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Stress and Fertility Treatment

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If you have read any news reports about stress and fertility treatment during 2011, you can’t help but be confused. Headlines range from “Study seeks to dispel stress myth in IVF treatment” to “Stress relief may improve IVF success.”

The relationship between stress and fertility is a controversial one, according to Alice Domar, Ph.D., Director of Mind/Body Services at Boston IVF.


But even though a recent meta-analysis of 14 studies, published in February’s British Medical Journal, did not observe a significant relationship between distress levels and outcome, Domar says there is a large body of research —including her own most recent study published in Fertility and Sterility — that has found relationships between distress levels and the success rate of in vitro fertilization (IVF).


However, these studies absolutely do not mean that you can tell someone to: “Just relax, and you’ll get pregnant.”


Why ‘Just Relax’ Doesn’t Work, But Mind/Body Programs Might
Infertility treatment is stressful, and patients report high rates of anxiety and depression. In Domar’s latest study, she looked at the effects of her Mind/Body Program on IVF pregnancy outcomes. The researchers approached women who were about to begin treatment at Boston IVF and who met the study criteria: 40 years old or under with normal hormonal levels. Participants were randomized into a group that entered the Mind/Body Program for Infertility or a control group that received no mind/body intervention. The women who participated in the mind/body program had significantly higher pregnancy rates than those who did not — 52 percent vs. 20 percent).


“‘Just relax and get pregnant,’ says go watch TV, have a glass of wine, don’t work so hard,” Domar says. “It’s a very demeaning thing. In fact, I participated in study that found that the most common offensive thing said to infertility patients is ‘just relax and get pregnant.’”


The Mind/Body program is a vigorous, time-intensive, ten-session program. Participants are taught relaxation techniques they are expected to practice daily, a variety of different stress management strategies to integrate into their lives, and lifestyle habit changes, such as stopping smoking, decreasing caffeine and alcohol, or perhaps decreasing the intensity of their exercise regimen.


A mind/body program “is not ‘just relax,’” Domar says. “This is participating in a program with research behind it designed to decrease anxiety, decrease depressive symptoms, decrease hostility and confusion, decrease physical symptoms like insomnia, headaches and neck pain.


“A mind body program cannot undo abnormal eggs; it can’t unblock tubes,” Domar continues. “But what we can say is that to the extent that stress may be decreasing your fertility or decreasing the efficacy of IVF treatment, a mind-body program can counter the impact of that stress. So we’re not making women more fertile, we are simply reversing the adverse impact of stress.”


Stress Before Cycling Might Actually Be Good
Interestingly, Domar’s research found that the most distressed infertility patients prior to cycling had the highest pregnancy rates—but only if their distress levels came down during their cycle.


Domar refers to the “Yerkes-Dodson law”—an empirical relationship between arousal and performance, originally developed by psychologists Robert M. Yerkes and John Dillingham Dodson in 1908. “It says that your performance improves as your level of stress increases up to a certain point, and then it starts to come down,” Domar explains. “So you want an attorney to be a little jazzed up as he goes into court. You want a quarterback to be jazzed up as he walks onto the field. You want your pilot to be jazzed up as he’s taking your plane down the runway, but you don’t want them to be stressed out of their minds.”


The Yerkes Dodson law might help explain the conflicting research on stress and fertility treatment, as researchers are measuring stress at different points in time, according to Domar. “Maybe patients need to be a little bit revved up before they cycle—not very revved up, but a little revved up. But their stress level has to come down while they cycle to achieve a pregnancy.”


The Takeaway about Stress and Fertility
So what is the takeaway message about stress and infertility? It is basically that:


  1. There is a relationship between stress and IVF outcome.
  2. If you are stressed prior to cycling, it does not appear to be a detriment to pregnancy rates; in fact the opposite might be true.
  3. Stress during a cycle might be associated with lower pregnancy rates.
  4. Learning relaxation and stress management strategies prior to and during infertility treatment are associated with significantly higher pregnancy rates, as well as far lower levels of anxiety and depression.
  5. Even if you are not feeling distress, learning stress management techniques can’t hurt.


“In the study we just published, these were not women who felt stress, these were just women we recruited,” Domar says. “I would say at this point, if you are planning to do the big guns like IVF — even if you are not feeling stress — it’s sure not going to hurt you to learn some stress management strategies.”

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