Infertility: Could stress be to blame?

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Ask some of the couples who've learned new ways to relax. They're now parents.

It was a serendipitous discovery, like looking for a shortcut to China and finding the wealth of the New World instead. And it all started because some nurses from the infertility department at the University of Mississippi Medical Center had an office next to Ron Drabman's.

One afternoon in 1986, psychologist Drabman fell into conversation with a couple of the nurses. You psychologists may think you know a lot about stress, they said, but you don't--not the overwhelming stress we see in infertility patients. Some women were on a daily regimen of hormones, often with such side effects as nausea, headaches, and loss of appetite. It wasn't just a matter of physical discomfort, either, they told Drabman. There were also widespread feelings of failure and the embarrassing, even dehumanizing techniques that were supposed to give the couples a better chance at conceiving. The nurses asked, Is there anything you can do to help?

Drabman tried. He designed a two-session program to teach couples about stress management and relaxation techniques. "I thought we were just doing something nice," Drabman says. "Just helping these people have an easier time."

Drabman's program, however, accomplished much more than that. Four out of the 14 couples attending his program, or 28 percent, conceived in their first attempt at in vitro fertilization. That's a pretty impressive result compared to the more typical 6 percent conception rate experienced by the couples who weren't able to participate.

Researchers have devoted much time and money to confirm what any infertile couple already knows. With its cycles of hope and crashing disappointment, its scheduled sex and strain between partners, infertility creates stress. But Drabman had stumbled onto an idea that's getting more and more attention these days: Stress may cause infertility.

To some people, this idea may recall bygone times when infertile women were made to feel that their problem was simply a matter of attitude. You'll get pregnant if you just relax, they were told. Have a drink, take an ocean cruise. Today, specialists trace about 85 percent of fertility problems to physiological causes, according to Alan DeCherney, president of the American Fertility Society. Many specialists suspect the percentage will climb even higher as diagnostic tests improve.

But it's becoming more and more evident that the mind frequently does play a crucial role. A 1993 study by reproductive biologist Samuel Wasset offers a hint about just how stress might cause infertility. Wasser, at the University of Washington in Seattle, gave a battery of psychological tests to 38 women. Then the women and their mates had thorough medical work-ups to determine why they hadn't been able to conceive. He found a striking pattern. Women whose infertility was caused by hormonal problems showed much higher levels of stress than those whose partners were found to be infertile or whose infertility was caused by anatomical problems, like blocked fallopian tubes. "This is exactly what you'd expect if stress caused the disorder," says Wasser.

Why might hormonal problems be the key, and how can they bring about reproductive meltdown? According to Wasser, the hypothalamus, a part of the brain that controls the flow and timing of reproductive hormones, is keenly sensitive to all kinds of tension. Stress, due to anything from job loss to infertility testing itself, can change the way the hypothalamus orchestrates these hormones. Without enough estrogen, an egg will never be released or will be too immature to grow. Not enough progesterone and an embryo can't be implanted or stay implanted.

Even when the infertility problem is purely physical, stress may impede conception even further, says psychologist Mice Domar, who directs a behavior modification program for infertile couples at Boston's New England Deaconess Hospital. Take a woman who has scarred tubes from past infections, she says. Even after the initial problem is surgically repaired, her accumulated stress can make it difficult for her to conceive.

Men show stress and strain as well. "One woman told me that at the beginning of treatment her husband's sperm count was a fabulous one hundred million," says Domar. "A year and a half into the workup, the count was at fourteen million. She'd been the one:with the medical problem, but this guy went from being normal to barely fertile." Other researchers have seen much the same thing.

You'd think this tantalizing evidence would inspire more experiments. "Let's face facts," says DeCherney. "We know some women who attend military academies stop having their periods; women who go for artificial insemination with donor sperm often stop ovulating. But most specialists have problems working with the idea of stress and infertility because it's so difficult to prove. They'd rather go into high-tech areas, where results can be quantified."

Maybe that's why Alice Domar has one of the few group programs that specifically teaches relaxation and stress management as ways of coping with in-fertility. Interestingly, her groups began as part of a controlled study that might have supplied the hard evidence experts find so elusive. But when the first three women scheduled to take part were placed in a control group instead of the experimental program, things quickly fell apart. "I couldn't get them to stop crying long enough to fill out the forms," Domar recalls. "They'd heard about relaxation for infertility and were desperate."

So desperate that Domar put her formal study on hold. Since September 1987, her groups have taught relaxation skills, stress management, yoga, and better nutrition as ways to cope with infertility. The ten weekly sessions also give women--and their spouses-a chance to commiserate about what many describe as the worst experience of their lives.

After 25 groups, Domar has quite a collection of baby photos decorating her office. The average conception rate for couples in programs similar to Domar's but without any psychological intervention is 18 percent. In her program, 34 percent of the couples have conceived.

Without formal studies to confirm the theories, Domar can only guess why her groups seem to help women get pregnant. The program may encourage them to stick to other treatments long enough for them to work, she says. Networking could help women find out about other doctors and treatments that lead to success. Or, Domar speculates, relaxation and stress management could actually be making a real difference on their own.

Domar has finally begun the five-year controlled study that will answer the question. But pregnancies are still just a wonderful side effect from her point of view. Domar's primary goal has always been to help couples stop living in 28-day cycles. "Most patients come here saying, 'I'm miserable. I just can't go on,"' Domar says. "And that's something we know we can change. People who cry every time they open their mouths at the first session are talking and laughing by the tenth--whether or not they conceive."

"It gave me my life back," says Patty O'Brien, who joined one of Domar's groups in her third year of infertility. "I was in such crisis I could only focus on whatever high-tech procedure was coming up next. The group helped me open up my vision--enjoy golf without thinking about infertility, enjoy my husband without thinking about infertility. And those coping skills we learned are a bag of tools I'll carry through my whole life."

In fact, two years later, O'Brien is dusting off those tools to deal with a different problem. She is trying to juggle her business as an independent insurance broker with the demands of Kienan, her eight-month-old son..

ILLUSTRATION

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By SUSAN GOODMAN

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