stress and fertility

Stress and fertility

Psychologists usually define stress as a form of psychological and behavioural interaction between people and their environment, i.e. the person responds to what is happening to them and around them.

There are essentially two types of stress – acute stress and chronic stress. Acute stress is a response to an immediate threat, such as an exam or public speaking. Chronic stress is a response to more prolonged or frequent, situations such as work pressures or unemployment.

The effects of stress can be beneficial and enable the ‘fight or flight response’ to help us escape from a perceived dangerous, or harmful, situation. However, the effects of stress can also be harmful by mediating a series of physical changes and responses in the body. Negative consequences of these stress responses can impair our thinking, metabolism, immune function and, potentially, even reproduction.

Fertility issues

Primary infertility is the term used when a couple have never conceived and is usually diagnosed after a year of sexual intercourse without contraception. Secondary infertility is the term used when there has been at least one prior conception, even if the pregnancy wasn’t carried to term. Other common infertility problems include early pregnancy loss and recurrent miscarriage. There are many known biological causes of fertility problems but some remain ‘unexplained’. Fertility problems are very common worldwide and are estimated to affect over 24 million women.

Fertility and stress: what the research says

There has been huge debate over the years about whether a link really exists between stress and fertility issues. Numerous studies over the years have found an adverse impact of stress on women’s reproductive health. Stress has been implicated in everything from causing premenstrual pain, loss of sex drive, sexual problems, absent periods to infertility, miscarriage, still birth and low birth weight in babies.

Most women have probably experienced their periods becoming irregular – or maybe even disappearing altogether during times of stress. Anovulation (not ovulating) is a medically recognised consequence of high-level stress. Equally, women who lose a great deal of weight due to stress may also find that their periods become irregular.

The general day-to-day stress of modern-day life can negatively impact couples’ sex lives and if partners are just too tired, or too unhappy, after a stressful day to have sex – or if they are only having sex infrequently – then that is also going to reduce the chances of having a baby!

stress and fertility

The stress connection

A link between psychological stress and reduced pregnancy rates has been highlighted. For example, one study found that high stress levels were associated with poor responses to fertility treatments and lower pregnancy rates. Another study of women who planned their first pregnancies, found that women with higher stress scores had lower pregnancy rates and higher early miscarriage rates than those with lower stress scores. Scientists have also found that, both in rats and in humans, stress can induce repeated miscarriage by negatively impacting small protein and cell changes. In women with recurrent miscarriage, some research findings have indicated that high stress levels are associated with an increased risk of subsequent pregnancy loss.

In one of the most recent studies, released in March of this year, American scientists from Ohio State University studied an enzyme found in saliva that provides a biomarker of stress. They found that for women with high levels of this biomarker were 29% less likely to get pregnant each month and doubled their chances of infertility.

So, based on some of this evidence, it does appear that stress plays a significant role in fertility problems but doctors, psychologists, scientists and researchers remain very much divided on the issue. There are an equally abundant number of scientific studies showing that stress is merely a side effect of fertility problems and not the central cause. The bottom line for the majority of health professionals working in, and researching, this area is that infertility is largely a medical problem and not a psychological one.

Reducing stress

For millions of people, trying to conceive a child brings cycles of hope as well as misery. Fertility problems can turn life into an emotional roller coaster affecting how people see themselves, their sex life, their relationship with their partner and their relationships with other people. Without doubt, the vast majority of individuals and couples that I see are suffering from some form of fertility-related stress. Many feel that they are no longer in control of their bodies or their life plans. Fertility investigations and treatments can also be physically, emotionally and financially very stressful.

However, attempting to reduce stress by giving up a job or suddenly and dramatically changing your lifestyle isn’t particularly recommended except in very extreme cases. There are many stress reduction techniques which may be helpful such as mindfulness, meditation, yoga, reflexology or acupuncture. Excessive caffeine and other stimulants such as alcohol should be avoided and regular exercise should be a normal, and important, part of your routine.

Therapy can help

Counselling is, unfortunately, very often viewed as the last ditch effort in fertility-related stress but in reality it is simply a better way of understanding fertility problems and their effects. Counselling can help individuals to develop better coping mechanisms, boost emotional reserves and facilitate couples in communicating more effectively.

Remember, a certain amount of stress is normal and whilst the link between stress and fertility does remain unclear it will only ever benefit our overall wellbeing to reduce stress levels as much as we possibly can. If high levels of stress continue for a long period of time, consider seeking professional help or talk to your GP about your concerns.

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Ask Allison

Q My sister-in-law and I both work three-day weeks and we help each
other out with child minding on our working days, which up until recently has worked out really well. Between us, our kids are aged between five and nine years – the problem is that it’s now become quite apparent that we have very different parenting styles. I prefer my two daughters (seven and nine) to have a structured day. For example, in my house, we have allocated times for television and iPads, etc. My sister-in-law, however, lets the kids run loose after school – homework is ignored and my kids end up wired after eating sugary treats all afternoon. I am considering looking at after-school childcare for the kids, but I’m worried that this is going to cause a family argument. Is there a diplomatic way that I can ask my sister-in-law to introduce some discipline into her child-minding days? It certainly doesn’t do her two kids any harm when I am minding them in my own house!

In a word, no, there is no diplomatic way to do this as it may very likely seem like your saying that your parenting style is better than
hers. As L’Óreal says, ‘now here comes the science bit.’ Dr. Kaylene
Henderson, a child psychiatrist, wrote a very interesting blog about ‘the
science behind the Mummy Wars’. She explains that before she had
children of her own she hadn’t been aware of how parents have a
very specific sense of the right parenting style. She also found that parents could be very definite in defending their chosen parenting style. Dr. Henderson, who describes herself as a curious, scientific, open-minded person, was surprised at how defensive parents could be and, at times, of their judgemental attitude towards each other. She explained the neurology of the Mummy Wars; okay, I’ll need you to bear with me for a second. Warning; I’m about to use some neuro-techie language.

Why do we judge each other?
As we have all had different experiences, this means that we all have very different memories stored in our brains. Most of our memories are ‘explicit’ memories – these are ones that we can recall easily such as important dates that mean something to us; important birthdays, special events or stories of and about our lives.
There is another type of memory called ‘implicit’ memory that plays a
key role in our parenting. This type of memory is the stuff that you do on autopilot. Psychologists call these heuristics or rules of thumb –
such as tying your shoelace, or driving your car (once you have learnt
to do both first!). Otherwise we’d really waste a huge amount of time
pondering over tasks that we have readily available to us. This seems to be where the science bit of our parenting style kicks in. This implicit memory goes all the way back to when you were an infant being parented by your parents. This is when you started the process of storing up how they did it into your memories.
Unless you make a conscious choice and effort to parent differently, what you saw and unconsciously learnt will be your automatic go-to parenting style.

We learn habits
This can really kick into gear when we feel our parenting style is
being mirrored or highlighted by disapproval from another parent. I know the cold sweat you feel when your child decides to make their outstanding bad behaviour performance at, of course, the most public and worst time. The implicit autopilot of how your parents dealt with these outbursts will flow unconsciously from you if you haven’t worked super hard to be aware and consciously change the old habits.
What’s happening for the on-looking parent is that they see you doing something they are used to doing, but you are doing it all wrong. Simply, because that is not how they know how to do it.

Find a way that works
You both have different parenting styles – who is to say which type is correct? You just need to know what works best for your family and that’s the bottom line. The irksome feelings won’t go away. You can talk to your sister-in-law, but I’m adding a caveat that it would be hard not to hurt her feelings. What we’re possibly looking at is that you prefer a more structured form of parenting, whereas your sister-in-law has a more permissive style. I’m not sure the two styles can mix, the mixture is a bit like oil and water.
If a collaborative shared form of parenting style can be agreed upon, then that is great, but our learnt hardwiring may prove difficult to change despite the intent to do so.
Perhaps, your own instinct of changing childcare might work best for you. In terms of making childcare work; the fit is ultimately the most
important aspect as you want a cohesive congruent feeling of the other caregiver to just ‘getting it’, like in any good partnership. Best of luck
with this and I wish you both well.


Beating pregnancy fatigue

Consultant dietitian Sarah Keogh has the lowdown on which foods will give you an energy lift that lasts.


Ask Sarah

Q I’ve heard a lot about the Paleo diet and as I am very interested in reducing the amount of processed foods and grain based meals my family eats, we are considering following this diet. From what I read it seems to be a back-to-basics type of eating. Is a Paleo diet safe for children? My kids are aged seven and nine.

A The Paleo diet is one of the most fashionable diets around at the moment. It is also known as the ‘caveman diet’ and is based on cutting out processed foods, starchy foods like bread and potatoes and eating more meat, vegetables and fruit.
As fad diets go, it is not the worst but there are some good and bad sides to it. Reducing the amount of processed foods we eat is always a good idea and by doing that you will usually reduce the amount of fat, salt and sugar you eat, which is a good thing! The problem with the Paleo diet is that it also cuts out dairy (on the basis that cavemen didn’t drink milk) and this means that the diet is very low in calcium. For this reason it is really not suitable for children who do need a lot of calcium for growing bones. How did cavemen manage without dairy? They ate a lot more food than we do (up to 10,000 calories per day compared to the 2,000 most of us eat). By eating that amount of food they were able to pick up just enough calcium from green vegetables and seeds. To put it in perspective, you would need to eat 16 servings of broccoli a day to get all the calcium you need. This is easier to do if you eat 10,000 calories per day rather than 2,000.
The other problem with the paleo diet is that it is not entirely based in science. Many of the Paleo diets out there say you should not eat wheat, even though we know that cavemen did in fact eat wheat and other grains. These diets also don’t recommend that you eat blubber and the big lumps of fat that were also a large part of the caveman diet!
A final problem is that many Paleo diets encourage people to cut out beans and lentils and to get their protein from meat and fish instead. Many studies over the last few years are clear that eating too much animal protein is linked with more cancer and heart disease. Eating some vegetarian meals based on beans and lentils is a great way to get your protein without always going for meat.
Is this a diet we should follow? I think there is a lot we can learn from the Paleo diets. We could all do with eating less salt, sugar and processed foods and adding in more nuts and seeds as well as more vegetables. However, I think following a strict Paleo diet could lead to low levels of calcium and vitamin D and so it is not suitable for children or teens and adults would need to think about a calcium supplement.