In 10 seconds: Infertility affects millions of couples around the globe. Although it is not a life-threatening issue, it is still considered a stressful life experience. It is less clear, however, whether stress itself causes infertility.
What’s the story? The impact of emotional distress on infertility treatment outcome has been considered “difficult to investigate” for several reasons, including inaccurate self-reporting and feelings of increased optimism at the onset of treatment. However, the most recent research has documented the efficacy of psychological interventions in lowering psychological distress which has been associated with significant increases in pregnancy rates.
So, is infertility is associated with stress and mental health problems?Infertility is often a silent struggle. A 2010 nationwide survey from Finlandrevealed that fertility issues were often associated with psychiatric disorders such as anxiety and dysthymia (a chronic form of mild depression). Recently in 2022, an Australian report published in Nature, showed that half of the women with infertility had significant psychological distress.
Is it just because of the inability to conceive? Patients who are struggling to conceive report feelings of isolation, and loss of control. Depression levels in patients with infertility have been compared with patients who have been diagnosed with cancer. But beyond that, it appears most infertile women, for instance, do not share their stories with family or friends, thus increasing their psychological vulnerability. The inability to reproduce naturally can cause feelings of shame, guilt, and low self-esteem. These negative feelings may lead to varying degrees of depression, anxiety, distress, and a poor quality of life indeed.
So major depression and anxiety are that common among people experiencing infertility? This has been a consistent finding. According to a recent review of the literature that evaluated six studies on the topic,the authors universally found that women with a history of infertility were at an increased risk of developing mental health disorders. Depression risk was found to be elevated in four out of the six studies based on scores from validated scales such as the Edinburgh Depression Scale. Five of the six studies noted significant increases in diagnoses of anxiety or psychosocial distress in the specific study populations.
But does stress itself cause infertility? While an association between stress and infertility is obvious, it is not clear whether stress alone could interfere with the ability to conceive. There is at least some evidence although weak, that stress could increase the risk of infertility. For example, some authors have succeeded in demonstrating - and this concerns men - that an inverse relationship exists between psychological stress and semen parameters and quality. More specifically, some studies have identified alterations in several different sperm parameters in diverse, stressful circumstances, such as in students during exam periods, times of war, periods of elevated stress in their professional careers, or during mourning.
How about in women, do studies also show that stress could increase infertility? Causal factors for infertility are not limited to medical problems but extend to psychological issues in women as well. According to a review published in 2021 in Experimental and Therapeutic Medicine, women's emotional stress can manifest as fallopian tubal spasms (in this case the tubes can get unbocked), anovulation (when an egg is not released from the ovary), and vaginismus (the body's reaction to the fear of penetration, complicating examinations of pregnant women). But the relationship between infertility and emotional stress in women is quite complex.