Dr. Gunasheela Gynaecologist & Obstetrician, Chairperson Of The Indian Branch Of Royal College Of Obstetricians And Gynaecologists Of U.K.

Is stress a causative factor of infertility or vice versa…?

Though it is not known to be an absolute causative factor leading to infertility, stress considerably influences the extent of psychological damage that can result from the condition. No doubt, stress is a contributing factor for couples dealing with fertility problems. In women, stress can affect hormone levels and even block ovulation. In men, high levels of stress may cause sperm problems.

To what extent is stress responsible for causing infertility problems?

The stigma associated with infertility causes a negative self-image, which could trigger a phase of stress in couples. On a physiological level, stress can adversely affect the hypothalamus, the brain area charged with controlling hormonal stimulation of the gonads. Stress can also bring about changes in the immune system that may interfere with implantation and growth of the early pregnancy. During the period of stress, women might start getting irregular periods and may even get into a prolonged period of ammenorrhoea. This can be due to many hormones produced by the adrenal cortex, which is the most important gland that comes into action during a stressful period. The stress of changing households or getting into a new environment after marriage, encountering hostility in a new place is some of the situations when women suddenly experience a change in their menstrual order. Stress and depression phenomena often result in overeating in some women. It may also result in complete rejection of food, causing extreme loss of weight. Both these conditions can result in pituitary and ovarian dysfunction. Obviously, the treatment is to find out the root cause of such changes in the menstrual order and counsel the patients on how to overcome them. Some of the hormones produced by adrenal and ovarian gland can cause disruption of ovarian follicles that stop their growth halfway or complete their growth by releasing poor quality oocytes, which are frequently unfertilizable. Women who are entirely feminine in appearance may become obese, start shedding hair and break out with acne (pimples).
Similarly in men, stress associated with long hours of working, smoking, alcohol consumption, lack of exercise result in release of increased amount of adrenocortical hormones thereby decreasing production, maturation and transport of sperm. Stress is shown to produce auto antibodies in the male although the exact pathway is not well known.

Does reducing stress have any effect on overcoming infertility problems?

It is quite natural that if stress should cause disturbance in neurohormonal secretions, withdrawal of stress would produce an improvement in reproduction capacity. It is not a myth if a doctor encourages a couple to go away for a holiday over a period or advise them to stop coming to the clinic for 6 months. This would surely break the vicious cycle caused by the intensity of stress. This of course is subject to the fact that there has been no major abnormality found in couples. When genetic disorder in the male is causing severe abnormality in nature of semen or in a female who may have hopelessly blocked tubes, stress may not have a positive role either in causing infertility or curing it.

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