Hi!
I'm Carole
Hello! I’m Dr. Carole Swiecicki, a licensed clinical psychologist with a 15 year career in helping people overcome trauma. I am also an infertility survivor, an IVF warrior, and a mom.
Spoiler alert –relaxation is not how babies are conceived.
You see, for pregnancy to occur under traditional circumstances (ASRM MHPG, 2016):
- An oocyte (“egg”) must be released from the ovary and picked up by an open and functional fallopian tube.
- There must be sperm of sufficient number and motility deposited in the upper vagina that move through the cervical mucus and uterine cavity
- Sperm and egg have to meet, successfully fertilize to create an embryo that travels to the uterus and grows for 6-10 days
- Uterine lining is ideally free of structural defects that would interfere with implantation
- Embryo must implant in the uterine lining and continue growing
(Yes, I realize that’s laden in sarcasm but it’s also TRUE!)
And yet, those of us who have struggled to conceive and shared our struggle with others have heard “Just relax,” many, MANY times. The research psychologist in me has wondered whether there may be some grain of truth to this which leads people to so unbelievably routinely recommend it. A bit of me worried, “Could it be that my own stress is causing my infertility?”
With a deep breath, I went through the scientific literature to see what I could find.
Relaxation serves a valid purpose – supporting your emotional and behavioral well-being.
First things first, although there is a bit of a debate in the reproductive medicine field on the impact of stress on conception, practice guidelines are clear that there is no consistent research showing that stress causes infertility, pregnancy loss or ART outcomes (ASRM). The debate is what often happens when there are multiple studies supporting somewhat different answers to the question, and as I was looking I found it helpful to learn what those said. There have been a couple of studies that have found that reducing stress may be related to pregnancy rates among couples attempting to conceive naturally, but not among those doing IVF (Hammerli et al., 2009). Yet others have found that stress prior to starting an IVF cycle was unrelated to the outcome of the cycle, oocyte maturity or embryo quality (Pasch et al., 2012; Cesta et al., 2018).
Part of the challenge is that it is hard to design a randomized controlled trial (the gold standard in medical research) studying this question. Even figuring out how to randomly assign “relaxed” and “not relaxed” people would be challenging, as the terms “relaxed” or “stressed” vary widely by person. Some people can be under tremendously stressful conditions and not FEEL particularly stressed – we all have a different degree of tolerance for stress and distress. Additionally, our stress levels often change throughout the cycle – you are continually receiving encouraging vs. discouraging news, and this impacts our moods!
Rather than stressing about stress, I think it can help to remind ourselves that there is no overarching evidence that typical levels of stress cause infertility or miscarriage. Even under high levels of exertion or general stress, women get pregnant and carry to term every single day.
So then, it still begs the question for me, why do people say this so frequently? And why does it seem that many actually believe it? Aside from the bit of a debate in the field that may contribute to this, so often, “Just relax” is followed by anecdotal stories about a friend who “took a break” or “took a vacation,” “relaxed” and – boom! – pregnant.
I’ve come to believe that this advice stems predominantly from a general lack of understanding that infertility is a medical diagnosis. For the 7 in 8 couples who are NOT infertile, it is possible that stress may interfere with them having sexual intercourse during their fertile window of the month. Certainly, if stress is interfering with having sex to help sperm meet egg, then, reducing the stress will help!
But for any of us who have gotten to the point of an infertility diagnosis (defined by World Health Organization as “a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse)- this is a condition that simply cannot be cured with relaxation.
And I say this with all the confidence and value in relaxation activities for OTHER aspects of well-being!!
Dipping your toe in the relaxation waters can be helpful for you, even if “just relax” advice is not.
Speaking of which, there is a good amount of research support that reducing stress is still helpful for those of us going through infertility. The stress associated with infertility can reduce our happiness and quality of life. And, importantly when we are talking about stress and pregnancy rates, stress and distress when undergoing infertility predicts dropout from treatment (Domar, 2004). One-fourth of people who drop out report that emotional factors were the main reason (Van den Broeck et al., 2009; Verberg et al., 2008). In one study where couples were offered three completed IVF cycles without charge (wow!!), 65% of couples did not finish the full treatment program (Olivius et al., 2002). Sixty-four percent (64%) of couples in another study where IVF was provide free of charge who dropped out cited the “emotional cost” as the reason for dropping out (Hammarberg et al., 2001).
It definitely make logical sense that, if you follow through with completing ART (which DOES have higher rates of successful pregnancy for infertile couples than continuing to try unassisted) – you are more likely to get pregnant. Thus, the logic continues that if you reduce stress so that it does not interfere with you completing treatment, you will have a higher likelihood of success.
One study supports this logic, a randomized trial evaluating the impact of a mind-body stress reduction program among infertile women (Domar et al., 2000). Interestingly, those women who completed the program had both reduced levels of stress and higher pregnancy rates (55% conceived within 6 months vs 20% in the control group). The authors were clear to note that these findings do not mean that stress causes infertility, but more that reducing stress can be helpful for improving outcomes. For example, it is possible that the reduced stress helped the women follow their assisted reproductive protocols more closely or “aggressively,” thereby resulting in higher pregnancy rates.
Taken in total, the link among relaxation and pregnancy is, at most, weak and indirect. So, if you are reading this and stressed – take heart. You are not ruining your chances of success.
Even if you are stressed.
AND, if you are reading this and stressed, we’d love to support you in feeling more relaxed – for YOU! There are proven tools that you can learn to help. Check out our courses and resources, or connect with a specialized provider.
Your mental health matters just as much as the outcome of your next cycle.
