Does Too Much Stress Cause Female Infertility?

“Just relax and it will happen” is a phrase commonly heard by women (and men) struggling to conceive. Believing this cautionary advice to be true, women often report fearing that their difficulty conceiving is their fault. As a psychologist at Northwestern’s Center for Fertility and Reproductive Medicine I have frequently seen women and men emotionally suffer because of this belief.

Although it is well known that infertility can cause stress, many women and men are uncertain if stress is also a biological cause of infertility. This is in part because, from a biological perspective it seems like it could be true. For example, we all know that when we get stressed, we can experience health-related problems (e.g., headaches).

If Stress Can Cause Headaches and Other Health Problems, Why Can’t it Affect Fertility?

When it comes to fertility, the stress-health interaction is based on the hypothesis that stress inhibits the reproductive system because of the effects of stress hormones released in the body. However, research doesn’t support this hypothesis. Further, although stress can affect our physical health; if stress affected the survival of our species, we would not have survived our history of famine, war, or the stress caused by daily physical labor.
Can Relaxing Help You Get Pregnant?

What Does Research on Stress and Fertility Show?

Despite the continued survival of our species during times of stress, many women are still told that their stress can cause their infertility. For example, women sometimes believe that being depressed or anxious can impair their fertility. Some studies on this topic show a relationship between psychological distress and infertility while others do not. This is because all research studies on this topic are flawed as they have not been conducted in a way to prove a relationship between psychological distress and infertility. Another area of research looks at the effect of levels of stress hormones and pregnancy chances. These studies are also inconsistent and again because of design flaws are incapable of determining if stress causes infertility.

Can Relaxing Help You Get Pregnant?

Research on relaxing and pregnancy chances holds the most promise in 

determining if stress causes infertility. This is because researchers can conduct a type of study called a randomized control trial (RCT) to carefully control the study and compare the pregnancy rates of women who did or did not engage in an assigned relaxing activity. Although over 40 RCTs have been conducted on this topic, unfortunately a review of all these RCTs prior to 2015 found them all to be so flawed as to be unreliable. RCTs published since 2015 have largely not found a relationship between relaxing and pregnancy chances.

What About Acupuncture or Other Ways of Decreasing Stress?

Another way of relaxing for which we have RCTs is acupuncture. However again, multiple reviews of the RCTs found that there was no relationship between acupuncture and pregnancy chances. Other ways of decreasing stress that have been said to increase pregnancy chances include adoption and starting or stopping fertility treatment. These studies show that women’s chances of conceiving don’t appear to be related to reduced stress; rather chances of

getting pregnant are instead related to the woman’s natural age-based chances of success and the severity of their infertility diagnosis.

Why Stress Still Matters

Although there is no rigorous research that shows stress causes infertility, being stressed feels bad and women and men often need increased emotional support to cope with this stress. Stress may also interfere with getting pregnant in non-biological ways. For example, if you are too stressed you might engage in less frequent intercourse, may drop out of fertility treatment, or may engage in unhealthy lifestyle habits (e.g., smoking) that can decrease your chances of conceiving. Stress matters for men too because high levels of stress can result in sexual dysfunctions (e.g., erectile or orgasmic dysfunctions) that can interfere with pregnancy chances.

But, How Do I Explain Anecdotal Stories About Women Who Relaxed and Got Pregnant?

Many women have heard stories about women who supposedly relaxed and got pregnant. Interestingly, few people report hearing the more common stories about women who relaxed and did not get pregnant. I believe that this is because we only tell the stories about fertility we want to hear, even if we can’t prove the stories are true. This is because we want to believe that stress causes infertility; because if stress is the cause of our infertility, then we can work to control and decrease our stress and thereby succeed in having a baby.

But the truth is that it is largely our biology (which we cannot control) that determines our fertility. Unfortunately, this means that fertility can be unfair and we may be unfairly affected by it. But we don’t want fertility to be unfair as this is anxiety provoking. So instead, we blame stress when what we should do is provide women with support need to cope with the unfairness of infertility.