Management of Stress in Fertility Care

“Just relax, Honey, and you will get pregnant.” “You’re too stressed out to get pregnant!” “You just need a vacation so you can get pregnant.”

Any patient who has been dealing with infertility for any length of time has heard one, if not all, of the above. While the person saying this means well, he or she has no idea most of the time what a fertility patient may need or not need. All of these statements are, at least for most of my patients, annoying, frustrating, and downright offensive. If all you needed to do was relax, you probably would be pregnant by now, right?

So, let’s take a minute and examine this whole stress thing. I believe that there is no question that stress, anxiety, and depression are part of any diagnosis of infertility. Just an infertility diagnosis is in and of itself a terrible stressor. It feels so unnatural, and many patients feel a total lack of control over their bodies. And then, to further complicate things, most patients know that stress is not good for them, so they stress over being too stressed. Nasty, vicious cycle.

Basically, there are two kinds of stress, good and bad. The good kind, which pushes a person to achieve goals and meet deadlines, is obviously productive and helpful. We have all experienced this, and many of us thrive on a certain amount of productive stress. That is not the kind of stress we are discussing in this article.

Bad stress, the villain, comes into play when the stressors in a person’s life begin to negatively affect the physiological and psychological function of the body, due to the “fight or flight” response. It is quite important that this type of stress be managed in the fertility patient, as it can have a very deleterious affect on fertility treatment outcomes. This applies to not only patients seeking natural fertility enhancement, as we see so frequently at Acupuncture Fertility Specialists, but also in patients undergoing more aggressive care such as IUI and IVF. Quite often, the patient feels like she has no control over her stress, cannot see a way in which to manage it, and feels like there is nothing she can do to help the situation.

Stress has been shown to have a negative impact on IVF outcomes (1). It has been shown to have a negative impact on IUI outcomes (2), and has been linked to PCOS and other disorders of ovulation (3). Even in men during IVF, stress has been shown to have a negative impact on semen quality (4). Finally, when the patient does fall pregnant, stress contributes to increased miscarriage rates (2). Most of these responses are a result of elevated cortisol and/or adrenaline levels in the infertile patient (5).

So, what’s a person to do?

I’ve been an acupuncturist for a long time, and I will tell you that this stress issue is rampant in our culture. Infertility adds to the load, a lot, for sure. So I have looked for ways for my patients to manage their stress that are easy, fun, doable, and not too time consuming. The best I have found are as follows:

Meditation. If you are a person who can sit still long enough, and empty your mind for 20-30 minutes, this is great.

Exercise. In my clinic, we generally recommend 45 minutes of brisk walking 4-5 times per week. Also other forms of exercise can be used. Be careful not to over- exercise, as that can also be detrimental to your outcome. In Chinese medicine, we believe that too much sweating can deplete the body’s vital “yin” fluids which are essential for reproduction, so we discourage our patients from any activity, such as Bikram or hot Yoga which cause a rolling, heavy sweat. Other, cooler, forms of yoga can actually be very helpful in stress management.

Tai Chi and/or Qi Gong. If you can find a class, this is great. Internet videos can help, too. Qi Gong would be the old school Asian way to really get relaxed and centered. I practice it myself!

Rock in a rocking chair. My Chinese teacher taught me this, she said it is the American form of meditation, and I think she was right. Fifteen minutes daily of rocking, in a quiet setting, is easy, cheap, and feels fantastic. The rhythm of rocking becomes sort of mantric after a few minutes.

Laugh. Laughter is, as the adage goes, the best medicine. One study in 2011 showed that daily laughter decreased several stress markers (8).

And finally, of course, my personal favorite is acupuncture. Most patients I treat tell me how profoundly relaxing acupuncture is, how it is “better than a good massage,” in fact. Most of our patients fall asleep on the treatment table during their acupuncture sessions. In one study, female patients undergoing an IVF cycle reported feeling an increased sensation of relaxation, decreased stress, and an ability to cope better for one week after an acupuncture treatment (7). Acupuncture in several clinical trials has been shown to improve IVF success by up to 17% (6). At Acupuncture Fertility Specialists, we almost never treat a patient with an infertility diagnosis without addressing the stress factor at every visit.

References:

1) Ebbeson, S. et al. Human Reproduction 2009, 24, 9, 2173-2183.

2) Demyttenaere, K. et al. Journal Psychosom Obstet Gyn. 1988, 8, 175-181.

3) Kisdon, W. 2011 Australian Doctor, June 24.

4) Clarke, R et al, Human Reproduction, 1999, 14, 3, 753-758.

5) Gallinelli, A. et al. FertilSteril. 2001. 76, 1, 85-91.

6) Paulus, W. et al. FertilSteril. 2002, 77, 4.

7) DeLacey, S. et al. BMC Complementary and Alternative Medicine, 2009, 9, 50.

8) Friedler, S. et al. FertSteril, 2011, 95, 6, 2127.

If you would like more information about this topic, or about acupuncture in general and how it might help you to conceive and have a healthy baby, please explore our website further.