There are women who get pregnant easily even if they smoke like a chimney, drink a six-pack after dinner, and think of exercise as a waste of good texting time. Then there are the women who do all the right things but months and years pass and the strip in the home pregnancy kit refuses to change color. Relax, say well-meaning friends. Chill out. Let it happen. Gee, thanks, thinks the beneficiary of their insight, gritting her teeth.
But as unwelcome as the advice may be, it may be right. New evidence suggests that stress does affect fertility. A recent study found that women with high levels of alpha-amylase, an enzyme that correlates with stress, have a harder time getting pregnant. Saliva samples taken from 274 women over six menstrual cycles (or until they got pregnant) revealed that those with the highest enzyme concentrations during the first cycle were 12 percent less likely to conceive than were women with the lowest levels.
What's more, women involved in the study, published earlier this month in the journal Fertility and Sterility, had no prior record of infertility. Participants were either planning to get pregnant or had been trying for less than three months.
Researchers do not yet understand the role stress plays, since women can and often do get pregnant even under the intense stress, for example, that follows the death of a spouse. "I suspect that some women are more reproductively sensitive to stress than other women," says Alice Domar, who directs the Domar Center for Mind/Body Health in Boston. And the effect can feed on itself. "If you are stressed and you don't get pregnant quickly, then you get more stressed," says Domar, citing evidence from a study in Taiwan in which 40 percent of participants seeking infertility treatment were diagnosed with depression or anxiety. The treatment itself can be stressful, she adds, adding even more uncertainty.
If stress can influence the chance of conception, managing it may improve the odds. Researchers like Sarah Berga, who heads the department of gynecology and obstetrics at Emory University School of Medicine, have been trying to prove just that. Berga and her colleagues studied women who had stopped ovulating for more than six months and found that they had high levels of cortisol, a stress hormone. In stressful situations, cortisol, like adrenaline, pushes metabolism into high gear; sustained high levels can raise blood pressure, cause weight gain, or lead to other health problems. In a small study by Berga published in 2003, seven out of eight participants who received stress management therapy began ovulating again versus two out of eight who got no intervention.
What are some practical ways women trying to get pregnant can reduce stress? Experts make these recommendations:
Enlist your partner. Research shows that women handle infertility-related stress differently from men. Women more often seek social support, for example; men lean towards problem-solving. That disconnect can strain the relationship. Constant attention on procreation, according to psychologist Julia Woodward of the Duke Fertility Center in Durham, N.C., also contributes, siphoning the fun and joy from sex. She advises couples to act as if they were dating again. Set aside time during the week to go to a movie. Take a dance class together. And put a time limit of 20 minutes or so on pregnancy discussions. Fertility talk that goes on and on can make matters worse, she says.
Rethink your attitude. Thinking "everybody else gets pregnant so easily" only causes distress. Woodward helps women counter their negativity with positive coping statements: "If getting pregnant was so easy, there wouldn't be fertility clinics." Recognize pessimistic thinking and practice forming a response that is more realistic.
Try journaling. Setting down on paper how you feel can take some of the pressure off, says Tracy Gaudet, executive director of Duke Integrative Medicine. It's a way to off-load concerns you feel uncomfortable sharing, she says. And you can shred the pages or throw them out, a physical act that contributes to the effect.