FAQ: Can stress affect your fertility?
If you are trying to conceive, you will no doubt have been told to ‘just relax’ at some point. It is one of those phrases that tends to land badly, and understandably so. Being told to relax when you are already anxious about something rarely helps.
But behind the well-meaning if unhelpful advice lies a genuine scientific question: can psychological stress affect your ability to get pregnant?
The honest answer is that the relationship between stress and fertility is real, but nuanced. Stress alone is unlikely to be the sole reason you are not conceiving, and it is important not to heap additional blame on yourself if you are finding this time emotionally difficult.
What the evidence does tell us is that chronic, sustained stress can create physiological conditions that are less favourable for conception, and that taking steps to manage your wellbeing is a worthwhile part of your fertility journey.
What happens in your body when you are stressed?
When your body perceives a threat, it activates the hypothalamic-pituitary-adrenal (HPA) axis, releasing stress hormones including cortisol and adrenaline. In the short term, this is a healthy and entirely normal response. The difficulty arises when stress becomes chronic, keeping cortisol levels persistently elevated.
High cortisol can interfere with the hormonal signals that govern the menstrual cycle. The hypothalamus, which sits at the top of the reproductive hormone chain, is sensitive to stress.
When it detects sustained physiological strain, it can suppress the release of gonadotropin-releasing hormone (GnRH), which, in turn, reduces the output of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) needed for ovulation. In some cases, this disruption can contribute to irregular cycles or even temporary anovulation.
What does the research say?
A landmark study published in Human Reproduction followed 401 couples over a 12-month period and found that women with higher levels of alpha-amylase, a biomarker of stress, had a significantly reduced probability of conception compared to those with lower levels.
Specifically, those with the highest alpha-amylase levels were 29% less likely to conceive in any given cycle. Importantly, cortisol alone did not show the same association, suggesting that the broader stress response, rather than a single hormone, matters.
Research published in Fertility and Sterility has also explored the impact of stress on IVF outcomes. A 2011 study by Matthiesen et al. found that women who reported higher levels of psychological distress during IVF treatment had lower rates of clinical pregnancy, though the authors were careful to note that causality is difficult to establish in this context.
The impact on male fertility
It is worth noting that stress does not only affect female fertility. Research has shown that psychological stress in men can reduce testosterone levels and negatively affect sperm quality, including motility and morphology.
A further study published in Fertility and Sterility demonstrated a significant correlation between elevated cortisol and reduced sperm parameters in men experiencing work-related stress. Fertility is a shared journey, and the emotional weight of trying to conceive can affect both partners physiologically.
What can you do to support yourself?
Managing stress during fertility treatment does not mean eliminating all worry from your life, which would be neither realistic nor helpful. It means building in evidence-based practices that support your nervous system and give your body the best possible environment for conception.
Mindfulness-based cognitive therapy (MBCT) and cognitive behavioural therapy (CBT) have both been studied in the context of fertility and shown to reduce anxiety and depressive symptoms in patients undergoing IVF. In a randomised controlled trial, it was found that women who participated in a structured mind-body programme had significantly higher pregnancy rates than those who did not. Regular gentle exercise, adequate sleep, and social support have all been demonstrated to have measurable benefits on HPA axis regulation.
At Aria, we understand that trying to conceive is one of the most emotionally demanding experiences a person can go through. Our team is here not only to support your clinical treatment but also to ensure you feel heard and cared for throughout the process. If you have concerns about how stress may be affecting your fertility, or you would simply like to speak to someone about where to begin, please do not hesitate to get in touch with our team.