Our clinic is seeing an increased number of women with a diagnosis of unexplained infertility. Tests and scan results come back as normal, but women are still struggling to conceive. The infertility rollercoaster can be a stressful journey.
What is unexplained infertility?
Unexplained infertility is diagnosed when a couple has been unsuccessfully trying to conceive for 12 months or more and all investigations have ruled out all other known explanations.
Living with a medically unexplained diagnosis can be both a relief and a cause of anxiety for patients. On one hand, your specialists have effectively ruled out several undesirable causes for your symptoms but on the other hand, you are still living with those symptoms. For couples who have been diagnosed with unexplained infertility, this can be particularly frustrating as it gives you no explanation as to why you’re struggling to start a family.
How Specialists Reach a Diagnosis of Unexplained Infertility
There are many causes and risk factors related to infertility and your doctor will explore all of these pathways when making a diagnosis. In general, infertility can be defined as the inability to get pregnant, carry a pregnancy to term and deliver a baby.
Male Infertility Tests
For male infertility specialists will look at factors that include:
- sperm size, shape, number and mobility
- the presence of varicoceles (enlarged veins in the scrotum)
- blockages of sperm-carrying ducts
- the presence of infections, cancer and STIs
- hormonal imbalances
- risk factors such as excessive weight, smoking, alcohol and drug abuse and a history of fertility disorders
Female Infertility Tests
To diagnose female infertility your specialist may look for:
- polycystic ovarian syndrome
- premature ovarian failure
- blocked or damaged fallopian tubes
- the presence of polyps or fibroids in the uterus
- an abnormally shaped uterus
- period irregularity and irregular menstrual cycle length
- weight gain, facial hair growth and lifestyle factors
Is Stress Affecting Your Fertility?
The journey through infertility can be a stressful path, how much do we know about the impact of stress on fertility?
There has been ongoing debate within the scientific community about whether stress may influence fertility and pregnancy outcomes.
Doctors are once more looking at the idea that stress may actually play a role in infertility problems. Studies are focusing more on the physiological effects of stress and how they may play a role in conception. In the UK 25 % of couples have been diagnosed with unexplained infertility. For these couples the effects of stress can be most profound.
Whilst there is not enough data to draw a clear conclusion, what is apparent is that when stress reduction techniques are employed something happens in some women that allows them to get pregnant when they were not able to previously conceive.
What is Stress?
Stress is a normal psychological and physiological reaction to changes in someone’s environment.
When most people talk about stress, however, they are usually referring to chronic and/or negative forms of stress, such as having too many demands at work, relationships or the death of a loved one. People experiencing chronic stress may feel that they are unable to handle daily life tasks, have limited-to-no control over the direction of their life or more easily become angry or irritated. This type of chronic stress can negatively affect a person’s short-term and long-term health.
When Stress Can Lead to Trouble Getting Pregnant
Stress can lead to toward unhealthy behaviours and non-fertility friendly lifestyles. For example, when you’re stressed out, you may:
- Sleep too much or sleep too little
- Give into emotional eating or not eat right.
- Not find enough time for exercise or push yourself to exercise too hard
- Drink one too many alcoholic drinks
- Smoke, or, if you quit smoking, start smoking again
- Drink too much coffee, especially if you’re sleep deprived
- Lose interest in having sex
How Stress, Sleep, and Fertility Are Connected
If your work schedule or lifestyle leads to late nights with early wake-up calls, the constant lack of sleep can affect your body, and hence, affect your fertility. Research has shown that people who get less than five hours of sleep are more likely to suffer from obesity, and obesity can lead to fertility problems.
How Stress and Emotional Eating May be harming your Fertility
When people are stressed, they tend to eat in less than healthy ways. Constant stress has been shown to lead to weight gain, and weight gain and obesity have in turn been linked to fertility problems. Just as eating too much junk food or being overweight can cause fertility problems, weighing too little or not eating enough can affect your reproductive potential.
Work out Mindfully
Getting a healthy amount of exercise can help lower stress and lead to a healthier body. It is important to exercise. However, the type, frequency and intensity of exercise is variable dependent on age, lifestyle and most importantly stress levels. Mindful exercise is best, i.e., listening to your body. A slow gentle walk has amazing health benefits and will aid body systems. Gentle walking in nature at least 30 minutes per day will benefit health and well being.
When Stress Gets in the Way of Sex and Fertility
Sex can be a stress reliever, something to relax with at the end of a long day. However, crazy work schedules, not to mention feeling exhausted, can make it difficult to find time for sex.
A stress-filled life can also lower your libido, so you might not be in the mood often. It seems logical to say that if you want to get pregnant, you need to have sex. Some couples are too stressed to have sex and do not have sex enough during ovulation to get pregnant.
Hormone mix-up – Stress impact on ovulation
Stress can hamper ovulation. No amount of sperm will make a difference if the woman’s body hasn’t released an egg. A woman’s body is involved in a constant monthly dance of hormones, for which ovulation is key to conception.
When a woman is stressed, other hormones are released in the brain, which can disrupt the hormone cycle.
Without ovulation, any eager sperm that arrives on the scene will find no egg to fertilise.
How does stress impact on the reproductive system?
Everyone experiences stress, and for many it’s not an enjoyable experience. It isn’t inherently bad, although research suggests that depending on the type and timing of the stressor (i.e. the reason for stress) it can cause changes to a person’s menstrual cycle.
Recent research tells us that stress boosts levels of stress hormones, such as adrenaline, cortisol, which can inhibit the release of the body’s main hormone, GnRH (gonadotropin releasing hormone), which is responsible for the release of sex hormones. Subsequently this may suppress ovulation in women, reduce sperm count in men and lower libido in both women and men.
Any disruption to GnRH may cause insufficient release of hormones from the pituitary gland which can cause their target organs to no longer work as they once did and in extreme cases, atrophy over time and no longer function.
Stress impact on Sperm Quality
Although mechanisms are not fully understood, there is a link between anxiety and sperm quality. A recent research study of 29,914 participants found that psychological stress lowers sperm concentration and progressive motility and increases the amount of abnormal forms of sperm.
How does stress impact on IVF?
An area that has received growing interest in recent years is the potential role that psychological stress may play in determining in vitro fertilisation (IVF) treatment outcomes. At least anecdotally, many infertile women and health care professionals alike believe that the experience of stress can play an important role in the difficulties that infertile patients face, and thus may be a contributing factor in determining the eventual outcome of IVF.
Whilst research in this area has been mixed, two recent systematic reviews suggest that self-reported psychological stress may well play a role in determining a patient’s IVF outcome.
These facts are very important to consider if you have been trying to conceive without success. It also shows that stress relief should be a part of every couple’s conception plan even if they are going through IVF.
Colette Assor LicAcMBAcC is an acupuncturist specialising in fertility and women’s health. Colette runs Acupuncture Works clinics based in North London