Friday, November 29, 2013

Is evolution stronger than psychology? Stress vs fertility.

Being told by friends, family, even our doctors to "just relax" when it comes to trying to conceive is a guaranteed way to send our blood pressure through the roof. We can take their well meaning comments to imply that if we were not as stressed we would be pregnant by now, but is that the case? At this year’s Fertility Show in London I attended four seminars, all of which discussed the links between stress and fertility, hoping to finding some clarity on this subject.

The first seminar was by Professor Jacky Boivin from the Cardiff Fertility Studies Research Group who has been investigating links between the success of fertility treatment and stress by undertaking a large scale review of related research. They also studied women throughout their monthly cycles and found that anxiety levels soar during the two week wait (the time between ovulation and test day.) This coincides with the time that an embryo needs to implant. This fact alone was probably enough to raise the stress levels of her audience but she assured us that “Evolution is stronger than psychology to ensure that populations populate.” She backs her findings by the fact that the world’s highest fertility rates are in areas affected by poverty, famine and war. Boivin’s conclusion from reviewing fourteen studies with 3,583 infertile women undergoing a cycle of fertility treatment is that “Emotional distress caused by fertility problems or other life events co-occurring with treatment will not compromise the chance of becoming pregnant.”

Do I hear a collective sigh of relief or a niggling yes ….but? 

You are not alone, Boivin explained that we are aggrieved to let go of the belief that stress affects fertility as we feel that stress is something that we can manage, can control. How many times have you said to yourself “ Well it didn’t happen this month as I was so stressed at work, next month it will be different”?

The plot thickened as Boivin’s talk continued, although her study indicates that stress does not prevent an embryo from implanting (mini pause for celebration dance, just hearing that made me feel 100 times more relaxed) it does affect your chances of becoming pregnant for the following reasons:
  • When you are feeling stressed you are less likely to have sex. I should not need to explain why this might be an issue!
  • When stressed you are more likely to indulge in coping habits which negatively impact fertility, such as smoking, drinking, recreational drugs or having a dysfunctional relationship with food, either under or over eating. All of which have been proven to adversely affect the quality of both sperm and eggs. 
  • There is a link between stress and the immune system, those under stress are more likely to experience health issues which could have a knock-on effect to fertility. 
  • To top it off if you are diagnosed with infertility you are more likely to stop trying to conceive if you are stressed. Studies show that more people either just did not commence treatment, or abandoned treatment due to emotional stress levels rather than medical prognosis.
All of these points were confirmed and expanded on in fertility specialist Zita West’s seminar. West claims that a significant percentage of her patients get pregnant within 6 months purely by having more sex at the correct time of the month. She believes that fertility begins in the gut so stress-related disorders such as IBS could be affecting your fertility as your body is not able to absorb the nutrients it requires to sustain a healthy pregnancy. West’s philosophy is that pregnancy is a whole body experience, our cycles are ruled by our bodies, so one that is exhausted, stressed and running on empty is not the optimum for conceiving.

West discussed how trying to conceive affects couples relationships, as did Tracey Sainsbury a councillor at the London Women’s Clinic. Both suggested finding ways to enhance your relationship and take the pressure off timed intercourse which is likely to be putting a strain on both partners. Sainsbury offered that the quickest way of reducing stress often means stopping doing something. One suggestion was to stop monitoring ovulation and instead focus on bringing the intimacy back to the relationship. The most important piece of information you may take from this blog is that the ideal time to have intercourse is the day before ovulation occurs, therefore the day before ovulation sticks indicate ovulation and two days before your temperature rises! West also warned that temping and ovulation sticks are not always accurate and a late-night, illness or false LH rise may give false results. Your cycle can also change dramatically month to month. Sperm can survive for 3 to 5 days in the fallopian tube hence the advice that having sex two or three times a week will usually hit the target. The trick is to find what works best for you, some women find trying to fit in “spontaneous” sex three times a week all month far more stressful than pinpointing ovulation. 

Sainsbury’s seminar was enlightening, she discussed how the majority of people experience infertility by cycling through denial, anger, depression, bargaining and finally coming to a place of acceptance and empowerment. I discussed this subject and my personal journey through this cycle in my last blog I’ll be happy when I’m pregnant vs what can I do to feel better right now? 

Sainsbury stated that infertility is a surreal situation and therefore our normal coping mechanisms and ways of communicating may not work. She likened couples experiencing infertility to two hedgehogs on a beach with suitcases! Unstable ground, huge amounts of baggage and two vulnerable centres surrounded by spikes!

All clinics must offer counselling alongside fertility treatments and Sainsbury discussed the benefits of seeking out additional support before, during and after treatment. Sainsbury’s following quote has stayed with me in regards to fertility treatment “Nothing is going to feel 100% right as the situation is not and never will be ideal.” This really hit home, the ideal would be to conceive naturally, if this is not a possibility, then the next best thing is to prepare yourself as best you can, both physically and emotionally for the next step. 

Sainsbury stated that we can not consciously affect fertility, if we could there would be no need for contraception as we would just think each month; “I do not want to be pregnant!” This leads me nicely into Russell Davis’s talk in which he stated that only 5% of our thinking is conscious, 95% is unconscious and makes up our automatic behaviour and beliefs. Davis is a cognitive hypnotherapist specialising in fertility. He has an opposing view to Boivin and quotes Harvard studies that show that stress does impact fertility. The pituitary gland controls all of our hormone levels from stress hormones to fertility hormones and a delicate cocktail of hormones is required for conception and implantation to take place. When we are stressed, we are in fight or flight mode, stress hormones flood the body and blood is pumped to our arms and legs and away from our internal organs such as stomach and womb. You can feel this effect by the butterflies you feel in your stomach when you get nervous. 

Davis asked us to tense our entire bodies and then imagine trying to get pregnant. As more and more studies prove the intricate link between the mind and the body it is worth considering how our thoughts are contributing to our well-being. Davis asked us to say to ourselves “I accept myself as I am today” and then tune in to our internal response, he went on to explain how external circumstances do not dictate how we feel, it is the thoughts we have about those circumstances that affect us. Relaxation techniques such as focusing on our breathing can help quieten our inner dialogue and bring our hormone levels back into balance. Davis’s seminar was inspiring, he concluded that it is possible to come to a place of peace while trying to conceive, this is an area I am passionate about and the reason I set up Mindful Muma-to-be. Zita West has the same philosophy and ‘managing the mind’ is always part of her treatment plans. 

All of the seminars focused on reducing stress and anxiety to improve quality of life while trying to conceive and words such as nourish and nurture gave comfort to audiences dealing with the uncertainty of infertility and treatment. Each speaker encouraged us to find our own coping strategies and among the suggestions were cognitive behavioural therapy, relaxation techniques such as meditation, visualisation and yoga, hypnotherapy, gratitude, distraction, counselling and peer support groups such as those listed on the Infertility Network website. 

A final quote from Sainsbury “We hear what we want to hear.” So you can pick and choose the information from this blog that you feel will benefit you most. I have chosen to take the following; I know that my body functions better when I am calm and relaxed, I am able to think more clearly and logically. When I am stressed my body feels physically uncomfortable and I want the feeling to pass. Therefore I intend to continue to focus on making space in my life for activities that nourish my well-being and reducing the activities that make me feel depleted. I will also be pocketing the nuggets that worrying about my fertility will not cause my womb to reject an embryo, nor will worrying about miscarriage cause a miscarriage. 

Mindful Muma-to-be

Final thoughts and resources:

1. A few final facts from Boivin, there is no evidence to suggest that going on holiday, adopting or ‘not thinking about it’ increases your chance of pregnancy. (Excellent ammunition for the next time somebody suggests one of these to you.) Stress can affect sperm quality. Depression can affect fertility. Read my blog on infertility and depression for more information.
2. Boivin’s study:
3. Boivin’s studies are controversial, the data and conclusions have been brought into question.
4. Zita West’s website:
5. From Sainsbury: “Stress can not cause miscarriage, but can lead to a small birthweight, which has its own complications.”
7. Russell Davis’s website:
8. Webinar from Russell Davis for the Infertility Network UK
9. Russell will be speaking at our January support meeting in London. See events page for details.
10. Infertility network UK support groups