Updated: Nov 5, 2021
Anyone who has been on an infertility journey will have been told at some stage by well-meaning friends and relatives to `just relax and stop stressing’ and it will be more likely to happen. We have all heard stories of someone we know who after 7 failed IVFs decided to give up trying and start a new career only to get pregnant naturally, or a friend who after years of infertility conceived while on a relaxing holiday. So, we know that stress does have an impact, by why is this? What happens in the body when we are under stress and how does this really affect fertility? Having an understanding of this can be a real ah-ha! moment and can help motivate you to look at how stress can be affecting you.
It is all about our hormones!
Without a healthy balance of hormones, getting pregnant or staying pregnant can be a challenge. It is also very hard for anyone to have a healthy hormone balance unless your life is in balance.
For optimal hormonal health, we need to balance all areas of our lives, whether physical and emotional. These include:
Work and a sense of purpose
Family and relationships
Exercise - not too much or not too little
Sleep, relaxation, and me-time
Gut health, allergies, and infections
Physical alignment and pain
Do you have space in your life for a baby?
Stress is a huge factor as it can mess up every single hormone. In particular progesterone, one of the most important hormones for fertility and pregnancy, is not only produced by the corpus luteum of the ovary, but is also produced by the adrenal glands. This means that if you are under a lot of stress then your adrenal glands may have shut down your production of progesterone in favour of stress hormones such as cortisol and adrenaline. I really believe this was a huge factor in my fertility journey and is likely to be a major factor with a lot of women in this day and age. When we are under stress our body tends to shut down our reproductive hormones as getting pregnant is not essential for our survival. `The stress response serves to prioritise survival over less essential physiological functions, inclusion growth, and reproduction’ (1)
During my journey with secondary infertility I was studying, raising a child, working part-time in a health shop, and starting my own clinic as a nutritionist as well as dealing with the emotional ups and downs of infertility and recurring miscarriage. I thought I was doing all the right things to keep my hormones in balance but obviously, I wasn’t. It was only when I quit working in the health shop in 2018 to start working exclusively on building my clinic, that I discovered I was pregnant 3 weeks later at age 43. Maybe it was because I reduced my stress levels or maybe I had finally made space in my life to have time to look after a baby. These are all important factors that play a part in having a healthy balance of hormones.
Stress also leads to an increase in the production of cortisol (a stress hormone) from the adrenal glands, which inhibits the body’s main sex hormones GnRH (gonadotropin-releasing hormone) and subsequently suppresses ovulation (by inhibiting the release of LH and FSH). In men, stress can have a negative effect on sperm health. Stress hormones affect the hypothalamus, pituitary glands, and reproductive organs.
Chronic stress can lead to adrenal issues, which can downregulate your thyroid gland and lead to an underactive thyroid, which can contribute to fertility issues and affect your energy levels and sense of wellbeing.
Stress is not just being busy. If you have an injury, infection, gut issue, or food intolerance that is causing inflammation and uncomfortable symptoms, this is stressful for your body as well. These situations can weaken the immune system and can become a form of stress that impacts your adrenal and thyroid glands.
So, if you are on a fertility journey then maybe it is time to take stock and consider what is causing you the most stress in your life, whether it is emotional or physical and what steps do you need to take to try and reduce this.
Adrenal Fatigue or HPA Axis Dysfunction
The Hypothalamic-pituitary-adrenal (HPA) axis is comprised of the hypothalamus, pituitary gland, and adrenal glands. It regulates the body’s adaptive response to stress. Adrenal fatigue, or HPA Axis dysfunction which is otherwise known, is when our adrenal glands function below normal levels, usually as a result of prolonged, chronic stress. The adrenal glands are situated on top of the kidneys and regulate our stress response by producing stress hormones such as cortisol and adrenaline in response to stress. Long term stress can lead to the depletion of the adrenal glands and can result in imbalances in the production of cortisol. When the body is in a long-term stress state, non-essential functions that are not important for immediate survival such as the digestive system, reproduction system, and thyroid start to slow down or switch off altogether.
`The hypothalamic - pituitary - adrenal (HPA) axis, when activated by stress, exerts an inhibitory effect on the female reproductive system. Corticotrophin-releasing hormone (CRH) inhibits hypothalamic gonadotropin-releasing hormone (GnRH) and glucocorticoids inhibit pituitary luteinizing hormone and ovarian estrogen and progesterone secretion’ (1)
The inhibition of luteinizing hormone (LH) can have a negative effect on follicular development and oocyte quality, so if high AMH and low egg quality is an issue for you then it is essential that stress is addressed as HPA Axis dysfunction is connected to poor egg quality. `Follicular fluid from follicles whose oocytes were not fertilised had levels of cortisol significantly higher than levels in follicular fluid from follicles containing successfully fertilised oocytes. This suggests that high levels of glucocorticolds negatively influences the ability of an oocyte to become fertilised ‘(1)
Here are some of the most common symptoms of adrenal fatigue or HPA Axis dysfunction:
Waking up unrefreshed after a long sleep
3 pm energy crash
Craving sugar, coffee, or salt
Tired in evenings but gets second wind after 10 pm and stays up late
Hormone imbalances, low progesterone, low thyroid
Infertility and recurring miscarriage
Blood sugar issues
Nutrients to support the adrenal glands
The two most supportive nutrients for the adrenal glands are vitamin C and vitamin B5 (pantothenic acid). The adrenal glands need both vitamin B5 (pantothenic) and vitamin C to function optimally and produce adrenal hormones.
Vitamin B5 (pantothenic acid)
Vitamin B5 (pantothenic acid) enhances adrenal function as it is involved in the production of adrenal hormones that help counteract stress and is involved in energy metabolism. Vitamin B5 is known as the `anti-stress’ hormone and a deficiency can result in adrenal dysfunction.
Vitamin B5 is found in many foods and is also manufactured by our gut flora so a deficiency is not that common. However, people who have diets high in refined processed foods and have poor gut health are more likely to be deficient. Some of the best food choices of vitamin B5 are brewers’ yeast, liver, egg yolks, fish, chicken, lentils whole grains, cheese, peanuts, cashew nuts, dried beans, green peas, cauliflower, mushrooms, and avocados.
Deficiency symptoms include fatigue, depression, allergies, poor digestion, blood sugar issues, vomiting, abdominal cramps, skin problems, tingling in hands and feet, and recurring upper respiratory symptoms.
Supplementation with about 500mg of Vitamin B5 can be helpful if fatigue is an issue. If you are supplementing with a single B vitamin it is also important to take a separate B complex with all the B group vitamins in and preferably activated in case of methylation issues. In addition, I like to also supplement with a whole B complex with all the B group vitamins together. This is because the B complex vitamins are a family and work synergistically together and an excess in one B vitamin over the long term can cause deficiencies in others.
Vitamin C increases adrenal function as it is involved with the production of adrenal hormones. The adrenal glands store and utilise vitamin C, so when the body is under prolonged stress, vitamin C levels in the adrenal glands can be depleted. This is why it is an essential nutrient to take every day if you are experiencing periods of stress, especially as vitamin C is a water-soluble vitamin that is easily excreted from the body.
In terms of fertility, a diet rich in vitamin C can protect against genetic abnormalities in both male and female. The ovaries are very rich in vitamin C which highlights the importance of this nutrient. It helps to promote ovulation and improve progesterone levels by lengthening the luteal phase. Vitamin C deficiency during pregnancy has been linked to an increased risk of miscarriage.
In men, it has been shown to help with sperm quality, protect sperm from DNA damage, and keep sperm from clumping together making them more motile.
Vitamin C levels in the body are reduced by stress, smoking, and infections. Here are some signs that you could be deficient in vitamin C: poor immunity, poor wound healing, rough bumpy skin, bleeding gums, easy bruising, fatigue, and dandruff.
Some of the best sources of vitamin C are: citrus fruits such as oranges, lemons, limes, tangerines, grapefruit, rose hips, acerola berries, strawberries, red and green peppers, broccoli, potatoes, tomatoes, asparagus, and Brussel sprouts.
During my fertility journey and pregnancy, I supported my adrenals daily with an adrenal glandular supplement, which I felt made a huge difference to my energy levels and feeling of wellbeing. Adrenal glandular supplements can be useful support for the adrenals as they contain nutrients, proteins, enzymes, and growth factors found in the adrenal glands that the adrenals need for repair. It provides the building blocks for the body’s own adrenal glands to support optimal function.
It is best to work with a qualified practitioner before supplementing with adrenal glandular to ensure it is suitable for you personally.
There are many supplement options for supporting the adrenals and many of these contain adaptogenic herbs such as ashwagandha, licorice, and rhodiola which are fantastic for the adrenals as they help you adapt to the stress in your life and increase your energy levels and feeling of wellbeing. One of the most important things for me during my fertility journey is to make sure I was taking a supplement that I could continue to take if I was to get pregnant and this is the approach I take with my clients. This is because it can cause a lot of stress and anxiety to have to stop a supplement during the first trimester that might be making a significant difference to your hormone levels.
Just stop and breathe.
When you are on the infertility rollercoaster of emotion or with any form of stress or overwhelm, it is important to take time out each day to just sit in silence and breathe. In fact, we can all benefit from doing this at the moment with the stress of the current world events.
So, stop now if you can. Close your eyes and take a slow deep breath into the count of 4, hold your breath to the count of 4 and exhale to the count of 4. Try to do this for about 4 – 7 times before you open your eyes. You should feel nice and calm and relaxed. I find this breathing technique works as instant stress relief when life starts to get a bit crazy.
Meditation and Fertility
One of the biggest lessons of my 10-year fertility journey is that I wish I had started meditation earlier. In fact, it was only about 3 years ago that meditation became a regular part of my routine after a friend recommended to me the Headspace app. I committed to 10 minutes a day and to be honest, initially, I found it really difficult as I had so much going around in my head that I wondered if I was doing it right as I just couldn’t switch off. After 2 weeks of committing to 10 minutes a day I started to find myself in a calm, happy, safe place every time I meditated. I then started to extend my practice and focus on positive visualisation which again I found hard to start with but got easier with practice.
Meditation is so important for anyone who is on a journey with infertility, as often we are in a dark place reluctant to open up and communicate to friends and family around us. I found I was often consumed by crushing disappointment month after month, as well as frustration at myself, fear of failure, and envy that others seemed to get pregnant so easily. Meditation helps you focus on the positives instead of the negative self-talk, and you start to be more able to pick up on subtle signs the universe is trying to tell you.
Meditation helped me to take a step back and see how my negative thoughts and feeling were affecting my physical body. Our mind and body are connected so we can’t just ignore our emotional health and expect our bodies to work efficiently. This is especially true with reproductive health as if we are in a state of stress our hormones go out of balance and our reproductive system literally shuts down. This is because getting pregnant is not considered essential for survival when we are in a ‘fight or flight’ stress situation.
When we are less stressed our hormones are more in balance and we sleep better, which increases our chances of conceiving and maintaining a pregnancy.
The Headspace meditation app is one of the most popular apps on the market and is what I used and I think it is great. There are however plenty of other free fertility meditation apps on the market such as Circle and Bloom and Expectful so have search on the web for the latest apps and see what is best for you.
10 minutes a day is all you need to start seeing positive changes in your stress levels and mindset, so why not give it a try.
It is quite common to suffer from anxiety when you are on the infertility rollercoaster. If you find it gets worse in the second half of your cycle then it could be due to a combination of high cortisol (due to stress) and low levels of the hormone progesterone so it is important to get your hormones tested and a DUTCH test is a beneficial test to do in this situation This is because progesterone is known as nature’s anti-anxiety hormone as it has a calming and soothing effect on our emotions.
I used to get terrible anxiety around the time my period was due, especially if I suspected I might be pregnant. I remember being so terrified of going to the bathroom in case my period had turned up that I kept putting it off. When I finally got around to going to the bathroom, I would physically shake like having a mini panic attack. I know now that a combination of high cortisol and low progesterone was likely to be influencing this. Thyroid dysfunction can also be another cause of anxiety so it is important to get your thyroid tested as well if you are trying to conceive.
Do you have space for a baby?
One thing I believed during my fertility journey is that my future baby was waiting for the right moment, for me to be ready when everything was aligned and the timing was right. This was one of the beliefs that kept me going all those years despite the negative test results and early pregnancy losses.
So, my question for you to consider is do you have space for a baby? Could a baby easily slot into your lifestyle at the moment? Do you have the physical or emotional energy to get pregnant or raise a baby? Are you in a good position financially? If you answer no to any of these questions then it is time for some self-reflection. Is there anything you can let go of to free up more time? What can you do to support your physical and emotional energy?
For me I created space by giving up my permanent job, which was a job that was quite draining and not very fulfilling, to build my business and work for myself. Having this new sense of purpose and extra time on my hands, helped to reduce my stress levels and anxiety and I feel this was one of the pivotal reasons I was able to conceive at the age of 43, although not the only one. So, what can you do to create space for a baby?
Dana N j, Whirledge S, Stress and the HPA Axis: Balancing Homeostasis and Fertility (2017) International Journal of Molecular Sciences, Oct 18 (10) 2224
Kalantaridou S N et al Stress and the Female Reproductive System (2004) J Reprod Immunol Jun, 62 (1-2) 61 – 8