from the book How to Have a Baby: Overcoming
Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani,
MD.
Previous page:
Childfree living - Life without children
Next page: The
Emotional Crisis of Infertility
Table of Contents
What
is the relationship between stress and infertility ?
Why
is infertility stressful ?
What
is the relationship between stress and infertility ?
Stress has become a buzzword today.
It is one of the most over used words in our vocabulary
- and one of the most poorly understood ones as well.
Stress is defined as any event that a person perceives
as threatening, and in order to protect itself, the
body responds to stressors with a classic "fight or
flight" response, which nature designed to allow survival.
In response to stress, the hypothalamus produces a hormone
called corticotropin releasing factor ( CRF) which activates
the hypothalamic-pituitary-adrenal (HPA) system, causing
it to releases neurotransmitters (chemical messengers)
called catecholamines, as well as cortisol, the primary
stress hormone.
The relationship between stress and
infertility is still poorly understood today. While
there is little doubt that infertility causes considerable
stress, the question whether stress can cause infertility,
and whether stress reduction can enhance pregnancy rates
in infertile couples, is still very controversial.
Historically, infertility, particularly "functional"
infertility, was attributed to abnormal psychological
functioning on the part of one or both members of the
couple. Preliminary works in the 1940s and 1950s considered
"psychogenic infertility" as the major cause of failure
to conceive in as many as 50% of cases. As recently
as the late 1960s, it was commonly believed that reproductive
failure was the result of psychological and emotional
factors. Psychogenic infertility was supposed to occur
because of unconscious anxiety about sexual feelings,
ambivalence toward motherhood, unresolved Oedipal conflict,
or conflicts of gender identity. Fortunately, advances
in reproductive endocrinology and medical technology
as well as in psychological research have de-emphasized
the significance of psychopathology as the basis of
infertility, and modern research shows that there is
little evidence to support a role for personality factors
or conflicts as a cause of infertility. This perspective
unburdens the couple by relieving them of the additional
guilt of thinking that it is their mental stress that
may be responsible for their infertility.
Biologically, since the hypothalamus
regulates both stress responses as well as the sex hormones,
it’s easy to see how stress could cause infertility
in some women. Excessive stress may even lead to complete
suppression of the menstrual cycle, and this is often
seen in female marathon runners, who develop " runner’s
amenorrhea". In less severe cases, it could cause anovulation
or irregular menstrual cycles. When activated by stress,
the pituitary gland also produces increased amounts
of prolactin, and elevated levels of prolactin could
cause irregular ovulation. Since the female reproductive
tract contains catecholamine receptors catecholamines
produced in response to stress may potentially affect
fertility, for example, by interfering with the transport
of gametes through the Fallopian tube or by altering
uterine blood flow.
However, more complex mechanisms may
be at play, and researchers still don't completely understand
how stress interacts with the reproductive system. This
is a story which is still unfolding, and during the
last 20 years, the new field of pychoneuroimmunology
has emerged, which focuses on how your mind can affect
your body. Research has shown that the brain produces
special molecules called neuropeptides, in response
to emotions, and these peptides can interact with every
cell of the body, including those of the immune system.
In this view, the mind and the body are not only connected,
but inseparable, so that it is hardly surprising that
stress can have a negative influence on fertility.
Stress can reduce sperm counts as well.
Thus, testicular biopsies obtained from prisoners awaiting
execution, who were obviously under extreme stress,
revealed complete spermatogenetic arrest in all cases.
Researchers have also showed significantly lower semen
volume and sperm concentration in a group of chronically
stressed marmoset monkey, and these changes were attributed
to lower concentrations of LH and testosterone (which
were reduced in the stressed group). However, how relevant
these research findings are in clinical practise is
still to be determined.
In addition to these direct effects,
stress can also suppress libido, cause erectile dysfunction,
and result in a reduction in the frequency of intercourse,
which in turn could also reduce fertility. Also, many
women start overeating in response to the stress of
infertility. The increased fat cells then disrupt the
hormonal balance, making a bad situation even worse.
While studies have shown that infertile
couples do show psychologic dysfunction and even psychiatric
abnormalities ( such as depression or anxiety), this
is actually a chicken and egg problem, and in reality
the response of the infertile couple is a perfectly
"normal" response to their abnormal situation, which
is designed to help them to cope with the difficult
circumstances they find themselves in. However, many
people start blaming the couple, and many couples themselves
start believing that it is the stress which they are
under which is causing them to be infertile.
Victim blaming is popular – especially
where fertility and women are concerned, and instead
of providing them with support, couples receive completely
gratuitous and unwanted advise. Ironically, victim blaming
has become more prevalent today because of the fashionable
"holistic health" belief about the influence of the
mind on the body, which holds that even patients with
cancer can cure themselves by the power of positive
thinking. Many IVF couples too may subscribe to the
belief that success is practically guaranteed if the
patient remain optimistic and relaxed. Thus, if the
attempt fails, it was because the patient was "too tense"
or " too stressed out".
This myth has been perpetuated by anecdotes
of friends or relatives who have conceived while on
holiday, and stories of couples conceiving after many
years of infertility after they have adopted a baby
are a part of today’s "urban myths".
Stress and infertility often have a
circular relationship, and they can aggravate each other,
setting up a vicious cycle. Infertile couples, who are
under stress because of their infertility, start blaming
themselves for their infertility. This increases their
stress levels and further aggravates the problem! As
one mind-body expert has said, "Stress causes illness
causes more stress which causes more illness."
Research has shown that women undergoing treatment for
infertility have a similar, and often higher, level
of "stress" as women dealing with life-threatening illnesses
such as cancer and heart disease. Infertile couples
experience chronic ( long-term) stress each month, first
hoping that they will conceive and then dealing with
the disappointment if they do not.
It is helpful to differentiate between
external stress and internal stress; as well as stressors
you can control and those which you cannot. Internal
stress arises when you are not able to achieve the goals
you set yourself while external stress is created by
relatives, friends, and work pressures. Some stressors
you can do nothing about – for example, the frustration
you feel when your period starts. However, there are
many others which you can control. As an example, many
patients get upset when they are forced to wait in the
doctor’s clinic. Waiting can be stressful, so do carry
a book to read – while you cannot control the stressor,
you can modify your response to it, and this helps to
decrease your distress.
Why
is infertility stressful ?
When diagnosed with infertility, many couples feel helpless
and no longer in control of their bodies or their life
plan. Infertility can be a major crisis because the
important life goal of parenthood is threatened. Most
couples are accustomed to planning their lives and experience
has shown them that if they work hard at something,
they can achieve it. With infertility, this may not
be the case!
However, not all stress faced by infertile
couples is emotional or psychological - infertility
treatment can be physically stressful as well! Blood
tests; injections; hysterosalpingograms, inseminations
and surgery can be painful, awkward, and embarrassing.
There is considerable financial stress
too and this is especially acute for poor patients.
Infertility treatment is expensive, and this represents
a major hurdle. Many patients drop out of treatment
because they cannot afford it, and this can be very
hard to come to terms with, especially when they know
they could have got pregnant, if only they could have
afforded the treatment.
Some of the hormonal medications you
may need to take can also cause mood swings and emotional
upsets, making it harder for you to cope with the stress.
Don’t forget the impact of being stressed
on your personal relations. Being stressed out can add
to marital distress and disrupt sexual intimacy as well,
making a bad situation even worse. It can also alienate
you from your friends, cutting off sources of support.
Also, if you are always irritable, tense, and angry,
it’s going to be hard to build a rapport with your doctor
or his clinic staff. You may get a reputation as being
a " difficult " patient, and this may make it harder
for you to get good medical care.
There are certain times which are especially
stressful:
- Having to time sex when trying at
home
- Waiting for the menses. The suspense
can be killing each month - and is even worse when
the period is delayed for any reason
- Having to answer questions from family-members
and friends. Many of these questions are insensitive
and hurtful.
- Having to juggle infertility treatment
with work pressures
- Making a decision to see the doctor
- Deciding which medical treatment
to take
- Waiting for results -Is the sperm
count normal? have the eggs fertilized?
Many of these stresses are amplified
considerably during IVF treatment. Many couples start
IVF focused anxiously on one primary concern: failure
of the procedure. To compound this anxiety, couples
are aware that they have little control over the final
outcome - and this helplessness can make the situation
even worse.
The inconvenience of daily injections
and blood tests, the perception of low success rates,
the wait for results, and financial pressures only add
to the travails. Often, IVF is their last hope after
many years of trying, and they feel that their entire
future rides on the outcome of the cycle.
While it is true that couples cannot
control the outcome, they can be helped to control their
responses to the various phrases of the process and
to the overall outcome.
It has been suggested that patients
who are better able to cope with stress have higher
pregnancy rates, although there have been relatively
few studies in this area. Interestingly, we find that
patients coming for the second IVF treatment cycle are
much more relaxed and in control, so that they are less
"stressed out".
Perhaps the best general approach for treating stress
can be found in the Serenity Prayer by Reinhold Niebuhr,
" God, Grant me the serenity to accept the things I
cannot change, the courage to change the things I can
change, and the wisdom to know the difference." Remember
that no single method is uniformly successful: a combination
of approaches is generally most effective. Also, what
works for one person does not necessarily work for someone
else.
There are a number of very useful books
which deal with stress management techniques in great
detail. A special bonus is that these tools will help
you cope with stress for the rest of your life as well!
Some of these tools, which you need to learn how to
use, so that you can deal better with the ups and downs
of your infertility include: imagery, visualization,
hypnosis, auto-suggestion, meditation, positive thinking,
progressive muscular relaxation, deep breathing, biofeedback,
and massage.
Infertility
Movie
Please do watch this movie
- it describes the emotional status of an infertile
couple so well !
Next page: The
Emotional Crisis of Infertility
Previous page:
Childfree living - Life without children
Table of Contents
|
