Stephanie (name has been changed to protect privacy) had been trying to conceive for 2 years when she first came to see me for a consultation. She was an accomplished attorney in Connecticut, who had immersed herself in her career. Now, at 34, she wanted nothing more than to be a mom. But unlike everything else she had worked for in life, getting pregnant couldn’t be achieved by working harder. She started to wonder if the intense stress of her demanding career and the constant cycle of disappointment each month were actually having a negative impact on her ability to conceive.

From a physician’s point of view, it is tough to quantify the degree that stress – or know what type of stress – can affect our fertility. We do know that intense stress can trigger changes to the menstrual cycle in women. For example, stress from such things as dealing with a volatile personality at work, over-exercising, or not getting enough calories in your diet may shorten or even stop a woman’s period. It’s the body’s way of saying it isn’t a safe time to get pregnant, as reproduction requires a safe environment and plenty of nutrition to make it successful.

How do you know when your cycle is irregular?

Your cycle doesn’t have to be exactly 28 days; it could be between 21 and 35 days, but it has to come predictably. Usually, anywhere from 21-35 days is a pretty regular pattern. Here’s my simple test: If you can’t predict when your next cycle is going to come within a one-week timeframe, then it’s an irregular cycle and you should see a Reproductive Endocrinologist.

Can stress delay ovulation?

When we are under intense physical, emotional or psychological pressure, our body actually shuts down our ability to release the hormones FSH (Follicle-Stimulating Hormone) and LH (Luteinizing Hormone) which are the powers behind both the development of a mature egg during the cycle and ovulation, respectively. Actually, it can delay or even completely prevent ovulation in a condition known as Functional Hypothalamic Amenorrhea, where the brain tells the ovaries to stop releasing mature eggs due to intense stress or calorie deprivation.

Can stress affect implantation?

Sometimes, even more subtle things, like persistent conflicts with your partner or not taking enough time off to relax, can affect the second half of the menstrual cycle called the “luteal phase” by shortening the duration or causing irregular spotting during this time. How? Stress affects the release of LH which is important in the maintenance of progesterone production, which in turn helps to prepare the uterus for pregnancy. Even if a degree of stress doesn’t completely shut off the menstrual cycle, sometimes this early termination of the luteal phase can disrupt implantation of the embryo and cause infertility or miscarriages.

Stress and infertility treatment

Without a doubt, patients who are undergoing treatment for infertility experience chronic stress and anxiety above normal levels. But does stress and anxiety affect their ability to conceive through IVF or other treatments? There have been many studies looking at IVF pregnancy and self-perceived stress. Some studies have indicated that higher levels of stress reduced pregnancy rates. But in a 2011 meta-analysis across more than 3,500 women, there was no proven association between failed IVF and emotional distress.

We all have inherently different abilities to cope with stress. Take an event like the loss of a pregnancy. Some may go into chronic depression and not come out of it for a long time, while others may experience acute stress and bounce back after 4-6 weeks because of their coping mechanism. Stress is hard to quantify but we can assume it is a contributing factor.

How to reduce stress when you are trying to get pregnant

It’s obviously important to reduce stress even though it’s difficult to say exactly what type of stress negatively affects fertility. Here’s my advice on how to address it:

I like to ask my patients: What helps YOU relax? Identify those things and make them a part of your day.
Yoga, meditation, massage and acupuncture are all proven methods for reducing stress
If your body fat level is unusually low, cut back on the intensity of exercise by moving to yoga and consume nutrients like protein.

If you are experiencing stress but have a normal cycle, you should still seek out relief. Try increasing exercise to release the nervous energy or anxiety.

Some people recommend counseling. This can be cathartic but is not effective for everyone
We all cope with stress differently. It’s hard to say, “Now, do this and you’re going to become a different person.” For example, some of you will feel less stress with acupuncture, while others of you may feel more stress from thinking about the needles. If it’s not helping, don’t continue it!

My advice for women undergoing IVF: Accept that it’s going to be an uncontrollable situation no matter what your intentions are. The act of “letting go,” to some degree, might help you reduce anxiety, prevent depression, and hopefully, improve the outcome.

If you do have an irregular cycle, or if you are 35+ and have been trying to conceive for more than 6 months, (12 months if you are under 35), you should see a Reproductive Endocrinologist right away. Don’t waste any time – see what a doctor can do to help you regulate your cycle and protect your future chance of pregnancy.