For all the success of in-vitro treatment, sometimes it does not work. According to a new generation of fertility experts, the problem may be attributed to stress.
These days about 15% of couples who want a baby end up with some kind of assisted conception: This can involve a multitude of tests, injections, operations, scans and medications. Women quickly become experts in hormones, clinical techniques and high-tech terminology, fluent in IVF, GIFT, ZIFT, ICSI or MESA. They may endure extraordinary disappointment and distress without telling a single friend or family member. Finances may be stretched to the limit, and relationships can be put under strain. At first you’re only having sex to get pregnant. Then when you can’t conceive, some patients think, “Why bother with sex at all?” You don’t even want to think about sex. Sex soon becomes associated with failure.
Research has shown that the more distress a woman reports prior to infertility treatment, the less likely she is to conceive. Infertility clinics in Britain now are obliged to offer all patients access to a counselor (a regulation imposed by the Human Fertilisation and Embryology Authority). In the United States, fertility patients’ access to counselors is widespread but optional.
One published study in 2001 found that women suffering from prolonged stress were likely to have a reduced implantation rate during IVF. Another paper showed that women with a history of depression are twice as likely to suffer from infertility than those without. Yet another investigation showed that women’s depression levels peak in the second to third year of infertility (which is exactly the time when many are undergoing stressful fertility treatment). And severe stress may affect more than IVF implantation rates: One study examined women living near ground zero in New York who were undergoing IVF around the time of 9/11. Those who got pregnant after 9/11 were 67% more likely to miscarry than those who became pregnant before 9/11.
Michael Pawson, consultant gynaecologist and past Chair of the British Society of Psychosomatic Obstetrics, Gynaecology and Andrology, says that while virtually all doctors would agree that extreme stress can disrupt ovulation, the real problem is that the precise biological links between stress and fertility remain vague. We do not know the exact mechanism stress impacts reproductive outcomes. The hypothalamus controls the pituitary gland (which produces both female and stress hormones), although the exact relationship among all the component parts remains incompletely understood. Moreover, the exact proportion of infertile couples affected by psychological factors cannot be measured with any accuracy.
Claire Brown, executive director of the Infertility Network, the UK’s biggest infertility support organisation, agrees that such systematic support would be helpful for many women undergoing fertility treatments: “The number one emotion expressed to us is isolation.” Indeed, she says, many couples currently turn down counselling because they fear that if they accept it, clinics in Britain might think they are “failing to cope” and might therefore stop treating them.
At CAG, we talk to our patients about reducing external stress in their lives, and offer counseling resources to any patient or couple who think they may benefit from this. If you would like to learn more about how infertility counseling may help manage your stress, please discuss your concerns with us during your appointment at CAG.
Text modified from The Guardian [Newspaper], 2005