Research Underscores Links Between Stress and Reproductive Hormones

by Colette Bouchez

Live a little, laugh a little, love a little -- and get pregnant.

That could be the next wave of advice for people who want to conceive, as doctors discover more links between stress and fertility.

In studies presented at the recent annual meeting of the Endocrine Society, researchers from Magee-Womens Research Institute in Pittsburgh revealed that at least one type of menstrual-related disorder linked to infertility may be the result of stress -- and resolving that stress could return reproductive functions to normal.

The problem is called functional hypothalamic amenorrhea, or FHA. It's a condition characterized by a lack of a menstrual cycle or a highly erratic cycle in women of childbearing years, says Dr. Sarah Berga, a professor of obstetrics, gynecology and psychiatry at the University of Pittsburgh School of Medicine.

FHA occurs, says Berga, when brain and body hormones go out of sync, curtailing ovulation and throwing the entire reproductive system into a tailspin -- something that often results in infertility. When no physiological cause for the problems can be found, Berga says stress is often the culprit.

"Stress can change a great deal about the way our body chemistry functions, and women are a prime target for the effects of even small stresses -- things we may not even realize are piling up and affecting the menstrual cycle," she says.

The concept of stress-induced infertility is, in fact, not new. Studies done by Harvard University fertility researcher Alice Domar have repeatedly found that when women are stressed -- particularly when they're stressed about trying to get pregnant -- their reproductive activity can be affected.

The good news is that, in both Domar's past studies and Berga's new research, classic stress reduction techniques -- such as therapy that changes the way we look at life -- appear to help stabilize hormonal activity and return menstrual cycles to normal. And that, say experts, makes it a lot more likely for a woman will conceive.

Although ideas about stress-fertility links are gaining momentum, many doctors are still skeptical. They believe that there's still far too much not known about communication between the brain and body to make any sweeping generalizations.

"I don't believe that measuring peripheral levels of hormones necessarily correlates with what is going on in the brain. And part of the difficulty with all these studies is that we can't really study the brain to understand what is really happening on a hormonal and neurochemical level," says Dr. Jane Rosenthal, an assistant clinical professor of psychiatry at Columbia-Presbyterian Medical Center.

As such, Rosenthal says, don't jump to conclusions about stress and infertility based on what is known so far.

"I think this is a very important area of inquiry because, if, in fact, it's true, it just gives us much more to do that is non-invasive. But I also don't think there is anything remotely conclusive about what we have learned thus far," says Rosenthal.

The new study itself was small, involving only 14 women whose average age was 28. All had significant menstrual irregularities, particularly highly irregular cycles or no cycles, a sign that they weren't ovulating. None had any documented eating disorders or specific psychiatric conditions.

However, researchers report that many in the group perceived themselves as "perfectionists," holding to high levels of achievement that they hoped would make them more accepted and liked.

At the start of the study, blood tests were used to verify levels of the estrogen and progesterone hormones, as well as cortisol, a biochemical that is linked to stress. The women were then divided into two groups. One group received 16 sessions of behavior therapy that concentrated on nutritional guidance and discussions to help identify stress patterns in their lives. The second group was observed but received no therapy.