An article in the May 7 edition of U.S. News and World Report titled “Success at Last: Couples Fighting Infertility Might Have More Control Than They Think” shows how health psychology can impact even something as basic as making a baby. This fascinating article shows that behavioral and psychological factors may play a big and controllable role in producing the infertility that 1 in 8 couples suffer. It turns out, that the body may be smarter than we gave it credit for. Woman’s bodies may recognize certain states as not ideal for childbearing, and therefore prevent or lower fertility. Two examples are being overweight or underweight. Overweight risks pregnancy complications such as diabetes, high blood pressure, so the extra estrogen produced by body fat interferes with ovulation. Underweight women may not have enough body fat to sustain a baby, so the pituitary gland releases less of key ovulation hormones. Other behaviors strongly influence fertility. Take smoking for example. Multiple studies show that smoking can delay getting pregnant by a year or more. And one study at ColumbiaUniversity found smokers entered menopause 3 years earlier on average. Or diet. Trans fats, a key component in such unhealthy foods as donuts, cakes, etc. may raise testosterone, which suppresses the ovaries. Research shows that as little as 4.5 grams, which is the amount found in one donut, can have this effect. Even positive behaviors can negatively affect fertility. One study found woman who exercised four or more hours a week were 40 percent less likely to conceive after their first IVF (In vitro Fertility) treatment than women who didn’t exercise. Once again, it may be that the body interprets hard exercise as danger and stress, and shuts down the fertility system.
Even pure psychological stress can affect fertility. Here’s the biological mechanism. A few hours before ovulation, the pituitary gland sends out luteinizing hormone (LH), which tells the ovaries to release an egg. But if you are experiencing psychological stress such as a fight with your husband, or a dressing down from your boss, or a kid having a tantrum, then your LH will be suppressed, disrupting ovulation.
Even mild stress may have a big effect. One study of monkeys found that moving monkeys to a new cage, combined with a little less food and 1 hour on treadmill caused 70 percent of the monkeys to have irregular menstruation! So don’t skip that meal and take a long run when stressed, or you’ll greatly lower you odds of getting pregnant.
What’s worse is that IVF treatment itself may lead to large amounts of psychological stress. One fertility expert found that 40 percent of women in infertility treatment had all of the symptoms of an anxiety disorder or depression: sleep disturbances, difficulty concentrating, and irritability. So if stress lowers fertility, and fertility treatment increases stress, then fertility treatment may actually harm fertility!
But cognitive behavioral therapy may improve the situation. Alice Domar and colleagues at Harvard found that a 10 week cognitive behavioral group therapy program improved the success of fertility treatment from 20 percent to 55 percent in the women who participated in the group therapy. So what can we learn from this research?
- A woman’s body is wise. It will respond to behavioral and psychological stressors by lowering fertility. Anything that resembles stress, even hard exercise, will trigger physical responses that lower fertility.
- At critical points such as several hours before ovulation, even normal stressors can disrupt the ovulation process. And in stress-prone or perfectionist or angry women, the likelihood of experiencing stress during these critical hours is very high. Thus for women who are experiencing difficulty getting pregnant and who by personality are “stressy” (you know who you are!) cognitive behavioral therapy (CBT) will be helpful in learning to manage and lower stress.
- Infertility treatment is by its nature stressful, and this leads to a paradox; infertility treatment may lower fertility if it increases stress. It may be helpful to evaluate stress levels in women undergoing IVF and if stress is high, intervene with CBT group or individual therapy.
- The ultimate in infertility treatment may be what I recommended to my friend Jill, who had tried many cycles of IVF to no avail. I told her, “You’re young, why don’t you and your husband stop trying to get pregnant, and just have sex for fun, and enjoy life for a few years. If nothing happens then you can adopt.” She was pregnant within the year, and now has two lovely children. A good long relaxing vacation with no schedule, no hard exercise, healthy food, and no stress may be the best fertility treatment available, and even if it doesn’t work, at least you’ve gotten a great vacation!
- Finally, what this research shows us is how linked our minds and bodies are. Changing thoughts and feelings and behaviors changes our bodies, and fertility is just one example of this.
Copyright 2007 The Psychology Lounge/TPL Productions
Dr. Andrew Gottlieb is a clinical psychologist in Palo Alto, California. His practice serves the greater Silicon Valley area, including the towns of San Jose, Cupertino, Santa Clara, Sunnyvale, Mountain View, Los Altos, Menlo Park, San Carlos, Redwood City, Belmont, and San Mateo. Dr. Gottlieb specializes in treating anxiety, depression, relationship problems, OCD, and other difficulties using evidence-based Cognitive Behavioral Therapy (CBT). CBT is a modern no-drug therapy approach that is targeted, skill-based, and proven effective by many research studies. Visit his website at CambridgeTherapy.com or watch Dr. Gottlieb on YouTube. He can be reached by phone at (650) 324-2666 and email at: Dr. Gottlieb Email.