Does stress impact fertility?

Have you ever wondered if stress has an impact on fertility? The evolutionary mechanism of how stress impacts fertility makes sense from a biological perspective. Now, modern science shows that the chronic stress many of us experience on a daily basis may also be contributing to the growing issue of fertility struggles, which, according to new data released from WHO, affects 1 in 6 people across the globe.

It’s also likely no surprise that undergoing fertility treatments is stressful in itself: According to a 2023 survey from Maven Clinic, 81% of patients say that the emotional stress of fertility treatment is equal to if not stronger than the financial stress of treatment.

As a licensed naturopathic doctor and root-cause fertility specialist, I’ve found that stress appears to be one of the major obstacles to conceiving in many of my patients. From recent research on stress and fertility to what to actually do about reducing stress, I’ll unpack it all for you here. 

Related: The 7 most misunderstood myths about fertility, explained

What is stress? 

Before we talk about the relationship between stress and fertility and what to do about it, let’s talk about what stress is. 

Stress is an umbrella term for the body’s response to physical, mental or emotional pressure. There are body changes that can happen in response to physical stressors like not sleeping enough, eating enough, or over-exercising. Mental and emotional stress is often defined as “a state of worry or mental tension caused by a difficult situation”. Stress is a natural human response designed to keep us safe from threats. 

However, the changes that take place in our body are meant to be short-lived.The problem in our modern world is that when we have chronic, long-term stress interwoven throughout our daily lives, we can experience many health issues, including fertility struggles. ¹McEwen BS. Neurobiological and Systemic Effects of Chronic Stress. Chronic Stress. 2017;1(1):247054701769232. doi:10.1177/2470547017692328,²‌Tsigos C, Kyrou I, Kassi E, Chrousos GP. Stress: Endocrine Physiology and Pathophysiology. PubMed. Published 2000. https://pubmed.ncbi.nlm.nih.gov/25905226/ 

Survival over reproduction 

Our body has two main nervous system branches: the sympathetic, which is activated in stress, and the parasympathetic, which rules our fertility. Each system controls a different set of hormones and actions in the body. If the body perceives a threat, even if it’s from traffic, a challenging boss, or lack of resting, it will prioritize survival (sympathetic) over reproduction (parasympathetic). 

During chronic stress, the messages to support the systems of reproduction, such as ovulation, egg maturation, and sperm production, become weak. Evolutionarily, if your ancestor was living in a famine or a dangerous environment, they would have had a better chance of survival if their body naturally prevented pregnancy. This is the evolutionary basis for stress’s impact on fertility. 

Related: How to reduce stress while trying to conceive

Stress and female fertility 

Today, stress can be challenging to quantify and study as it is multifactorial and depends on a person’s history, individual experiences and perceptions. Many studies on stress and fertility are done in the realm of infertility, a condition that itself contributes to stress. Although there are some conflicting studies, there is growing evidence that stress does impact fertility in a big way.

It has been found that distress is “associated with decreased conception rates and long menstrual cycles (≥35 days) and lower outcomes of reproductive medicine, including oocytes (eggs) retrieved, fertilization, pregnancy, and live birth rates.” 

It has also been found that ovarian reserves, essentially the amount of eggs a woman has, decreases with the more lifetime chronic stress a woman reports.³‌Palomba S, Daolio J, Romeo S, Battaglia FA, Marci R, La Sala GB. Lifestyle and fertility: the influence of stress and quality of life on female fertility. Reproductive Biology and Endocrinology. 2018;16(1). doi:10.1186/s12958-018-0434-y This could be due in part to stress increasing oxidative damage, a molecular process where reactive oxygen species cause cellular damage.⁴‌Møller P, Wallin H, Knudsen LE. Oxidative stress associated with exercise, psychological stress and life-style factors. Chemico-Biological Interactions. 1996;102(1):17-36. doi:10.1016/0009-2797(96)03729-5 Oxidative stress has been found to reduce oocyte count and quality, ultimately impacting a woman’s ability to conceive.⁵‌Wang L, Tang J, Wang L, et al. Oxidative stress in oocyte aging and female reproduction. Journal of Cellular Physiology. 2021;236(12):7966-7983. doi:10.1002/jcp.30468,⁶‌Agarwal A, Gupta S, Sharma R. Oxidative stress and its implications in female infertility – a clinician’s perspective. Reproductive BioMedicine Online. 2005;11(5):641-650. doi:10.1016/s1472-6483(10)61174-1 

One of the main reasons behind stress’s impact on fertility is the activation of the sympathetic-adrenal-medullary (SAM) axis, essentially the nervous system and hormone systems of stress. In one study, researchers found that a high marker for the SAM system correlated with more difficulty conceiving.⁷‌Louis GMB, Lum KJ, Sundaram R, et al. Stress reduces conception probabilities across the fertile window: evidence in support of relaxation. Fertility and Sterility. 2011;95(7):2184-2189. doi:10.1016/j.fertnstert.2010.06.078 High-stress hormones in the body disrupt the HPO (hypothalamic-pituitary-ovary) axis, which is the communication pathway between the brain and ovary, needed for egg maturation, sex hormone production, and ovulation.⁸‌Whirledge S, Cidlowski JA. A Role for Glucocorticoids in Stress-Impaired Reproduction: Beyond the Hypothalamus and Pituitary. Endocrinology. 2013;154(12):4450-4468. doi:10.1210/en.2013-1652 This happens partly by reducing FSH and LH production, the two key hormones that rule a woman’s monthly ovulation and fertility cycle.⁹‌Damti OB, Sarid O, Sheiner E, Zilberstein T, Cwikel J. Stress and distress in infertility among women. Harefuah. 2008;147(3):256-260, 276.

Independent of ovulation, some animal studies point to the impact of stress on uterine embryo receptivity,¹⁰‌Kondoh E, Okamoto T, Higuchi T, et al. Stress affects uterine receptivity through an ovarian-independent pathway. Human Reproduction. 2008;24(4):945-953. doi:10.1093/humrep/den461 which could partly explain why IVF embryo transfers sometimes fail even when the embryo quality is good or excellent. 

Depression and anxiety also seem to negatively impact fertility, as well as self-measured quality of life. Ironically, infertility can decrease quality of life measures, and increase anxiety, depression, and stress.[‌mfn]Palomba S, Daolio J, Romeo S, Battaglia FA, Marci R, La Sala GB. Lifestyle and fertility: the influence of stress and quality of life on female fertility. Reproductive Biology and Endocrinology. 2018;16(1). doi:10.1186/s12958-018-0434-y[/mfn] 

Stress and fertility can therefore be a vicious cycle, with stress impacting a woman’s ability to conceive, and the inability to conceive subsequently increasing stress. 

Related: 12 signs you might be having fertility struggles, according to experts

Stress and male fertility 

It’s not only female fertility that is affected by stress. Mounting evidence is showing that stress impacts male partners, too.¹¹Nargund VH. Effects of psychological stress on male fertility. Nature Reviews Urology. 2015;12(7):373-382. doi:10.1038/nrurol.2015.112

Many clinical studies show an inverse relationship between stress and semen markers. In states of stress, the brain dials up communication to the adrenals, the place where stress hormones are made, and dials down the communication to the testicles via lower hormones FSH and LH. This results in lower testosterone in the testes, which directly impacts sperm production.¹²Nargund VH. Effects of psychological stress on male fertility. Nature Reviews Urology. 2015;12(7):373-382. doi:10.1038/nrurol.2015.112

In one study, researchers found that short-term and chronic stress reduced sperm functionality by 3.2 and 2.5 fold, respectively. Only chronic stress decreased sperm numbers. The stress hormones themselves, such as cortisol and adrenaline, decreased sperm functionality and impacted the sperm mitochondria, the essential energy powerhouses that sperm must have to survive.¹³Starovlah IM, Radovic Pletikosic SM, Kostic TS, Andric SA. Reduced spermatozoa functionality during stress is the consequence of adrenergic-mediated disturbance of mitochondrial dynamics markers. Scientific Reports. 2020;10(1):16813. doi:10.1038/s41598-020-73630-y 

In addition, another study found that occupational stress was correlated with higher rates of sperm DNA fragmentation, which is essentially the breakdown of the integrity of the sperms’ genetic code. DNA fragmentation is another key factor in male infertility.¹⁴‌Radwan M, Jurewicz J, Merecz-Kot D, et al. Sperm DNA damage—the effect of stress and everyday life factors. International Journal of Impotence Research. 2016;28(4):148-154. doi:10.1038/ijir.2016.15

In summary, stress impacts men’s brain hormones FSH, LH, and lowers testosterone, the main hormone needed to make sperm. It also impacts sperm functionality and may negatively impact mitochondria as well as contribute to sperm DNA fragmentation. Given the emerging evidence, it would be beneficial for the male partner trying to conceive to take active steps to reduce his stress. 

Stress and infertility 

Difficulty conceiving is inherently stressful, and many couples who are studied in the infertility stage experience stress from the process itself. The loneliness and isolation of infertility, the financial burden of it, the daily disruption of doctor’s visits and procedures, the lack of control feelings, and the grief around a potential childless life can all take their toll on a couple trying to conceive.¹⁵Schenker JG, Meirow D, Schenker E. Stress and human reproduction. European Journal of Obstetrics & Gynecology and Reproductive Biology. 1992;45(1):1-8. doi:10.1016/0028-2243(92)90186-3 Data from Maven Clinic found that 39% of patients undergoing fertility treatments felt least supported around their mental health, experiencing stress or anxiety associated with treatment.

Regardless of whether stress contributes to infertility or if infertility causes stress, we know that reducing stress is helpful whether a couple is trying to conceive naturally or going through assisted reproductive measures. 

Related: 5 questions to ask at your first fertility appointment

What to do about stress when you’re trying to conceive

From taking stock of your stress to shifting your mindset, here are meaningful ways to reduce your stress.

1. Take a stress inventory 

From working with many women and couples struggling with infertility, I have found that it’s most helpful to first take an inventory of your stressors. It’s difficult to shift something you aren’t aware of. I recommend writing out a list of anything you are aware of that may be contributing to your stress. (For more tips I use in my private practice, check out my Stress Survival Guide Mini-Course.) 

2. Identify what you can change

Once you write down everything that is stressing you out, identify if each stressor is something you can shift or change.

For example, if your main stressors are:

• A stressful job 
• Waking up early for that stressful job
• Commuting 30 minutes in traffic to that stressful job
• Working late at night for that stressful job
• Watching the news 

Then ask yourself, “Is there a potential reality where I could quit my stressful job and apply for a less stressful job closer to home that respects my home and work life balance? Could I stop watching the news or perhaps receive it second-hand from a trusted friend?” More often than not, there are ways to shift our stressors, although it may take some major life changes.

3. Consider shifting your perspective 

If you can’t shift or change a stressor, you may need to gain tools and insights to help you shift your perspective on that stressor. 

For example, if your main stressor is not being able to conceive, ask yourself, “Is there a way that I can shift my perspective about this stressor?” Perhaps you could work with a counselor or therapist on releasing the fear associated with not conceiving, or bring in a spiritual practice to find the meaning in your struggle or journey. If you’re just starting out, consider working with a professional.

4. Bring in stress-reducing practices 

There are many practices that have been shown to reduce stress. The key is finding which practices you like doing and which ones you can commit to doing regularly. 

• If you are more of a body-focused person, exercise may be a great option for you. However, avoid over-exercising during the trying-to-conceive season as this could affecting ovulation, potentially hindering your fertility.¹⁶‌Hakimi O, Cameron LC. Effect of Exercise on Ovulation: A Systematic Review. Sports Medicine. 2016;47(8):1555-1567. doi:10.1007/s40279-016-0669-8

• If you are an external processor, talk therapy, talking to a friend, or journaling may be great options for you. 

• If you love to receive healing treatments, you may benefit from therapeutic massage or acupuncture. Acupuncture has been shown to not only reduce stress, but improve natural fertility and IVF outcomes, making it a highly beneficial therapy.¹⁸Huang D, Huang G, Lu F, Stefan D, Andreas N, Robert G. Acupuncture for infertility: is it an effective therapy? Chinese Journal of Integrative Medicine. 2011;17(5):386-395. doi:10.1007/s11655-011-0611-8

• If you find it challenging to calm your mind, you may benefit the most from mindfulness practices and stress-reducing guided meditations. You can find options on apps such as Insight Timer or Expectful. 

One study found that a mind/body behavior-based program for 10 weeks, including relaxation response training, stress management training, exercise, and information about diet and exercise “showed statistically significant decreases in anxiety, depression, and fatigue as well as increases in vigor. In addition, 34% of these women became pregnant within 6 months of completing the program.”²⁰‌Domar AD, Seibel MM, Benson H. The Mind/Body Program for Infertility: a new behavioral treatment approach for women with infertility. Fertility and Sterility. 1990;53(2):246-249. doi:10.1016/s0015-0282(16)53275-0

A note on stress and fertility

When it comes to stress and fertility, there seems to be a strong correlation between the two and various mechanisms at play in both females and males. Stress can impact a couple’s ability to conceive, and infertility can worsen the stress response. There are many things that can be done to support a woman or a man’s stress, with the first step being awareness. Regardless of where you are along the trying-to-conceive journey, from preconception to pursuing assisted reproductive technology, taking active steps to reduce your and your partner’s stress is well worth your time and effort. 

A version of this story was originally published on April 25, 2023. It has been updated.

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