having them exercise intensely for long periods of time or by limiting food intake. In each group, again about 10 percent stopped menstruating, and again the effect was reversed when the diet or exercise binge stopped. When researchers combined the psychological and physical stress, making already stressed monkeys eat less or exercise more, 75 percent stopped menstruating. It’s hard to get pregnant if your whole reproductive cycle shuts down. It is reasonable to expect similar effects in humans. Most women will be able to handle a certain amount of stress without any impact on their fertility. But start layering stress upon stress, and the majority are going to run into problems.
Turkish studies have clearly demonstrated the fertility effects of stress in men as well. The research in this area has mainly been done on men with fertility problems, but this muddies the waters, since infertility all by itself is a major cause of stress. Scientists in Turkey took a different tack by recruiting healthy men with no fertility problems. As in so many cases, a pool of such men was readily at hand: medical students. Researchers collected semen samples from their volunteers at a time of stress (just prior to final exams) and again at a time of no extraordinary stress (three months later). The first (stressed) samples showed lower sperm counts, lower motility, lower semen quality, and a higher percentage of abnormal sperm compared to those taken later (not under stress). Fortunately, full fertility was restored when the stress disappeared. We think that is the most important lesson to be drawn from this study: reducing stress can reverse fertility problems.
The stress effect shows up less formally as well. One of my (Sami’s) colleagues noted that during the recent economic crisis, he’s seen a significant decrease in sperm quality in his patients.
AN EVOLUTIONARY IMPERATIVE
The way fertility shuts down under stress should not surprise us. Our bodies are obeying a larger evolutionary imperative. Consider the way animals in the wild have more or fewer babies depending on the cues they are picking up from their environment about personal and pack safety and access to resources. And we know that animals in zoos have trouble getting pregnant. They unconsciously evaluate the lack of space and limited resources, and their bodies respond by not allowing additions to the population. Zoo vets are experts at all kinds of ARTs, from insemination to IVF, as they try to get the animals under their care to reproduce in defiance of nature.
Humans react in ways similar to other animals. Birthrates decrease in times of war, for example. Evolutionarily, humans, like all animals, want to reduce reproduction whenever reproduction could interfere with (as opposed to bolstering) survival. Although most of us are not actually living in a war zone, our bodies may behave as if we are. Think about how news coverage is sensationalized to provoke as much fear as possible. Personal communication devices beep endlessly; our bosses and clients expect us to get back to them on the double. Advances in communications technology have not freed up our time, as predicted, but have enslaved us. In our deepest subconscious, this endless vigilance, this inability to switch off, feels like danger. Our bodies take evasive action, in part by reducing our ability to conceive.
We have several wonderful, accomplished, and resourceful patients who can’t bring themselves to switch off their Blackberrys when, say, they receive an acupuncture treatment. Their approach to what should be a moment of calm appears to include e-mailing colleagues and talking on cell phones. And their bodies get the message loud and clear: no time or space here for a baby. For them, making their bodies understand that there is room can be the key to getting pregnant at last. These are extreme cases, but most of us are overscheduled and lacking in balance in essentially the same way. The bottom line is, you have to be in harmony with yourself; anything else is stressful.
HORMONES, STRESS, AND ANIMAL BEHAVIOR
Say you’re an African naked mole rat, but not just any naked mole rat: the queen of the colony. You are the only reproducing female in the whole group. If there’s going to be any young, you’re going to bear them. But there are all those other females living with you, and all those males ready and willing to mate—perhaps not as picky about their partners as you’d like. How are you going to make sure none of those rats, male or female, gets in on the reproduction action without your say-so?
You stress them all out—way out. You bully them into submission. You literally push them around, give them a good shove once in a while, just to show them who’s boss. And in this way, you make sure their hormone levels drop low enough to decrease testosterone and sperm counts in the males and turn off the ovulatory cycle in the females, low enough even to prevent puberty.
In our fellow primates the marmoset monkeys, it’s been shown to work pretty much the same way. Biologists call this social suppression of reproduction. The areas of the brain devoted to fertility and stress are pretty closely connected in mammals, so scientists think that what goes on in these animals, behaviorally and hormonally, can tell us a lot about how stress impairs human fertility as well. In fact, the naked mole rat study is not from the pages of some animal behavior textbook, but rather from the proceedings of the European Society of Human Reproduction and Embryology’s annual meeting.
So even though you’re not a naked mole rat, you might want to take a look at what’s pushing you around. Get out from under it, and you’ll be doing yourself and your fertility a favor.
ANIMALS IN CAPTIVITY DON’T BREED WELL
Reproductive endocrinologists have a task not unlike vets at the zoo: to help people breed in captivity. And they are pretty good at it, too. But we all tend to be blind to the other option available to humans, if not to zoo animals: to leave captivity. Turn off the bad news and unpleasant images, learn to laugh more, and try to relax when you have the time. In fact, make the time!
So if you are having trouble getting pregnant, especially if no one can come up with a medical reason why, you should consider whether your body might be getting the impression that you are too unsafe, too underresourced, and too busy to provide for and look after a baby. Try to reverse those messages, letting your body know that you are fundamentally safe, that there is enough to eat, and that when you do have a child, you will be able to drop everything and play with building blocks on the floor for half an hour. We’ve seen many patients who have come to respect the way their bodies are connected to a larger evolutionary design slow way down and then become moms.
Case Study: JoanneLearning to manage her stress level was a key component of fighting fertility problems for Joanne, whom you read about in chapter 2. Her irregular periods and slow hormonal transitions made it hard for her to get pregnant until she pinpointed when she ovulated using a BBT chart. Even then, however, I (Jill) think she would have had trouble conceiving if she hadn’t also finally dealt with how stressed-out she was. gets in on the reproductio stressed-out even before I met her. She had made several appointments to see me, only to cancel them all due to her busy work schedule. When she finally made it in, she told me how hectic and overscheduled her life was. Then she whipped out her cell phone to make several calls while I gave her acupuncture. It took some doing to get her to set aside one minute every morning to take her BBT. And it was even harder to convince her to shoehorn regular acupuncture appointments into her calendar. And then it took all my powers of persuasion to get her to turn off her cell phone during the acupuncture. Ultimately, though, Joanne began to appreciate the value of taking those brief breaks. She also began to notice some signs that she was a bit more relaxed even when she wasn’t in my office. For example, she wasn’t so irritable right before her period. The tightness in her body was softening as she felt better–and she was feeling better as that tightness softened. I can’t say for sure what part this newfound sense of space played in her ability to conceive after six months of Chinese treatment and BBT charting, but I feel confident it was an important piece of the puzzle.
WHAT YOU CAN DO ABOUT STRESS
We can’t live a life without any stress at all, and we are designed to cope with, or at least endure, acute stress, at least up to a point. Chronic stress, however, will compromise your fertility (along with your health in general) if you don’t find ways to manage or disperse it. You need to find out what works for you and do it. Adopt daily stress management habits; try yoga, meditation, guided relaxation, or simply taking a walk after work to unwind.
You should also take a look at yourself and your habits to see if you have any negative ways of handling stress that could be revamped. Many women, for example, undereat or overexercise in an attempt, conscious or not, to deal with stress; both can lead to fertility problems. Maybe you’re trying to cope by drinking coffee all day or having a couple of glasses of wine every night, or by working like a fiend. Whatever the case, it is important to deal with the underlying stress directly, rather than layering on additional problems.
Dealing with infertility, no matter the cause, brings its own stress. Studies have shown the effectiveness of “mindfulness” practices and other specific approaches to handling the stress of being diagnosed with and treating infertility. For example, research shows that just sixteen weekly sessions of cognitive behavioral therapy geared directly toward issues around infertility can not only reduce stress but also restore ovulation and fertility in cases where stress is the cause of, as well as the response to, infertility.
Case Study: Mariel and T.J.Mariel was deeply frustrated, sad, and angry about her unsuccessful quest to get pregnant, although she didn’t like to complain about it. It had been eight months, and as the pressure and resentment mounted, she and her husband, T.J., argued more than they used to–always right around the time Mariel was ovulating. Then they didn’t feel like having sex–exactly when they should have been having sex to conceive–and another month would slip by with no pregnancy. It didn’t take long to recognize the pattern, and when they did, Mariel and T.J. promised each other they wouldn’t fight the next month. When the next month came around, they were at it again. I (Jill) didn’t find anything that should be keeping Mariel from getting pregnant, but I suggested that she and T.J. consult a psychotherapist. A short stint in couples counseling helped them understand how and why the stresses of trying and failing to conceive, and the fear of facing the same disappointment again and again, were leading them to such poorly timed clashes. They also learned some more constructive coping mechanisms. Not long after that, Mariel became pregnant. She went on to have a healthy baby and began planning for their second child.
Stress Reduction Throughout Your Cycle
Chinese medicine holds that where you place your mind, the qi will follow. This section walks you through the phases of your cycle, looking at strategies that can support the connections between mind and body and emotions to maximize fertility at specific times. The sections that follow give specific visualization exercises and self-massage techniques for each phase of your cycle. Try to carve out some quiet “me time” every day to practice whichever of these approaches fits you best.
Phase 1 (Menstruation)
• Your energy is naturally low at this point in your cycle, so focus on relaxing and resting so that your body can direct its energy to the regeneration that is beginning. Some cultures have a tradition of women withdrawing from society when they menstruate. Most of us don’t have the time or inclination for that today, but it is still natural to feel more withdrawn during your period. If you feel a bit less sociable than usual, go ahead and stay at home and cocoon. • The best way to handle the disappointment that your period has come is to accept, for now, that you are not pregnant and, with a positive attitude, begin making a plan for the next cycle.
Phase 2 (Pre-ovulation)
• Estrogen tends to put you in a positive frame of mind and increase your feelings of well-being. We often hear from our patients that they feel a renewed sense of hope and optimism as their fertility efforts resume after their periods end. Many women find that their energy is high at this time. Some report that they feel sexier and more attractive. Take advantage of this time. The quest to conceive can get incredibly intense, so make the most of this little break. Some of the greatest benefits will come from enjoying low-intensity connected time with your partner, such as taking a walk together, going out on a date, talking about the future, and making love even though you are not yet at your most fertile.
Phase 3 (Ovulation)
• Studies have shown that the increase in estrogen, FSH, and LH lead to a sense of overall well-being right around ovulation. This can be a welcome relief in a stressful situation, so try to note, appreciate, and build on it. • You may feel more sexual desire as ovulation approaches. Heed its call!• Many couples feel very anxious that they have only a small window of time in which to fertilize an egg. This pressure can take a toll on your relationship, leading to conflicts that get in the way of using that window wisely. It also can translate into performance trouble for men. The best advice is to feel confident that in having regular sex in the lead-up to ovulation, you are doing what needs to be done. Take care of any other issues that could stand in the way of conception—the ones within your control, anyway—then relax, knowing you’ve done your best. And remember, the window’s not all that small, since sperm can survive in fertile cervical mucus for days, as they wait to catch the egg as it is released.
Phase 4 (Potential Implantation)
• This can be the most anxiety-provoking part of your cycle, waiting to see if your period will come. Once ovulation has passed, the optimistic feelings and excess energy of the follicular phase diminish, and women tend to become pensive and reflective. Try to focus on staying steady, looking at this as a long-term process rather than a month-by-month one. Feel secure in knowing that you are doing the right things to reach your goal.
Spending a few minutes a day centering yourself and focusing positively on your body, your health, your cycle, and your fertility is a great way to tap into the Chinese medicine idea of qi following intention. Shifting your focus slightly with each phase of your cycle will keep your attention on where the action is at that time. But each time you perform this easy meditation and relaxation exercise, you’ll begin and end the same way.
What to do:
• Sit on a chair in a comfortable position with your feet touching the floor.
• Inhale deeply, allowing your abdomen to expand. As you inhale, imagine breathing light into your body.
• Exhale, pulling your abdomen in. As you exhale, imagine breathing out light all around you.
• Continue breathing in and out this way until your body feels full of light and you can imagine yourself surrounded by light emanating several inches out from your body.
• Turn your attention inward, according to which phase you are in, as directed below. Continue for a few more minutes.
• Finish by imagining yourself under a waterfall. Envision the cleansing water passing over and through you, taking with it any problems, worries, or health issues.
• When you feel ready, slowly open your eyes.
Phase 1 (Menstruation)
• Turn your attention inward, focusing on your uterus.• Imagine the lining of the uterus sloughing off easily, leaving behind a smooth surface.• Visualize the blood vessels leading to your uterus and blood flowing through them to replenish it with a new supply of blood.
Phase 2 (Pre-ovulation)
• Turn your attention inward, focusing on your ovaries.• Imagine ten to twenty small follicles growing on your ovaries.• Visualize one follicle becoming dominant. See it receiving all the resources it needs from your body. See it growing. Feel the potential this follicle holds.
Phase 3 (Ovulation)
• Turn your attention inward, focusing on the dominant follicle on your ovaries.
• Imagine the egg emerging from the follicle and being squeezed out until it is sitting on the surface of the ovary.
• Visualize the egg being gathered up by the little fingerlike structures at the end of the fallopian tube.• See the egg in the lower part of the tube, being met by sperm.
• Imagine a sperm merging into the egg.
• Imagine the fertilized egg continuing its journey to the uterus.
Phase 4 (Potential Implantation)
• Turn your attention inward, focusing on your uterus.
• Imagine the embryo arriving in the uterus and burrowing into the uterine lining.
• Visualize the embryo drawing nourishment from the uterus’s rich blood supply.
• Turn your attention back to your ovaries and see the ruptured follicle that the egg left behind. Imagine this follicle secreting progesterone to maintain the pregnancy.