Emotions directly affect fertility levels, which can be a challenge, as getting pregnant is both an emotional and a physical journey. The emotional ride varies from person to person, but after a year of trying and no conception, the emotional journey gets tougher for everyone.
The word “infertility” starts to be used, and expectations with the “baby-to-be” and the wider world become challenging. Plus, friends and family who get pregnant or have children may expect you to share their delight. It’s a situation designed to create new levels of uncertainty about self, your partner, what’s going on, the possible treatment choices and their outcomes. Not to mention the question of when “enough is enough”, and it can easily become all-consuming, depressing and isolating, which is a place where emotions and hormonal balance start to wobble. This situation is one of the main reasons morefertile® was written, and the best way to reduce stress and manage expectations is to fully understand the situation; this article covers:
- Infertility stress
- Women and fertility stress
- Men and fertility stress
- The best ways to cope
Fertility and stress
Fertility medicine is different from nearly every other medical experience simply because there isn’t a clear problem that needs a “remedy”, but a “lack of” baby, which fundamentally changes people’s expectations and experiences. People find themselves faced with unusual questions, including:
- Who should we tell?
- How do we interpret these tests?
- What’s the plan?
- What are treatment options and costs?
These bring unusual stresses and strains on us as individuals and as couples, so if you’re curious about your stress levels, assess them with the “perceived stress scale“. Stress and anxiety affect the fertility of both partners, whether it’s natural conceptions or having ART, i and it’s so significant some experts recommend patients have treatment to reduce stress before ART is even started! While we know stress profoundly affects us, it’s not easy to measure, and personal responses to given stresses vary enormously.
Whenever we get stressed, it alters our nervous system, and the nervous system connects to the hormonal system by the hypothalamus at the base of the brain stem. The hypothalamus is an essential and very sensitive gland that’s the “master control box” for the Autonomic system in the body, and it controls:
- Numerous hormone systems, including sex hormones, thyroid and adrenal
- Body temperature
- Fluid levels
- Thirst and hunger
- Emotional responses
Infertility and stress
Infertility is upsetting and distressing for both partners, but childless women who’re actively trying for a baby feel it worst, and the two issues that distress them most are: ii
- Feeling isolated
- Arguments about the situation with her partner, family or friends iii
Just coming to terms with the idea of infertility is stressful, then add in the investigations needed for a diagnosis, and there’s a lot more uncertainty and stress. So it’s not surprising depression and social withdrawal become an issue for many childless couples, and the stress can also affect men, who become unable to perform sexually when they’re under pressure. Studies tell us how men and women are affected and suggest the best (and worst) ways of coping with a tough situation.
Women and fertility stress
The women who self-diagnose themselves as infertile are the most distressed group, which makes them even more stressed than women who’re having treatment. iv So, despite it potentially being bad news, getting a diagnosis usually reduces uncertainty and helps to lower stress.
Despite this, having fertility treatment doesn’t necessarily bring happiness, and a year of unsuccessful treatment leaves 15% of women very depressed. Nearly a quarter (23%) give up treatment during the year, and the women who are most likely to stop treatment: v
- Feel unappreciated by their family
- Have highly demanding relationships
- Are in conflict with family, friends or neighbours
The question of “who to tell” is fundamental and important, and it depends on how supported a woman feels. A rule of thumb is you don’t have to tell anyone, and just tell people who’re likely to be supportive, as telling anyone who then questions your situation, or the decisions you make will distress you.
Men and fertility stress
About 6% of men become very depressed after a year of unsuccessful fertility treatment, and these men say it’s often because: vi
- They feel little emotional support or appreciation
- Excessive demands from their partner
Having to perform sex in the woman’s fertile phase is a difficult issue for many men, and when previously virile men are asked to have sex to the fertile phase, 42% of them experience erectile dysfunction. Unfortunately, the more men are asked to “perform on request”, the less likely they will manage it. This unhappy situation can have serious consequences as about 10% of the affected men have extra-marital affairs (particularly men with erectile dysfunction) as the affairs are probably a coping mechanism to combat low self-esteem and high anxiety levels. vii
While there are advantages to timing sex to the most fertile days of the month, it obviously doesn’t help if it destroys the relationship. Ovulation predictor tests put great (and unnecessary pressure) on the couples who use them, and we suggest that fertility awareness with cervical changes is a more accurate and less stressful way to monitor the fertile window. When stress is an issue, couples are best off timing sex to peak fertility for three months, then focusing on something else for a month or two before trying again.
- Counselling is recommended for depression (particularly CBT), while regular exercise is a great way to reduce depression and frustration. viii
- Acupuncture helps to reduce stress and balance hormones.
- Good-quality social networks reduce the stress of infertility, and women, in particular, should seek positive support from family, partners and the wider community. ix
- Coping strategies based on avoiding the whole issue of babies and children don’t work well as it restricts and limits lives and focus attention on “what isn’t there” rather than resolving the hurt.
- All research indicates that couples experiencing infertility and struggling to cope are best off setting new life goals and meaning. While this doesn’t stop the experience of the stress of infertility, it helps reduce the worst of the negative responses affecting people in this situation. x
There is no magic wand to overcome infertility, but it’s possible to adjust how big a space it takes up in lives. Actively improving health and fertility is a positive response to the situation and also improves the function of the hypothalamus (along with the rest of the body), and following PFP advice to promote health and fertility is a gentle but effective way to reframe the situation and increase the chances of success.
ii‘Variation in distress among women with infertility: evidence from a population-based sample’ Arthur L. Greil, et al. Hum. Reprod. (2011) 26 (8): 2101-2112.
iii‘The impact of social relations among men and women in fertility treatment on the decision to terminate treatment’ Ditte Vassard, et al. Hum. Reprod. (2012) 27 (12): 3502-3512.
<supiv‘Psychological distress by type of fertility barrier’ Mary Casey Jacob, et al. Hum. Reprod. (2007) 22 (3): 885-894.
v‘The impact of social relations on the incidence of severe depressive symptoms among infertile women and men’ R. Lund, et al. Hum. Reprod. (2009) 24 (11): 2810-2820.
vi‘The impact of social relations on the incidence of severe depressive symptoms among infertile women and men’ R. Lund, et al. Hum. Reprod. (2009) 24 (11): 2810-2820.
vii‘Timed intercourse induced erectile dysfunction and extramarital sex- a prospective study of 439 men’ C. Bak, et al. J Androl. 2012 Nov-Dec;33(6):1245-53.
viii‘The risks of selective serotonin reuptake inhibitor use in infertile women: a review of the impact on fertility, pregnancy, neonatal health and beyond.’ A.D. Domar, et al. Hum. Reprod. (2012)
ix ‘Direct and indirect effects of perceived social support on women’s infertility-related stress’ Mariana V. Martins. Hum. Reprod. (2011) 26 (8): 2113-2121.
x‘The longitudinal impact of partner coping in couples following 5 years of unsuccessful fertility treatments’ B.D. Peterson et al. Hum. Reprod. (2009) 24 (7): 1656-1664.