Stress may be a factor in conception
By HILARY WALDMAN
LOS ANGELES TIMES WASHINGTON POST NEWS SERVICE
(Original publication: October 15, 2002)
"Just relax, dear."
The words are enough to incite even the mildest woman struggling with infertility into a fire-spitting rage.
But old Aunt Tilly and all those other purveyors of unsolicited childbearing advice may be onto something.
A growing body of scientific evidence is beginning to support the notion that stress indeed may play a role in the quest for a baby.
A recent study found that women undergoing in-vitro fertilization who had higher levels of stress produced fewer eggs and so had fewer embryos to be transferred into their wombs than their more relaxed counterparts.
Conversely, women undergoing IVF who were the most optimistic about their chances of having a baby produced more eggs and had more usable embryos.
The finding surprised lead researcher Hillary Klonoff-Cohen, who expected to find that a woman's anxiety about the procedure would be more important than her overall background stress level.
"Procedural stress is important, but I thought it would play more of a role," said Klonoff-Cohen, an associate professor in the Department of Family and Preventive Medicine at the University of California at San Diego. "It turned out that baseline stress was more important."
Although the link between psychological distress and infertility remains controversial, studies have shown an association between depression and infertility. But the questions remain: Does depression hinder the ability to conceive children, or does infertility make women depressed?
"Most of these women were intact before infertility," said Alice Domar, director of the Mind-Body Center for Women's Health at Beth Israel Deaconess Medical Center in Boston. "The infertility destroys their coping mechanisms."
To test the psychological connection, Domar looked at a group of women who had tried to get pregnant for one to two years.
The women were divided into three groups: One set was enrolled in an infertility support group; one group was given other forms of psychological and emotional support; and the third group was given fertility medication alone.
About half of the women in both types of emotional support groups got pregnant during the one-year study period, compared with only 20 percent of the women who got no emotional help.
Domar and her colleagues at the Mind-Body Medical Institute, which is affiliated with Harvard University, now run 10-week infertility support groups in which women are taught skills that Domar says are vital for emotional health.
Women are taught breathing and yoga techniques to help relax their bodies.
They are told to stop vigorous exercising and to improve their diets. Most important, they are taught to replace negative thoughts, such as "I will never have a baby," with more constructive ones.
"If you are willing to change your lifestyle and work hard to get out of your depression, you will have a better chance of getting pregnant," Domar said.
She said 40 percent to 45 percent of women who enroll in her program get pregnant within six months.
By the time Kristen Magnacca arrived at one of Domar's support groups four Decembers ago, she had been through medications, painful surgeries and a devastating tubal pregnancy.
The ordeal left her incontinent, furious at God, resentful of pregnant women and anybody with children, and in a near-war with her husband.
"I didn't realize how depressed I was," said Magnacca, 38, whose book, "Girlfriend to Girlfriend: a Fertility Companion," details three years of infertility treatment with fingernails-on-the-blackboard candor. "I figured I was treading water."
Magnacca, who lives in Upton, Mass., outside Boston, said the technique that Domar calls "mindfulness" was most helpful to her.
Domar teaches her clients to become aware of their bodies and their senses and to enjoy those sensations in the here and now. So much of fertility treatment, she said, involves anticipating the future.
What is the next step in your treatment? What will the ovulation test show tomorrow? Women lose sight of what is going on around them, she said.
Magnacca and her husband had stopped trying to conceive and were concentrating on restoring their bodies and their marriage when she became pregnant early in 1998. Their son, Cole, is now 3.
"I feel if I didn't integrate those strategies, I don't think we would have rebounded," Magnacca said.
Relaxation is not a magic potion. Anatomical and biological problems are significant contributors to the inability to bear children, and a full 40 percent of infertility is caused by problems with the male's sperm.
Klonoff-Cohen, who found lower rates of egg production in stressed-out women, said her research is only an early step in documenting the stress connection. But she said early psychological intervention with women struggling with infertility probably cannot hurt.
"We're realizing that a lifetime of baseline stress may play a role," Klonoff-Cohen said. "With that information, as soon as a woman starts coming to the office, the clinician might want to start talking about that."
