The Impact of Stress on Fertility
By Dr. April Graham
I recall a day in my final year of naturopathic medical school where a mid-30-something female popped on my schedule for infertility. My heart was jumping for joy (not because this woman struggled with infertility), but because I felt it was such a gift and joy to help improve the health and terrain of a woman’s body to help her bring a baby into the World.
I had my preliminary treatment plan already figured out before she arrived; however, I did not want to just talk about nutrition and supplements and send her on her way. I wanted to be the physician to truly address this patient on a deeper level. Once I met this woman, and she was sitting in front of me, I intuitively knew there was something deeper we needed to address.
I excused myself from the room and begged my supervisor to just let me do a homeopathy intake instead (after all, this could be the only time I ever saw this woman). My supervisor kindly agreed, even though that was not her primary form of treatment. (Side note: Homeopathy is a system of medicine that addresses the whole person based on the principle of “like cures like.”)
This woman had been trying to conceive for several years and had tried nearly everything natural. I dove into the homeopathic intake, which involves asking many open-ended questions for the purpose of understanding the whole person, and what needs to be healed. I discovered that she was under a great amount of emotional stress, with her job and relationship with her husband being the biggest stressors. We uncovered some core belief systems that were false and affecting her overall sense of wellbeing. This essentially turned into a counseling session, where she ultimately did the work of making the connection as to how this was affecting her fertility. Tears poured out of her eyes. Emotions that had been held back were released. I prescribed a well-indicated homeopathic remedy that I was very excited about.
A few weeks later, she came back for a follow up. As I was talking with her, she shared that she was in a much better mental-emotional space, and that she was no longer carrying around her stress in the way that she was. She also mentioned, somewhat casually, that her period was a few days late. My heart was exploding, I knew something had shifted. We did an in-office pregnancy test, and sure enough, she was indeed pregnant! I was feeling a little proud of myself assuming that the homeopathic remedy I had given her had worked. Then, I discovered that that she never even took the remedy!
While I was still so happy for my patient, I was confused. Could I take any credit for her pregnancy? But, why did this matter? It didn’t, really. It wasn’t about me, it was about her. She was pregnant, after trying for several years! Back in the preview room, I expressed some disappointment to my secondary (third-year student), who had participated in both visits, “So, it wasn’t the homeopathy. It had nothing to do with our treatment,” I said. She responded by knowingly smiling, saying “Maybe, it did.” I paused. What did she mean by that? Could it have been the process of the homeopathy intake? Treating the whole person? I then remembered the counseling, and the emotional release that my patient had had a few weeks prior. “I think you are right,” I replied. I was completely stunned.
But, why should I have been stunned? The physiology makes perfect sense. Stress increases circulating cortisol in our bodies. This cortisol sends a message to our brain to produce less cortisol through negative feedback (this is what people refer to as the HPA axis). This happens in the same part of our brain that directs the production of other hormones such as progesterone, estrogen, and testosterone (HPO axis). This means that through a complex process called reciprocal inhibition, the excess cortisol response can actually lead to fewer sex hormones being produced. Research has backed up this idea by showing that stress can affect hormone production, as well as endometrial receptivity (Whirledge & Cidlowski, 2017).
In addition, there is something we know as the “pregnenolone steal.” Pregnenolone is a precursor hormone. Its role is to produce other hormones including estrogen, testosterone, progesterone, and the stress hormone cortisol. When our bodies are under a significant amount of stress, including emotional stress, pregnenolone is shunted into cortisol, reducing production of the other hormones (which we need for fertility!).
Women intuitively know that our menstrual cycles are directly affected by stress. In fact, in her new book The Fifth Vital Sign, Lisa Hendrickson-Jack states that stress “can shorten your luteal phase, delay ovulation, and in some cases, suppress ovulation together.”
There is less research focus on stress and male-factor infertility but considering the Leydig and Sertoli cells that produce testosterone, and sperm, respectively, are under the direct hormonal influence of the brain (HPG axis), there is every reason to believe that stress can also affect semen health.
It has actually been reported that feelings such as uncertainty, conflict, lack of control, and lack of information are considered the most stressful stimuli and strongly affect the HPA axis (Kloet, 1992). I have to say that it is no coincidence that these feelings are at the core of many couple’s struggles with infertility.
Unfortunately, in North America, when a couple has been trying to conceive for 12 months (or 6 months when the woman is over the age of 35), they go to their primary-care doctor, and are then referred to an OBGYN or Reproductive Endocrinologist. At this point, they will undergo a full workup, and depending on the results of the blood and semen tests, they will be provided with a treatment plan. The treatment plan usually includes some combination of drugs, hormones, injections, or procedures such as intrauterine or in vitro insemination. This process causes undue stress on so many couples, and the results are not always great.
Considering emotional stress can influence our biology, including our hormones, immune system, nervous system, and cellular function, doesn’t it make sense to consider the mind-body connection when searching for a root cause of infertility?
It was such a gift for me to see first-hand, the power of a patient healing herself through counseling. Since then, I have witnessed many healing moments and could never go back to practicing without treating the whole person. Our bodies do not exist in isolation from our minds. We are more than just people with reproductive system issues. We are whole beings!
I have to wonder how different infertility rates might be if primary-care doctors recognized the importance of establishing the foundation for optimal health and recognized the importance of the mind-body connection to hormonal function and infertility.
Dr. April Graham is a naturopathic physician who created the Faithful Fertility Method to help those struggling with infertility. She does video-conferencing sessions, or takes visits in her comfy clinic (if you are in the Seattle area). She combines her counseling skills and advanced fertility training with her own personal experience and wisdom, and the tools of naturopathic medicine, to set you up for fertility success. For more information, visit www.faithfulfertility.com.
Hendrickson-Jack L, The Fifth Vital Sign, Fertility Friday Publishing (2019).
Kloet ER, “Corticosteroids, Stress, and Aging,” Annals of the New York Academy of Sciences,663(1 Aging and Cel.), 357-371; doi:10.1111/j.1749-6632.1992.tb38679.x (1992).
Whirledge S & Cidlowski JA, “Glucocorticoids and Reproduction: Traffic Control on the Road to Reproduction,” Trends in Endocrinology & Metabolism, 28(6), 399-415; doi:10.1016/j.tem.2017.02.005 (2017).