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

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.

Emotional Stress

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.

Financial Stress

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!

Relationship Stress

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.

Do you take your hormones seriously?

Many of my clients tell me that they find great support, help, advice and guidance from the web when experiencing many of the emotional and physical ups and downs that increased infertility, pregnancy anxiety, pregnancy loss and hormonal imbalance can bring.

I therefore felt that writing about these subjects, referring to ‘real’ experiences, or highlighting information can only prove to be beneficial and also, can reach so many – I often forget that when publishing posts etc, they reach all over the world and not just us, in the UK!

Some of the subjects I discuss are becoming increasingly highlighted in the media – assisted fertility procedures such as IVF for example, however, other areas such as disruptive hormonal imbalance in the form of PCOS (Polycystic Ovarian Syndrome), severe Breast Tenderness (Mastalgia), and Menopause are less often written about and yet are so common amongst women.

I have become increasingly surprised and frustrated by how little we know about the hormonal workings of our bodies.  So little information is provided to teenagers experiencing puberty, ladies in their 20s struggling with hormonal fluctuations, couples in their 30s desperately seeking fertility support (although this area is changing dramatically), 40 somethings careering towards menopause etc, and yet hormonal balance is such an integral part of our health and well being!

Despite learning and researching keenly for the past few years I still feel completely inadequate in this area but I am genuinely driven by a thirst for more understanding and information.

I therefore write in an attempt to release the frustration, and impart as much knowledge as I may to my readers.  The purpose therefore is to provide a safe, nurturing informative environment for women experiencing the hormonal challenges that infertility, pregnancy, menopause and miscarriage can bring… Men also experience hormonal issues, share the fertility concerns, suffer the emotional distress of miscarriage and often feel at a loss to support their partners through the stress that these issues can bring.  My posts and my site are for them too!

Why its not so good for the sperm, whoops I mean Soul!!

I recently visited The Fertility Show in London – something I have done for the last couple of years.  The show remains small but informative and provides a variety of talks on all aspects of natural and assisted conception.  This year the emphasis seemed to be on Male Fertility!

There were several talks on the subject from a lifestyle perspective – I pinched this title from one of them.  So what did I learn?

Male Fertility has only been researched in the last 50 years and during that time the evidence suggests that the quality of semen is deteriorating…. why is that?

Well it must be to do with changes to our environment, our lifestyle for sure and our nutrition.

So chaps, prick up those ears because here are some hard truths …..

Some facts about male fertility and lifestyle:

• Male Factor – Approximately 40% of fertility issues are based on the Male Factor (i.e. sperm – low count/poor quality).
• You produce a startling 500 million sperm in one ejaculate, however (before you get too excited), only 50 make it to the egg, if at all.
• Smoking causes impotence and is a no no as far as fertility is concerned – it has more impact on the male factor than the female factor.
• Alcohol impacts on blood sugar levels and fertility but moderation is acceptable.
• STI’s – in the last 20 years these have increased enormously and therefore more relevant to the younger male – STI’s cause infection that can impact on fertility.
• Recreational Drugs – the use of impacts on libido and produces poor quality sperm.
• Viagra – increases motility of sperm but impacts on quality and, by the end of the journey the sperm can’t do their job!
• Steroids – Impair virility.
• Stress – Adrenal exhaustion impairs Testosterone.
• Heat Exposure – to the Testes reducing sperm quality can be caused from obesity, sitting for long periods (Lorry Drivers etc), Synthetic Clothing, Laptops.
• Environmental Chemicals – in house, air, food, water, furniture etc impact on our oestrogen levels and our endocrine or hormonal system – basically they can potentially wreak havoc with your DNA/sperm or embryo development.

So, what is the answer?  Well as always its about health and well-being.  Stop smoking and any use of the drugs mentioned above.  Cut down on alcohol, sugar, coffee, salt etc.  Eat well – go organic where possible.  Exercise, get fresh air and avoid chemicals in your environment and if you are unsure about the health of your lovely sperm, get tested!!!

It strikes me, as I research this subject, that there are a great many sites and organisations devoted to this area and whom specialise in providing help and support be it onscreen, on the phone or in person¹ – The Miscarriage Association provide some really good downloadable information on their site (see below).  Still despite this assistance, many tell me how emotionally and physically devastating Miscarriage and Pregnancy Loss can be.  All we can do to help is to provide as much support and advice as possible.

Pregnancy Loss is very common – approximately 1 in 4 pregnancies end in miscarriage³. It can happen at any time during the entire term but is most common in the first Trimester – usually pre 10 weeks although perhaps not discovered until the 12 weeks scan.

A ‘Chemical or Biochemical’ pregnancy is one that is lost prior to confirmation by an ultrasound scan.  A ‘Clinical’ pregnancy is one that is lost post confirmation by scan. Both terms are viewed as ‘medical/clinical’ and don’t appear to adequately or emotionally describe the ‘pregnancy’ that is owned by the potential parents.  The new terminology of ‘Pregnancy Loss’ rather than Miscarriage is hoped to be more sensitive.

Early Pregnancy Units (EPUs) are available at most NHS Hospitals and provide emergency care, help and support for those needing assistance with a pregnancy related problem.  However some units provide more care than others and opening times vary i.e. some are only open Monday to Friday, whereas others are also open on Saturdays.

Some GPs recommend trying to conceive straight after a Chemical/Biochemical pregnancy but often suggest waiting for the body to normalise after a Clinical Pregnancy Loss.

However from an emotional point of view, when dealing with your grief and loss, you are unlikely to differentiate between either of the above.  Whichever way you look at it, a pregnancy is a pregnancy and a loss is a loss.  Every individual/couple will deal or cope with this in a very personal manner – best advice would perhaps be to say, do what feels right for you and take your time.  Ask or seek help and assistance should you feel it necessary – there are many organisations out there wanting to help….. and please, don’t forget the men – their loss is often as greatly felt but not necessarily shown, nor sometimes considered…..

Do contact The Miscarriage Association, www.miscarriageassociation.org.uk; and The Association of Early Pregnancy Units, www.earlypregnancy.org.uk for further information.

I feel strongly that the emotional and physical trauma should be treated in the very least holistically and spiritually, as the impact is often silent but felt very individually.

Despite the fact that this is sadly a very common occurrence, often little help and support is provided and very little information is given to those in need at the time.  Many have shared their experiences in the hands of staff who lack any understanding or empathy in such circumstances.

As a Reflexologist and Hypnotherapist, I strongly recommend Reflexology to help the body to hormonally rebalance after such a trauma.  Time and time again I have seen great benefit from such a rebalancing treatment.   I also feel that Hypnotherapy can help to address the emotional stress often caused by such circumstances, which can often lay dormant for great lengths of time.

It is true to say however that a great number of women/couples who suffer from such loss, whether primary or secondary, do go on to conceive healthily.

For some getting pregnant can be reasonably straight forward.  For a larger number of 30 somethings, it can be a roller-coaster of cycle monitoring, tests, more tests and procedural failures, and for others, it just doesn’t happen…

You would think therefore, that when you finally fall pregnant you would be elated, and overjoyed, and swinging from the rafters?!

However, this is often just not the case.  Many of you spend your entire pregnancy in a state of anxiety and worry, especially if it has taken a great deal of time and effort to achieve, your concerns often based on a previous trail of failed  IVF, miscarriage, hopes and disappointments.

Here are some thoughts and feelings of one of my clients…

“After the initial elation (and disbelief) I am trying really hard not to worry constantly.  I feel completely fine but I’m almost wishing morning sickness on myself so that I ‘feel’ pregnant!  I’m trying to stay neutral – not get too excited, just in case, but at the same time, why shouldn’t I?  We’ve been waiting for this for so long and surely if I think positively, that’s half the battle?  I kind of feel in limbo at the moment….”

This lady is hoping that after her 12 week scan, her fears will die down and she will be able to enjoy the remainder of the pregnancy and I’m sure she will.  But for many I know that the fears simply continue and at times even grow… and the entire term stretches out in front of you in a daunting number of weeks, broken up by the thought of the next scan date or check up.

So, what positive steps can you take to support yourself through this time?

Here are some things that my clients have found genuinely really helpful:-

• If possible book an extra scan for reassurance
• Try the Baby Heart Beat Monitor for peace of mind – can be used anytime.
• Try Hypnotherapy cd’s for relaxation or a Hypnotherapy session to help alleviate some worries
• Read helpful articles or blog posts or on-line forums
• Talk to a friend or supportive person – away from your relationship – someone who has been through a similar experience or someone who works in this field such as your Midwife, Doctor or Therapist.
• Gentle exercise is known to help relaxation – try Pregnancy Yoga and Swimming.
• Ensure you’re eating well – apparently B Vitamins found in wholegrains increase levels of serotonin (the anti-stress hormone).

Comment – “Complementary Therapists recommend that you should cut out caffeine altogether when trying to conceive as it can reduce your changes of fertility” (there is also some evidence to say that it can increase the risk of miscarriage).

The problem with this statement is that it is rather generalised and does not provide an explanation.  So where does this leave the ‘fertility’ argument? And why or how does it affect our endocrine system?..

Firstly caffeine is found in coffee, tea and chocolate – (the most common offenders), but it is also present in a greater number of products these days – including fizzy drinks, face and body products and cold/cough remedies.  As an ingredient it must be marked on the packaging – look out for this – you’ll be amazed at how many face creams, under eye creams and body products (especially those for firming and toning) contain caffeine.

Secondly the affect of caffeine in our system is not always obvious.  The obvious ones are feeling shaky, having an increased heart rate,  an inability to focus or concentrate and an inability to sleep.  The main mild reaction (often enjoyed) is that it stimulates us and gives us a bit more ‘get up and go’.. but the unseen reactions can be found in our monthly cycle (this is also true of sugar and alcohol).  If you were to temperature chart your cycle for a month where you consumed caffeine products versus a month without caffeine products, the result is likely, depending on the quantities consumed, to be significantly different i.e. the caffeine cycle appears more erratic and imbalanced with greater increase in irregularity and PMT/PMS symptoms.   Thus demonstrating the affect on the flow and health of the cycle and its potential impact on fertility.

So what does the caffeine do to the body?  In essence it stimulates (that’s the bit we like!) the adrenal glands – which are part of the complex hormonal system, the Endocrine System, and the body has to respond to rebalance the system again.  In short quantities or bursts of caffeine, the effect may be slight and have no real bearing on the system, but in larger quantities or to a more sensitive system, the effects can be great.  It is therefore dependent on the reaction of the individual.  In effect, it stresses the body and we know that stress is definitely an underlying problem in fertility.

So, do you give it up altogether or reduce it?  The general consensus appears to be that one cup of coffee per day is acceptable but additional cups or other caffeine in the form of chocolate and the products mentioned above will potentially impact on your hormonal cycle and, for that matter, on your health and well-being in general….

This is also relevant in Peri-menopause (the run up to Menopause) where the hormonal system is naturally changing and fluctuating and additional stimulation can cause more extreme reactions – but this, is another story, for another post!!