Guest blog by Dr. Samina Mitha, ND, a Naturopathic Doctor.
Infertility can often be a very lonely and stressful process.
You’ve probably been told, “Just try to relax. You should consider taking a vacation. Maybe you are just trying too hard.”
Many couples keep this part of their lives to themselves, increasing the mental struggle that comes along with the entire process. Couples who struggle with infertility report feelings of depression, anxiety, isolation and loss of control.  It’s very well known that infertility treatments can naturally cause stress. But what is hard to investigate is if stress is the cause of infertility.
Which begs the question, what is the true connection between stress and infertility?
What is stress?
Cortisol is our “stress hormone”. It’s produced in the adrenal glands that sit on top of the kidneys. Think of it as your body’s natural alarm system. You’ve probably heard of the “fight or flight” response before – it occurs when the body’s instinct is to produce cortisol in what it interprets to be a crisis situation (ie. getting into a heated argument, the pressure before an important exam/meeting). Energy is diverted away from the reproductive organs and directed towards other areas to help deal with the crisis. After the response has passed, the cortisol that is produced during a particular crisis should enviably decline, but if you are in a state of constant chronic stress it can stay elevated for longer periods of time.
Research Linking Stress and Infertility
It’s not surprising that patients with infertility concerns report significantly more symptoms related to anxiety and depression versus fertile patients. In a literature review, it has been suggested that 25-60% of infertile patients report psychiatric symptoms and the longer the duration of fertility treatments the more prevalent the symptoms become. 
It has also been hypothesized that the signals from the brain instructing the adrenal glands to produce cortisol, known as the hypothalamic-pituitary-adrenal-axis (HPA), can have an impact on signals from the brain to the ovaries known as the hypothalamic-pituitary-gonadotropic axis (HPG). As a result, cortisol can downregulate the signals from the brain to the ovaries and from the pituitary in the brain itself, reducing the hormones that help to build the follicle that houses the egg. 
Researchers are now acknowledging the impact that stress can have on fertility. Dr. Sarah Berga, MD notes, “We know now that stress hormones such as cortisol disrupt signaling between the brain and the ovaries, which can trip up ovulation.”  This trip up is a common diagnosis of “anovulation,” meaning the patient isn’t ovulating, which can prevent a couple from conceiving.
A study with 501 patients in the United States measured salivary alpha-amylase levels, a marker of stress. It was found that women with the highest amount of salivary alpha-amylase were twice as likely to experience infertility. 
There is still more research to be conducted to conclude the connection between stress and its impact on fertility outcomes. However, we know that reducing stress will improve your health in general and create an environment conducive to conceiving.
What can you do?
Your body is smart – if you are tense, anxious and stressed, the environment in your body is not going to be receptive to creating a new human being. It’s going to be focused on the tension at hand.
We do know that psychological interventions can work to lower mental and emotional suffering and have the ability to significantly improve pregnancy outcomes. Below are four ways to help reduce stress associated with infertility:
4 Ways to Reduce Stress Associated with Infertility:
- Meditation/Mindfulness – Mindfulness is a trending topic lately, however, most of us shy away from meditation. While calming the mind in meditation can be difficult, remember that it is a practice and it takes time to build. Start off with 3-5 minutes a day. Any time spent quieting the mind is beneficial to reducing stress. A study with IVF patients compared those who practiced mindfulness-based interventions versus those that didn’t and found those that did the interventions showed increased mindfulness, self-compassion, and higher pregnancy rates.  Guided meditations by Circle+Bloom can be a great way to get started with your meditation practice!
- Yoga – Practicing yoga has been shown to calm the body and nervous system. It also allows us to get back in touch with our physical self, which can be helpful for many women after feeling as if their body has let them down. Often times, the poses in yoga can also help to improve blood flow to the reproductive organs to aid in proper hormone production.
- Practicing Gratitude– It can be understandably difficult to keep a positive outlook while going through the rhythm of fertility treatments, especially dealing with the uncertainty of it all. Practicing gratitude on a daily basis will program your brain towards a positive mindset and will help to keep you on the right track of having an optimistic outlook. Practice gratitude by writing down three things that you are grateful for before going to bed. Compliment friends and strangers, express your thanks throughout the day and recognize negative thoughts and try turning them into positives.
- Cognitive Behavioural Therapy (CBT) – CBT is a form of psychotherapy that focuses on identifying your thoughts, how they make you feel and the common actions associated with your thoughts. It challenges the thoughts that come up, recognizes the mental and physical effects and ultimately helps us to change the negative behaviours that we have developed. In a study comparing CBT to a common anxiety medication (fluoxetine) and a control group, it was found that CBT can be a reliable alternative to reducing infertility stress over pharmacological intervention, such as fluoxetine. 
 Can Stress Affect Your Ability to Conceive?. (2019). Retrieved from https://www.webmd.com/baby/features/infertility-stress#3
 Damti OB, e. (2019). [Stress and distress in infertility among women]. – PubMed – NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18488870
 Kristin L. Rooney, A. (2019). The relationship between stress and infertility. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016043/
 Mahbobeh Faramarzi, Z. (2019). The Effect of The Cognitive Behavioral Therapy and Pharmacotherapy on Infertility Stress:A Randomized Controlled Trial. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3914487/
Samina Mitha is a graduate from the Canadian College of Naturopathic Medicine. Through her previous work for an online health promotion company called Everyday Health in New York City, Samina realized her true passion of helping people one-on-one to achieve their optimal health potential and heal naturally. Having been diagnosed with Polycystic Ovarian Syndrome (PCOS), Samina has a personal connection with women who experience hormonal imbalances. She has witnessed the tremendous success naturopathic medicine can have on women with fertility challenges and is motivated to share her knowledge and expertise in this field. She has a special interest in fertility management and reproductive health. In her clinical work, Samina has supported and treated patients with PCOS, endometriosis, fibroids, and IVF/IUI/ICSI processes. The tools she utilizes include: clinical nutrition, acupuncture, herbs and lifestyle counseling. Samina currently maintains a blog where she shares her PCOS journey, which includes recipes and health articles. Visit Samina’s blog at: www.saminamitha.com