How Stress Can Impact Fertility In More Ways Than One!
Stress affects our overall health and wellbeing and this is no exception with infertility. Why do couples fail to conceive when there is no known medical cause?
NICE Fertility Report (February 2013) advises GPs to inform potential infertile couples of the following – 80% of couples conceive in their first year of trying naturally (women under 40 years). Of the remaining 20%, 10% go on to conceive within a total of two years of trying – therefore 90% of couples (woman under 40 years) conceive within two years of trying. With Assisted Reproductive Techniques, (ART) 50% of couples (women under 40 years) conceive within 6 cycles of IUI. A further 25% conceive with another 6 cycles of IUI.
These statistics are clearly designed to give hope to couples, however HFEA Fertility Facts & Figures Report (2008) states that 1 in 7 couples experience infertility which is approximately 3.5 million people in the UK.
Stress, in its many forms, wreaks havoc with our hormonal and nervous systems and certainly impacts upon fertility. Here are the 5 main causes of stress in fertility but don’t forget, they overlap, interrelate and are virtually impossible to separate.
Age Factor And The Pressures of Time
Infertility is the most common reason women age 20-45 seek advice from their GPs. (HFEA Fertility Facts & Figures 2008). Fertility declines with age in woman and more recently shown to be declining in men too. Draft NICE Report on Fertility (October 2012), states fertility declines with age in both women, and to a ‘lesser extent’ men.
The proportion of women having their first baby at, or after age 30 has steadily increased since the mid-70s. The probability factor for potential fertility issues increases from the age of 30 onwards (HFEA. Register Data 1991-2006 Report 2008). If couples only start their fertility journey at this age or later, then there is already a potential issue.
Not only that but the NHS will reduce the ART funding available to women aged 40 – 42 and stop funding to women over the age of 42, NICE Report on Fertility (February 2013), which will therefore affect couples that are unable to finance their own treatment.
As couples start to experience problems, they feel the pressure of the time factor and the need to try to conceive as quickly as possible to avoid either missing out on funded treatment and/or to ensure that they do not further complicate the issue as age impacts on their fertility.
Physical stress can affect a couple in many ways. A significant decrease in sperm quality has been reported in research (Carlson 1992; Sharp & Skakkebaek 1993; Irvine 1996). Male factor as a percentage of infertility has increased from approximately 27.5% in 2000 to 32.5% in 2006 (HFEA data 1991-2006, extract 2008).
Other lifestyle factors affect fertility such as alcohol, coffee, weight, smoking, recreational drugs, some prescription drugs, exercise, nutrition, heat. Couples try to improve their lifestyles by abstaining from behaviours but then often feel the pressure of ‘not being able to enjoy themselves’ or turn to these behaviours when failure or disappointment occurs, adding more guilt and stress.
Many feel that after a prolonged period of ‘trying to conceive’ sex becomes ‘on-demand’, routine and pressurised, resulting in further stress to the relationship. Women particularly feel exhausted from going through a variety of tests, protocols, procedures, interventions, scans and drugs. There is also pressure from daily monitoring of their cycles or from repeated disappointment of failed treatment.
Added to which, they can experience miscarriages which prove to be physically draining and emotionally devastating. There then follows a waiting period before the body recovers and is able to start the whole process again causing more delay and more time pressures.
The pressure starts quite soon after couples begin to try for a baby. Healthy couples naturally assume that their fertility journey will be relatively straight forward. However after just a few months, doubt and concern start to creep in, resulting in visits the to GP, a string of tests and finally being diagnosed with either ‘unexplained fertility or a medical diagnosis’. This often results in a search for further assistance which can be overwhelming, time consuming and exhaustive. So, by the time the couple realise that there is a problem, they have been trying for some time. If they are not successful, the time factor increases and most if not all the stressors mentioned here start to play a part.
Physically the body is now struggling to perform or behave and the emotional stress is evident in many forms. Women particularly experience a feeling of failure and often begin to dislike their reproductive body. Depression can affect both parties. Sadness, constant disappointment and total grief are most familiar to these couples.
Some begin to withdraw from their social network as they are unable to explain their emotional state. Some suffer anxiety on may levels. Some turn to coping behaviours or such as drinking, eating etc to cope with their situation – knowing that these will only impact further on their infertile state.
Some may have subconscious blocks or fears about being a good parent or from their own childhood experiences. However, if they didn’t have any fears at the beginning of this process, they often develop them as the failure builds.
Miscarriage causes terrible emotional stress. Fear then builds as they wish to try again but are worried they will experience the same outcome all over again.
One constant pressure for many women is the inability to share their infertility problems with friends, families and employers. The process is simply to raw and they feel too vulnerable, or they fear for their careers – something that they want to keep constant in case the do not become parents. Often they have to lie about their fertility appointments – all adding to the pressure.
In his forward for Dr Sammy Lee’s, Counselling in Male Infertility, Rex Cowen wrote ‘Dr Lee points out Male patients often develop serious depression and sexual impotence following diagnosis of infertility. Once seen only as a woman’s problem, it is now clear from research that, in around 50% of all cases, a male factor is involved. Health Care professionals need to address this development and increase their knowledge and understanding of men’s feeling in coping with this difficult situation’. He goes on to describe male infertility as one of society’s taboo subjects.
After trying for some time, couples often require medical intervention in the form of IVF/ICSI. Whilst they may be eligible for NHS funding initially, this funding soon runs out. Also they may want various additional tests and/or to try forms of complementary treatment. The cost of acupuncture, nutrition, hypnotherapy, reflexology, homeopathy etc can add financial pressure when in addition to private medical procedures. Multiple courses of ART, together with additional costs of donor eggs/sperm or treatment abroad can be phenomenally expensive and cause great pressure on the couple both jointly or can form a pressure between them. If they’ve had to take time off work, they may also fear for their job security too!
The pressures of trying to conceive affect relationships emotionally, sexually and financially. Throughout their entire infertility journey, they make sacrifices and changes to their lifestyles and this can lead to relationship stress. There may be disagreement about their course of action, the reason for infertility may be specific to one of them causing feelings of guilt and inadequacy, it may be the stressful stretch on finances or the lack of lifestyle ‘freedom’ that finally leads to a difficult decision of when to continue, and when to stop, or when to look at alternatives such as surrogates or adoption.
These pressures were unlikely to be present initially but build over time – most couples are unaware that they are going to experience problems with fertility and have therefore never discussed what they feel about the subject before they are already some way into the issue itself.
Many couples experience some, or all of the above pressures, which compound and may potentially account for the continuing failure to conceive despite subsequent treatment/intervention in the form of drug protocols and ART and procedures. The overall chance of a live birth following IVF treatment falls as the number of unsuccessful cycles increases. (Draft NICE Report on Fertility October 2012).
At this point they begin to feel they have run out of options – the final stress in itself. All the time there are options then there is hope, but when they have exhausted everything, they finally have to face a decision to give up, or to adopt. The adoption process in the UK is exhaustive and lengthy and not one to be considered lightly when you are already shattered from your emotional and physical roller-coaster.
Sjanie Hugo comments in her book ‘The Fertile Body Method’ (2009) ‘The role of the mind and the emotions in fertility is a vital one that is often overlooked. ‘A truly integrated approach is far more likely to give people the best possible chance of having children. Mind-body medicine is an approach to health that recognises the effect that our mind has on our body and vice versa’ …….
…….and that is why many do consider natural therapy and Hypnotherapy to help reduce the impact of Stress!!
If any of the above resonates with you and you would like to consider natural therapy such as Reflexology or Hypnotherapy to help alleviate fears, anxieties or clear emotional blocks, please do view the therapies or contact me if you’d like to make an appointment.