The effect of stress on fertility has long been suspected by married couples and medical professionals, and this suspicion is confirmed, in particular, by the occurrence of “natural” pregnancies after adoption or in vitro fertilization (hence, after stress elimination), as well as the influence of observed biochemical changes for people experiencing stress.
But is it only subjective, or is it possible to really objectify this impact? In addition, does the possible effects of stress vary depending on the phases of the menstrual cycle? For example, when you take an ovulation test after prolonged stress and notice that she didn’t arrive on time, is that a reason to worry?
The results of one of the largest studies in history on this topic, confirm the link between increased stress during the pre-ovulatory or ovulatory period and a significant decrease in the chances of conception (from -27 to -46%).
These results confirm the need to encourage (of course, without stigmatizing them) women to cope with stress when they want a child (for example, tips on suitable relaxing activities), in particular, and this is logical, in the pre-and perinatal period.
Stress and Fertility
An increase in stress is associated with a significant decrease in fertility, hence the importance of relaxation, and positivism, although not always easily realized.
The relationship between stress and difficulty conceiving is revealed by observations and several prospective studies. Stress has long been considered a factor that can reduce the fertility of couples wishing to conceive a child. In addition, recent studies have confirmed that good stress management increases the likelihood of pregnancy in couples undergoing EKO (in vitro fertilization).
Several more prospective epidemiological studies have thoroughly investigated the relationship between stress and fertility, but have never looked at different periods of the menstrual cycle: ovulation, follicular phase (especially during the ovulatory window), luteal phase, fertilization, or implantation.
Research on stress and its effects
 The study included 400 American women who were interviewed, examined, and then regularly monitored. A sample of 400 office workers, all under the age of 40, was recruited from 14 American companies and government agencies. Sexually active women are hospitalized, regardless of whether they used contraceptives in the previous month. Women who used intrauterine contraceptives (IUD), underwent hysterectomy, and were diagnosed with polycystic ovarian syndrome or infertility (attempts to conceive for more than 12 months) are excluded.
There was data about age, body mass index (BMI), ethnicity, marital status, education, pregnancy history, medical history, and desire to become pregnant. Each participant agreed to keep a monthly diary of her menstrual cycle, sexual intercourse, contraceptive use, alcohol, caffeine, tobacco consumption, and self-reported stress levels. The first-morning urine was collected and analyzed on the first two days of each cycle (D1 is the first day of menstruation). If pregnancy occurred during the cycle, a urine sample was collected on time anyway. All women were monitored before pregnancy or on average for 8 menstrual cycles (maximum 20 cycles).
Correlation of stress felt during different phases of the menstrual cycle
Three models were built:
- The first analyzes the age of the woman and the average stress for each of the three windows, mutually agreed with each other;
- The second includes potential interfering factors such as parity, desire to get pregnant, education, and marital status;
- The latter includes variables that may act as distorting or mediating factors: BMI at the time of switching on, alcohol, tobacco, and caffeine consumption, cycle duration, and frequency of unprotected sexual intercourse during the ovulatory window.
Since it is possible that each woman interpreted the stress scale differently, “relative stress” was calculated based on the average stress value over the entire study period and for each woman in each window of each menstrual cycle by subtracting the average total stress from the average stress. A positive relative stress value indicates that during this window, the woman felt more stressed than she could have reported; similarly, during a negative value, she felt less stressed.
The results showed
Thus, the stress observed here appears to occur after implantation. Therefore, it is likely that this stress is associated with awareness of pregnancy and the resulting hormonal changes.
Stress has almost the same effect when a woman has already given birth to a child. If a woman has had trouble conceiving in the past, she may have fertility problems and her stress may be higher than others. Therefore, the same analysis was conducted only among 249 women who had already given birth.
Although the confidence intervals are wider, the magnitude of the effect is almost the same for all analyses (for example, for the first model, FOR = 0.58; 95% CI [0.31-1.07] during the ovulatory window and FOR = 1.56; 95% CI [0.86–2.83] during the luteal phase).
In conclusion, stress in the pre-ovulatory or ovulatory period seems to be associated with decreased fertility, so additional recommendations are possible.
