A New Fertility Factor

A New Fertility Factor

Stress is just one of many obstacles to pregnancy, but it's one you can control

A productive calm: Studies have found that distress can hamper fertility - and that relieving it can improve the chances of conceiving

By Alice D. Domar, Ph.D.
Newsweek, September 27, 2004

Melissa was 33 when I met her, and she'd been trying to get pregnant for more than two years. Fertility tests had found nothing wrong with her or her husband. Yet all she had gained from two cycles of injected fertility medication was some extra weight. And though she was running 20 miles a week to reduce stress, the experience had left her feeling overwhelmed and isolated. Melissa was crying almost every day when she joined the 10-week mind-body program I oversee in Boston, but she soon realized that she was neither helpless nor alone. Supported by peers and counselors, she dialed back on her running regimen (excessive exercise can hamper fertility), gave up caffeine and alcohol, and started practicing relaxation techniques. After five weeks she resumed fertility-drug injections and conceived on her next cycle. Her daughter arrived nine happy months later.

There are many myths about becoming pregnant. In truth, deciding to adopt a child doesn't boost the odds of conception. Nor does taking a vacation, having a glass of wine before sex or trying an unusual new position. But frustrated couples shouldn't assume that mind-body medicine is irrelevant to their quest for pregnancy. Studies are now confirming what Melissa's experience implies. Distress can hamper fertility—and relieving distress can help improve your chances of conceiving. Though practices like meditation and yoga certainly can't guarantee pregnancy, they have now established their place along with high-tech medicines and procedures.

What do we really know about fertility and the mind? For starters, we know that infertility is stressful. Women who have difficulty conceiving suffer as much anxiety and depression as women with heart disease or cancer. A recent study found that 40 percent of them were anxious or depressed. This shouldn't be surprising. Procreation is one of the strongest instincts in the animal kingdom. Males will die fighting for a chance to mate, and females will die to protect their young. Moreover, most people assume they are fertile. When you've spent your adult life taking precautions to avoid pregnancy, it's a shock to discover that you can't make it happen at will. Treatment can add to the anguish. You get poked, prodded, injected, inspected and operated on, and you have mechanical sex on schedule.

No one has proved that feelings of distress actually cause infertility, but there are good reasons to think so. Women with a history of depression are twice as likely to suffer from the problem—and research has shown that distressed women are less responsive to treatment. In one recent trial, high-tech fertility procedures were 93 percent less effective in highly distressed women than in those reporting less emotional upset.

Can mind-body medicine counter these effects? The first mind-body fertility program started in 1987 at Boston's Deaconess Hospital. Thousands of patients have since participated, and the results have been encouraging. Approximately 45 to 50 percent become pregnant within six months (success rates are closer to 20 percent when patients lack psychological support), and most participants experience a significant reduction in both physical and psychological symptoms. My own research supports these observations. With funding from the National Institute of Mental Health, I conducted a controlled clinical trial comparing women in mind-body programs with those receiving only routine medical care. Pregnancy and delivery rates were nearly three times higher among the women who got the additional support. In yet another study, Turkish researchers found that couples attempting in vitro fertilization achieved a 43 percent pregnancy rate when their treatment included psychological help, but only a 17 percent success rate when it didn't.

Mind-body fertility programs vary, but the ones I have led share several key features. Besides practicing relaxation techniques, participants learn to cut back on caffeine and alcohol, and they use cognitive behavioral therapy to transform negative thoughts ("I will never have a baby") into positive ones ("I am doing everything I can to try to get pregnant"). Indeed, our programs focus less on getting pregnant than on getting your life back—and thinking about all the possible paths to parenthood, including adoption and egg or sperm donation. Similar programs are taking shape in many parts of the world, and their patients are enjoying similar benefits: less distress, higher pregnancy rates and a better quality of life.

Adapted from "6 Steps to Increased Fertility" by Robert L. Barbieri, M.D.; Alice D. Domar, Ph.D., and Kevin R. Loughlin, M.D. (Fireside. 2001). For more information about mind-body techniques and fertility go to health.harvard.edu/NEWSWEEK.

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