Without a doubt, trying to conceive (TTC) can be stressful. Sadly, those struggling during this time have reported elevated levels of anxiety and depression. In fact, levels of anxiety and depression in those with infertility were comparative with patients who have been diagnosed with cancer (1). That being said, there are many ways to help manage stress that can bring the enjoyment back to TTC.
Don’t worry, I am not going to tell you to just relax – you will know how frustrating this is! It offers absolutely no support or help, and often just adds to the stress and isolation. Before I provide you with three key strategies to manage stress when trying to conceive, it’s important to first understand what the stress response of the body actually is in order to understand how we can positively ‘hijack’ this.
The Impact of Stress When TTC
We know now more than ever before how the mind and body are connected – you may have heard of the ‘gut-brain axis’, as an example. We also know that fertility can cause stress, however, what isn’t entirely clear-cut is whether stress can cause fertility issues. The current evidence does lean towards there being a vicious cycle with our body’s stress response having the ability to influence our hormones, which may very well contribute to a cause-effect relationship.
In a study of both fertile and infertile populations, distress was respectively associated with decreased conception rates, longer menstrual cycles (≥35 days) and lower outcomes of reproductive medicine, including oocytes retrieved, fertilization, pregnancy and live birth rates (2). Experimental data found statistically significant reductions in conception probability during the fertile window of women with higher levels of a biomarker of stress, salivary α-amylase (3). Research has also found that stressful stimuli may impact ovulation, fertilization, and implantation rates. For example, job-induced stress increased LH-plasma concentrations in both the follicular and luteal phases of the cycle (4). This is one of the many reasons why using OvuSense can be really beneficial to detect the influence of external stress on your cycle health.
This potential cause-effect relationship does make sense, given the body has many signaling molecules which act as messengers between cells. These include neurotransmitters and hormones. These molecules are very delicately balanced and can be impacted by any internal or external signal, such as stress, diet, toxins, and infections. So, we can see why it is vital to prioritize mental well-being while TTC.
If you have had or are experiencing difficulties in your TTC journey, you will no doubt agree that it can feel out of your control, uncertain, and isolating at times. Reassuringly, research does indicate that managing stress could make a positive difference in your journey. Interventions put in place to lower stress were associated with increased pregnancy rates in one study (5).
What Happens to Our Bodies When We’re Stressed?
Our bodies are designed to respond and adapt to acute stress, with a response known as ‘fight or flight’ controlled by our sympathetic nervous system. Here, communication molecules such as cortisol and adrenaline are released. This cascade starts in the brain and goes on to increase heart rate, slow digestion, dilate pupils, and raise blood pressure. Although this is a beneficial survival response to an acutely stressful event, we are now living in a world where our lives are becoming continuously stressful. We can always be ‘on’ due to smartphones, the internet, and the fact that modern-day ‘success’ is often seen as ‘how busy you are’ and constant action or multi-tasking.
Despite our environment changing, our body's response is the same as our ancestors. Longer-term chronic stressors of modern-day life (e.g. disrupted sleep, work pressure, limited relaxation, excessive strenuous exercise, inadequate nutrient intakes, fertility struggles) can cause dysregulation in this response and prolonged activation of our sympathetic nervous system. This can lead to panic attacks, anxiety, poor digestion, fatigue, disruption to sleep cycles, and menstrual cycle disturbances (6–10).
So, what can you do to practically intervene in this stress response and manage stress when trying to conceive? Check out these three ways to prioritize mental well-being while TTC.
1. Reduce Hidden Stressors
Stress signals that can impact the body from various sources are known as stressors. Everybody that is exposed to different stressors has a different resilience capacity to these. Stressors could be physical (e.g. injury), physiological (e.g. poor sleep, excess toxins/alcohol, low nutrient intake) and psychological (work stress, relationships, TTC).
I often ask my clients to picture their capacity to stressor load as a bucket. Although some items pouring into the bucket may feel outside of our control (such as TTC, or being stuck in rush hour traffic), there are often factors filling up our bucket that we have control over and can remove to help reduce overflow. I like to call these hidden stressors. Identifying these can really help you to feel empowered and in control by reducing those that you have an influence over, in turn reducing the stimulus these stressors have on our stress response – which as we discussed may have a negative cascade effect on fertility. Examples of ‘hidden’ stressors to consider:
- Poor sleep and irregular schedules
- Exercise – finding the right balance of movement and not over exercising with strenuous intensity
- Low-nutrient diet and nutrient deficiencies (did you know stress can also deplete certain nutrients such as vitamin C, magnesium and some B vitamins)
- Alcohol and toxin exposure
- Inadequate hydration
- Unstable blood sugar balance
2. "Hijack" Your Stress Response
Stress is regulated by our nervous system. As mentioned, the sympathetic nervous system is in control when we are stimulated by a stressor – this controls our ‘fight or flight’ response. I tell my clients to think of this as our body’s foot on the accelerator.
Whereas, the opposing parasympathetic branch of the nervous system is designed to turn on our body's ‘rest and digest’ phase. Here, communication molecules are released that can slow the heartbeat, stimulate bile release and digestion, promote relaxation, and bring a sense of calm and peace (due to an oxytocin release). Think of this as the body’s foot on the brake. But, we can’t be pressing the break and accelerator at the same time, so one is always dominant. In our busy, chaotic, often stressful world – the sympathetic nervous system often dominates.
The communication highway that regulates the parasympathetic nervous system is
controlled by the vagus nerve. The vagus nerve is the largest nerve in the body. It begins in the brainstem and extends throughout the body, touching upon the cardiovascular, digestive, reproductive system and many other organs; constantly taking information back and forth to the brain.
If you improve ‘vagal tone’, which represents the activity of the vagus nerve, you can help to activate the parasympathetic nervous system. Therefore, taking the foot off the accelerator and the body out of the sympathetic nervous system’s flight or fight response. Having a higher vagal tone means that your body can relax faster after stress, improving resilience. Furthermore, when working well it can help to reduce inflammation by inhibiting proinflammatory cytokines (11,12), beneficial given inflammation can impact fertility and the ability to carry to term. A variety of factors can improve vagal tone, or stimulate the vagus nerve. Encouragingly, many are totally free and easy to implement.
- Breathe – This is one of the easiest, totally free ways to improve vagal tone and stimulate the vagus nerve. Even just 5 minutes a day can make a difference. There are lots of techniques online, but the key is deep, slow abdominal breathing. You can also try making your exhalations longer than your inhalations, or try guided yogic breathing such as alternate nostril breathing techniques (13).
- Singing, Humming, Chanting, and Gargling – The vagus nerve is connected to your vocal cords and muscles at the back of your throat. Therefore, when singing, humming, gargling, or chanting, you are activating these muscles and stimulating the vagus nerve.
- Gut Health – The vagus nerve is also the main communication highway for the gut-brain axis, reading the information in your gut and sending impulses to the brain. When this pathway or your gut health is irritated or inflamed, it can impact communication and mental well-being (14,15). If you experience digestive issues or gut symptoms (like so many of my clients do), it is always worthwhile speaking to a registered nutrition practitioner to get to the root cause(s) of these.
- Yoga and Meditation – Research suggests that yoga can increase vagal dominance during practice and regular ‘yogis’ were found to have increased vagal tone at rest compared to those who did not practice (16).
- Cold Exposure – Cold therapy improves vagal tone. Cold exposure, particularly to the face and neck, activates the parasympathetic nervous system (17).
3. Seek Support
Isolation and not being able to discuss our emotions can really contribute to stress and feeling overwhelmed. Sadly, this can be common when trying to conceive as fertility issues can often be a silent struggle. Yet, it is really important to validate your feelings and feel them. Accepting stress as part of the journey of TTC can help you proactively find ways to manage it and support yourself as much as possible.
Often my clients can feel that they are thrown into a situation that is without control, either when TTC naturally or with assisted fertility, such as IVF. Yet, empowering them by uncovering root causes behind fertility struggles, and supporting them with personalized nutrition and lifestyle medicine can really help on the journey. Seek support and talk to others. In fact, a meta-analysis (which is research that pools together results from a large number of studies) found that psychotherapy interventions can lead to improvements in the pregnancy rate for infertile patients, particularly those receiving assisted fertility. It was also seen to improve depression and anxiety (18). Remember, you most definitely are not alone in this journey.
Alexandra Emerson White, MSc, BSc (Hons), MBANT, CNHC, is a registered nutritionist, functional medicine practitioner and mental wellbeing expert, specializing in fertility, pregnancy and motherhood; offering one-to-one support. Alex is passionate about demystifying the nutrition and wellbeing noise for women, helping you to understand that there is no ‘one size fits all’ approach; that similar symptoms can have different root causes amongst us, and how personalized nutrition can help you to find and address this. If you want to find out more about supporting nutrition and lifestyle throughout your journey to, and through motherhood download your free QuickStart guide here.
If you have any questions or would like to find out more about personalized nutrition and lifestyle support with Alexandra, contact her via her website, Instagram, or book a complimentary nutrition review call to find out more.
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