Dear Doctor: My husband and I are trying to have a baby, but we're having problems conceiving. Could my stress be to blame?
Dear Reader: First, let's consider a couple of statistics, specifically as they relate to women. The federal Centers for Disease Control and Prevention estimates that 6.1 percent of married women between the ages of 18 and 44 are infertile, while 12.3 percent of women between the ages of 18 and 44 have difficulty getting pregnant. Infertility is known to be linked to alcohol use and smoking, and possibly caffeine, so in assessing your own risk factors, I would first look at those potential influencers -- as well as the fact that your husband's sperm may be the source of the infertility.
As for stress, psychological stress has been an everyday part of life for generations of people. Today, our stress comes from such things as driving, shopping for essentials, managing finances and, of course, work. A Dutch study found that women who worked more than 32 hours per week took longer to first become pregnant than those who worked between 16 and 32 hours, but that both groups did eventually become pregnant at the same rate.
The best study of stress and pregnancy was among 401 married couples in Michigan and Texas attempting to get pregnant. The women in this study were followed for 12 months. They filled out questionnaires to assess their stress levels and took part in a measurement of their saliva's amylase. Salivary amylase is an enzyme that has been shown to be a reliable marker of psychosocial stress. Levels of it rise with increased activity of the sympathetic ("flight or fight") nervous system.
This study found that the group of women with the highest level of amylase was 29 percent less likely to become pregnant than those with the lowest level of amylase. Further, the level of amylase correlated well to a woman's stress level based on the scores from the questionnaires that were filled out.
So it seems reasonable from this study, and from a similar study in the United Kingdom, that psychological stress can reduce the chance of getting pregnant.
Further, simply trying to become pregnant -- and being unable to do so -- can create stress, as many studies have shown. A Korean study found that the levels of psychological distress were significantly higher in women who had difficulty conceiving compared to women who were able to conceive. This level of distress was twice as high in women than in their male partners.
Even the stress of fertility treatments can affect a woman's ability to get pregnant. One study found that women who were undergoing fertility treatment and were part of a support or therapy group had a 54 percent conception rate, while those who were not in a support group had a 20 percent conception rate.
Note that men are not immune to the negative aspects of stress. Men who have experienced more than two stressful life events have been found to have lower sperm concentration, motility and morphology.
It would be easy for me to tell you: "Stress less." But no one knows your typical life stressors better than you. My advice is threefold. One, turn to your husband for support. The two of you are in this together, after all, and he's in the best position to understand what you're going through. Second, develop some coping skills through relaxation techniques, meditation or simply going for a walk within nature. Hearing the sounds of the waves as you walk along the beach, listening to the sounds of birds or enjoying the view from a mountain can provide a calming perspective to your everyday life.
And three, if you find yourself still unable to become pregnant, consult a fertility specialist. Having some answers can point you in the right direction -- and reduce your stress.
(Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.)
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