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Stress and Female Fertility Issues - Causes and Treatment

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Stress and other psychological factors have been associated with female infertility in several ways. Read this article to know more about this topic.

Written by

Dr. Asna Fatma

Medically reviewed by

Dr. Richa Agarwal

Published At December 14, 2022
Reviewed AtFebruary 9, 2023


Stress and female fertility issues are mutually responsive. Stress, anxiety, depression, and other psychological factors have been known to cause female fertility issues to some extent. On the other hand, infertility is the number one cause of stress in women. The correlation between stress and fertility is complicated; however, there is evidence that stress affects hormone levels and menstrual cycles. Moreover, patients who cannot conceive experience depression, anxiety, isolation, and a sense of loss of control. Patients experiencing infertility had their depression levels compared to those diagnosed with cancer.

What Is Stress?

The emotion of being overwhelmed or unable to manage mental or emotional pressure is known as stress. It is the body's reaction to physical and emotional tension. When an individual encounters something new, unexpected, or something that threatens a sense of safety, or when there is little control over a situation, it is frequently triggered. Stress can be beneficial in short bursts, such as when it aids in avoiding danger, running a marathon, giving a speech, or meeting a deadline. When a stressful incident is over, stress hormones (cortisol) typically return to normal levels quickly, with no long-term consequences. However, excessive stress might have detrimental effects. It might put an individual in a constant state of fight or flight, leaving them feeling overwhelmed or helpless. This can have a long-term impact on physical and emotional health. Short-term stress is acute stress, whereas stress that lasts for a more extended period is known as chronic stress. Adverse effects of long-term stress on the body include:

What Is Infertility in Women?

Female infertility is defined as the inability or failure to conceive (get pregnant) after one year of having unprotected sex. Several people of reproductive age around the world are suffering from infertility, which impacts their families and communities. According to reports, infertility affects 48 million couples and 186 million people worldwide. Infertility in women may occur due to various problems with the ovaries, uterus, fallopian tubes, and endocrine system, among other factors. In addition, stress, smoking, excessive alcohol consumption, and obesity are some of the environmental factors that can affect fertility adversely. Along with women, men can also face fertility problems due to several reasons. One-third of all cases of infertility are caused by a male partner problem. Male and female issues cause another one-third of infertility cases. It is estimated that one out of every eight couples, or 12 % of married women, has difficulty conceiving or maintaining a pregnancy.

Does Stress Cause Fertility Issues in Women?

Yes, stress can cause female fertility problems to some extent. However, stress alone cannot cause fertility issues. When presented with other causes of infertility in women, stress can interfere with the ability to get pregnant. For example, according to research, women with a history of depression are twice as likely to have infertility. Anxiety also has a negative impact on fertility because it can extend the time needed to conceive. Studies have suggested that women with high amounts of alpha-amylase, a stress-related enzyme in their saliva, took longer to conceive than those with lower levels of alpha-amylase in their saliva.

How Can Stress Cause Fertility Issues in Women?

  • Stress and fertility are complex topics to understand on their own, but understanding how they correlate is even more challenging.

  • Infertility causes stress, as evidenced by the fact that women experiencing infertility have higher levels of anxiety and depression. However, it is less known if stress contributes to infertility. Recent studies have shown that psychological therapies effectively reduce psychological distress and are linked to increased pregnancy rates. Hence, it is safe that low levels of stress increase the chance of getting pregnant.

  • Any system that is not essential for survival shuts down during a high-stress situation. For example, the hypothalamic-pituitary-gonadal axis, which governs the reproductive system, can be shut down by stress; disrupting the connection between the brain and the ovaries can cause delayed or absent ovulation and irregular or missed periods.

  • The hypothalamic-pituitary-adrenal axis is activated during psychological distress, resulting in the release of stress hormones such as cortisol and corticotropin-releasing hormone. Physiological changes such as elevated heart rate (tachycardia), shallow breathing (tachypnea), hypertension (increased blood pressure), and headaches are caused by the production of these hormones. These physiological changes and the presence of the alpha-amylase enzyme in saliva are some of the biomarkers used to evaluate stress.

  • In a recent study, the hair cortisol levels of 135 IVF patients (in vitro fertilization) were sampled. The results suggested that the cortisol level in the hair was correlated with pregnancy rates.

  • During the luteal phase of their cycles, women with high stress had lower levels of estrogen, luteinizing hormone, and progesterone and greater levels of follicle-stimulating hormone, indicating a higher likelihood of anovulation (the egg does not release from the ovaries during a menstrual cycle). It is crucial to understand that anovulation (delayed or absent ovulation during a cycle) is not the same as chronic infertility. Even yet, when periods are irregular, one of the most difficult challenges is figuring out when to time intercourse to enhance the chance of getting pregnant. Furthermore, if the menstruation entirely stops, it is impossible to conceive.

  • During stressful times, the nervous system produces chemicals known as catecholamines which may reduce the blood flow to different body parts, including the reproductive organs.

What Are the Stress-Induced Lifestyle Factors That Can Cause Fertility Problems?

Long-term or chronic stress can throw an individual into habits or lifestyles that can promote fertility problems. Examples include disturbed sleep cycles, unhealthy eating habits, lack of physical exercise, caffeine addiction, alcohol abuse, smoking, unhealthy sex life, etc. These are all factors that can be triggered by stress, and they have an adverse effect on female and male fertility.

  • Sleep: Unhealthy work-life balance, hectic lifestyle, and overworking can lead to difficulty in getting pregnant. An inadequate amount of sleep is important for relieving everyday stress; therefore, people with improper sleep schedules do not distress properly, which has subsequent effects on their fertility.

  • Diet: People with stress have unhealthy eating habits, which can eventually lead to obesity or increased weight, along with other health issues like increased blood pressure, high blood sugar levels, increased cholesterol, etc. All these health issues occurring due to unhealthy diet habits have an adverse effect on fertility.

  • Exercise: Working out regularly is an amazing way of de-stressing. However, people with stress tend to have an unhealthy and sedentary lifestyle with little or no physical activity. However, too much exercise or physical stress is also not very helpful in getting pregnant. A maintained and well-balanced workout schedule helps distress and tackle fertility issues.

  • Caffeine: Coffee or tea is often used as an easy de-stressing drink. But one study suggests that too much caffeine intake can cause fertility problems.

  • Alcohol: Alcohol abuse and habitual drinking are highly harmful to female fertility. Studies have shown that no amount of alcohol is safe for pregnancy.

  • Smoking: Smoking in the form of cigarettes, vaping, etc., are known to be harmful to health in general, particularly to reproductive health. For example, women who smoke have an increased chance of blocked fallopian tubes, cervical cancer, damage to the eggs, and miscarriage.

  • Sex: Stressful life can lead to an unhealthy sex life as well. Moreover, stress also decreases libido or lowers the sex drive.

Does Managing Stress Improve Infertility?

Several studies have reported that taking measures to keep a check on stress levels is extremely helpful in preventing infertility issues. In addition, implementing psychological therapies to manage stress has improved conception outcomes.

How Can Stress Be Reduced to Increase Fertility?

Stress can be reduced in the following ways to manage or prevent fertility issues:

Stress Management: Symptoms of stress like anxiety, depression, hypertension, increased heartbeat, etc., can be controlled by implementing the techniques like:

  1. Exercise.

  2. Yoga.

  3. Meditation.

  4. Acupuncture.

  5. Consulting experts in stress management.

  6. Cognitive-behavioral therapy.

  7. Massage therapy.

  8. Mindfulness.

  9. Mind/body program.

  10. Physiotherapy.

  11. Walking, hiking, and other activities.

  12. Reading.

Addressing The Cause: The underlying cause of stress should be immediately stopped or avoided to control stress.

Support: Seeing support from a partner during fertility issues can help manage stress, and seeking professional health from a psychologist or psychotherapist to manage stress is also advised.


There are limited studies and noted cases to completely understand the impact of stress on female fertility and the impact of infertility on stress. However, several small-group studies have proved that, directly or indirectly in various ways, stress has an adverse effect on fertility in both men and women. And when present in combination with other factors, stress can induce fertility issues in women. Moreover, keeping a check on stress is always a good idea for general physical and mental health. While diagnosing infertility, it is important to rule out other physical causes that may prevent pregnancy before concluding that infertility is stress-induced.

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Dr. Richa Agarwal
Dr. Richa Agarwal

Obstetrics and Gynecology


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