Can Stress Affect Fertility & Ovulation?

Worried that stress might be impacting your ability to conceive? Read on to learn the link between stress and fertility—plus practical tips for managing stress levels.

By Dr. Kenosha Gleaton, OBGYN and fertility expert

Getting pregnant can be a quick and easy process for some and a much longer, complicated process for others. Many of us have heard the dreaded words just relax, but does relaxing really help? The short answer is no, it’s not likely to, but let’s take a closer look at what the research has to say. 

How does stress affect the body?

Stress can be an emotional and physical reaction to work, life, and health challenges. When someone is stressed, their body reacts by releasing hormones, increasing heart rate, blood pressure, and breathing rate, some muscles may tense up, and perspiration (sweating) may increase [1]. It’s normal to feel some stress occasionally, but long-term stress isn’t good for the body and may contribute to a wide range of health problems. Stress has been linked to depression and anxiety and may worsen conditions such as sleep disorders, digestive disorders, headaches, and more [1].  

Research on stress and fertility

A few studies have found associations between stress levels and reproductive hormones or conception rates [2-4]. For example, specific hormones and enzymes related to stress are sometimes found in higher amounts in those struggling to conceive. A few studies have found mixed results when measuring stress and IVF outcomes [12-14]. More data is needed to form a conclusive answer, but IVF and stress do seem to be connected in some ways. It’s more likely that having poor outcomes causes stress than the other way around [12-14].  If you’re going through IVF soon, you may want to read this guide on preparing for IVF.

As pointed out in a New York Times article, most of this data poses the chicken and egg question [5]. Did the stress come before the infertility, or did infertility cause the stress? It’s also hard to rule out other factors that may be impacting fertility, such as sperm health, egg health, regular ovulation, etc. 

How stress can impact ovulation and menstrual cycles

Other data does suggest that chronic stress can have an impact on menstrual cycle regularity [6]. Increased levels of cortisol may interfere with luteinizing hormone (LH) levels and follicular development, leading to anovulatory (non ovulatory) cycles [6-7]. While it would likely take the body reacting to stress for long periods of time to disrupt the menstrual cycle, it is possible. 

If you need a recap, ovulation refers to the period of time when an egg is released from the ovary and fertilization may occur. In order for an egg to be released, hormones such as LH and follicle stimulating hormone (FSH) must be present to grow the ovarian follicles and trigger the release of an egg. Successful ovulation is the first step in conceiving, so it’s important that you’re tracking ovulation when TTC to improve your chances of pregnancy. Find out more about what abnormal ovulation is.

To summarize, some data does show weak associations between stress levels and reproductive health, but there’s no conclusive evidence to prove that stress can cause infertility. The American Society for Reproductive Medicine (ASRM) states that the impact of stress on fertility is unknown, but quality of life in general is improved when stress is decreased [8].  

Managing stress levels when TTC

Reducing and managing stress is a great way to support your mental and physical health. Regardless of its impact on fertility, reducing stress provides a better quality of life and can make focusing on TTC more enjoyable. Here are a few things you can do to manage your stress.

Spend time in nature

Green spaces can improve mood and reduce stress [9]. Consider eating your lunch outside, walking in a nearby park, or allowing yourself a 10 minute break to sit outside and breathe deeply when you’re feeling stressed. 

Get active

Physical activity can be great for stress and overall health. If the gym isn’t your cup of tea, consider going for a bike ride, taking a walk, doing yoga, the list goes on! Whatever you can do to move your body for at least 30 minutes is a win. 

Lean on your loved ones

Surround yourself with a comforting and compassionate group of people. Whether you need support while battling infertility, or general stress tends to eat away at you, it’s important to have loved ones you can lean on when needed. 

Schedule you time

Make sure you’re scheduling time for yourself every day. This can be meditation, journaling, drawing, reading, or meeting up with a friend, anything that brings you joy and helps you destress.  If you’re feeling especially stressed at work, take a 15 minute break to focus on something that makes you feel good. You may want to look into a magnesium drink or supplement to support relaxation and calm! [15] 

Read more tips for managing anxiety before pregnancy.

Managing infertility

Infertility is categorized by the inability to conceive after six months or a year of having unprotected heterosexual sex, depending on age [8]. Infertility occurs in up to 15% of couples and can be caused or impacted by various factors, including male fertility, endocrine disorders like PCOS, anatomical problems, and more [8]. If you’re worried about your fertility and haven’t already spoken to a healthcare provider, you should consider making an appointment with a healthcare professional who may be able to help you narrow down why you haven’t been able to conceive. Here are some general suggestions that may help you manage infertility. 

Regulate your cycle and track ovulation 

In order to get pregnant you need three things— healthy sperm, a healthy egg, and a way for the two to meet. Ovulation is key for conception, so it’s important that you have a regular cycle and successful ovulation. There are more in depth guides you can read on how to determine if you’re ovulating and how to track ovulation. The basics are to keep track of your menstrual cycle and purchase ovulation tests to keep an eye on your luteinizing hormone levels. If you have an irregular cycle, you may be able to help regulate it through lifestyle changes, supplements, medications, and more. 

Consider taking supplements 

There is no magic fertility pill on the market that will cause you to get pregnant, but there are some supplements that may improve egg health, sperm health, and support overall fertility [10-11]. Inositol is a great example of a cycle-supporting supplement that may benefit fertility. Inositol has been shown to facilitate ovulation and improve egg and embryo quality [11].  CoQ10 is also a beneficial supplement, with data supporting its role in improving egg quality and sperm parameters [10-11]. It’s also recommended by the American College of Obstetrics and Gynecology (ACOG) that those trying to get pregnant begin taking a prenatal vitamin at least a few months prior to conceiving. You should always speak to your healthcare provider about supplements before adding any to your vitamin routine. 

Test your hormones 

Our hormones are responsible for most of our body processes, including ovulation and general reproductive health. Hormone testing kits or sperm testing kits may be a good option for you and your partner to rule out hormonal imbalances or male factor infertility. 

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Explore fertility treatment options 

If you feel as if you’ve exhausted most of your options, it may be time to speak with a fertility specialist or other healthcare provider about fertility treatment options. Your age and health history will likely play a factor in what fertility treatment is right for you. If you know that anovulation is contributing to your infertility, ovulation induction may be a good option for you. Ovulation induction is a treatment that involves taking prescription drugs known as ovulation induction medication to stimulate ovulation. However, depending on your unique health history and goals, you may also want to consider treatments such as IVF or IUI. We have a resource that compares IUI vs. IVF. 

Key Takeaways

• Stress can be a reaction to work, life, or health challenges and can be seen in our body processes.

• Stress has been linked with poor mental health and may worsen some conditions such as sleep disorders and digestive disorders.

• Some data shows weak associations between stress levels and inability to conceive, although not all researchers are sure which one caused the other.

• Chronic stress may have an impact on cycle regularity, although it is hard to measure how much stress one is under and for how long. 

• There’s value in improving mental health in general, regardless of if you’re TTC.

• Some things you can do to manage stress levels include physical activity, journaling, spending more time in nature, and leaning on your loved ones. 

• If you’re concerned about infertility, speak to your healthcare provider about their recommendations. You may want to consider tracking ovulation, taking supplements, and/or testing your hormone levels. 

References:

1. Stress. National Institutes of Health. Updated April 2022. Accessed March 2023. URL. 
2. Haimovici F, Anderson JL, Bates GW, et al. Stress, anxiety, and depression of both partners in infertile couples are associated with cytokine levels and adverse IVF outcome. Am J Reprod Immunol. 2018;79(4):e12832. doi:10.1111/aji.12832
3. Schliep KC, Mumford SL, Vladutiu CJ, et al. Perceived stress, reproductive hormones, and ovulatory function: a prospective cohort study. Epidemiology. 2015;26(2):177-184. doi:10.1097/EDE.0000000000000238
4. NIH study indicates stress may delay women getting pregnant. National Institutes of Health. August 2010. Accessed March 2023. URL. 
5. Epstein R H, Does Stress Actually Affect Fertility? New York Times. April 17, 2020. Accessed March 9 2023. URL. 
6. Vigil P, Meléndez J, Soto H, Petkovic G, Bernal YA, Molina S. Chronic Stress and Ovulatory Dysfunction: Implications in Times of COVID-19. Front Glob Womens Health. 2022;3:866104. Published 2022 May 23. doi:10.3389/fgwh.2022.866104
7. Kellie M. Breen, Fred J. Karsch, New insights regarding glucocorticoids, stress and gonadotropin suppression, Frontiers in Neuroendocrinology, Volume 27, Issue 2, 2006, Pages 233-245, ISSN 0091-3022, https://doi.org/10.1016/j.yfrne.2006.03.335.
8. Defining Infertility. American Society for Reproductive Medicine. Revised 2014. Accessed March 2023. URL. 
9. Kondo MC, Fluehr JM, McKeon T, Branas CC. Urban Green Space and Its Impact on Human Health. International Journal of Environmental Research and Public Health. 2018; 15(3):445. https://doi.org/10.3390/ijerph15030445
10. Ahmadi S, Bashiri R, Ghadiri-Anari A, Nadjarzadeh A. Antioxidant supplements and semen parameters: An evidence based review. Int J Reprod Biomed. 2016;14(12):729-736.
11. Vitagliano A, Petre GC, Francini-Pesenti F, et al. Dietary Supplements for Female Infertility: A Critical Review of Their Composition. Nutrients. 2021;13(10):3552. Published 2021 Oct 11. doi:10.3390/nu13103552
12. Aimagambetova G, Issanov A, Terzic S, et al. The effect of psychological distress on IVF outcomes: Reality or speculations?. PLoS One. 2020;15(12):e0242024. Published 2020 Dec 14. doi:10.1371/journal.pone.0242024
13. Bapayeva G, Aimagambetova G, Issanov A, et al. The Effect of Stress, Anxiety and Depression on In Vitro Fertilization Outcome in Kazakhstani Public Clinical Setting: A Cross-Sectional Study. J Clin Med. 2021;10(5):937. Published 2021 Mar 1. doi:10.3390/jcm10050937
14. Miller N, Herzberger EH, Pasternak Y, et al. Does stress affect IVF outcomes? A prospective study of physiological and psychological stress in women undergoing IVF. Reprod Biomed Online. 2019;39(1):93-101. doi:10.1016/j.rbmo.2019.01.012
15. Arab A, Rafie N, Amani R, Shirani F. The Role of Magnesium in Sleep Health: a Systematic Review of Available Literature. Biol Trace Elem Res. 2023;201(1):121-128. doi:10.1007/s12011-022-03162-1