by Andrea Mechanick Braverman, PhD

"Just relax and you'll get pregnant.."
"Take a vacation.."
"Don't think about it too much.."
"You're trying too hard.."
"Just adopt and you'll get pregnant.."

If you have been trying to get pregnant, chances are that you have heard some or all of this advice. Underlying the statements above is the basic assumption that infertility and stress are linked. This advice, while well meaning, is often very hard to hear because that assumption has very negative implications for you. The message is one of blame: if you were better at relaxing and not being overly concerned with your fertility, then you would be pregnant.

When you are trying to get pregnant, it is impossible not to feel stress as months pass by and diagnoses are confirmed. Hope waxes and wanes depending upon what treatment is available and how long you have been trying to get pregnant. Add to this emotional mixture the real demands of doctor's visits, medications, monitoring, and cost, and it would seem impossible for stress not to enter the picture of coping with infertility.

Stress can have a dramatic impact on one's reproductive life. Most physicians and mental health professionals who work in this field have encountered men who have experienced temporary impotence when diagnosed with azoospermia (the inability to produce sperm), or women who have temporarily lost all interest in sexual intimacy after a diagnosis of female factor infertility. Feelings about our fertility are entwined in our feelings about sexuality. Many women with infertility will share with me that they do not feel like "real women" and are not members of the club who have experienced pregnancy and childbirth. These women will tell me that they feel like outsiders at social functions when talk inevitably turns to children related topics.

Men can often feel that having normal sperm function is related to virility, when in fact impotence (male sexual dysfunction) and male infertility are not the same. Hearing phrases such as "he shoots blanks" reinforces feelings of inadequacy and complicates these feelings for men.

The Relationship Between Stress and Infertility

Which is Cause and Which is Effect?

The relationship between stress and infertility can be seen as either causative (where stress causes infertility) or reactive (where infertility causes stress). Researchers have studied the possibility that stress causes infertility. Unfortunately, these studies have contradicted each other. Some studies show a relationship and others do not. In my opinion, the best designed studies have not shown a strong relationship between stress and the ability to become pregnant.

This relationship is very hard to study. Think about all the factors that go into our concept of stress. Are you a Type A personality? Do you like stress and perform better under stress? Is infertility only a small part of the stress in your life compared with other stresses such as illness or family problems? Personality styles, ways of coping with stress, the amount of stress in your environment, and support systems are only some of the factors that need to be considered when we look at the relationship of stress and pregnancy.

When working with individuals going through infertility treatment, I often hear them wish they had more control over the events in their lives, particularly their fertility. The desire to be able to directly affect your ability to become pregnant is powerful. On the other hand, acting on this desire may make you feel responsible if you are unable to get pregnant because you are "too uptight", "working too many hours," or "not relaxed enough". It is still unknown whether stress causes infertility. More research is needed in this area to prove this relationship.

The Impact of Infertility on Self-Esteem

Infertility places a heavy burden upon people's self-esteem, and stress arises from this negative self-image. Many men and women report feeling less masculine or feminine after a diagnosis of infertility. I often hear infertile women and men tell me that they feel their bodies do not work right or are defective. Phrases such as "everyone else can get pregnant" or "I must have done something wrong to deserve this" reflects how badly individuals view themselves.

Unknowingly, family or friends can reinforce this image. Hearing statements like "I just had to look at my husband to get pregnant" can be very hurtful. Some mothers have told their daughters "I don't understand -- I never had a problem getting pregnant". This statement, which may have meant to reassure the daughter that there cannot be a major problem because it would have been known previously in the family, only serves to make the infertile daughter feel defective or estranged from her mother.

Research has shown that women going through infertility rated themselves as having higher levels of depression than women going through cancer treatment. How can infertile women rate greater levels of depression than cancer patients? We all know we can get sick, even with terrible diseases like cancer, but not that we may be infertile.