impact of stress on fertility

Studies have shown that stress can negatively affect fertility and in some cases IVF outcomes. One of the suggested mechanisms for the positive impact that acupuncture may have on IVF outcomes, is its ability to reduce stress and anxiety.

Acupuncture for Depression: A Systematic Review and Meta-Analysis

Armour M et al J. Clin. Med. 2019, 8(8), 1140

Journal of Clinical Medicine

The authors of this meta-analysis scrutinised more than 1000 reports on the effect of acupuncture on depression in medical journals, and by applying strict clinical trial standards reduced the number of reports down to 29 for analysis. These reports included more than 2000 patients. Their analysis indicates that acupuncture can make a useful contribution to the management of depression, either on its own or alongside medication.  This report did not focus particularly on women, or on women who were pregnant, post partum or infertile. However its findings could find application in these areas where depression has been diagnosed.

Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms − a randomised controlled study

Bergdahl L et al, Eur Jn Int Med, Vol 16, 2017, 15-21

European Journal of Integrative Medicine

Ear Acupuncture was seen to reduce anxiety and depression in this study on 57 participants with insomnia disorder and long term use of hypnotic drugs. 74% of them managed to discontinue their hypnotic drug consumption post-treatment. Future studies could examine whether ear acupuncture could be useful for women suffering anxiety, depression or insomnia related to infertility.

A Comparison of Stress Levels in Women Undergoing Single Versus Multiple Acupuncture Session Prior to Embryo Transfer

C. Sutton, MD et al, 2015 Fert Stert, Vol 103, Suppl2, Pages e36–e37

Fertility and Sterility

This report is a retrospective study done on 78 women undergoing IVF, who had acupuncture for more than a month prior to, or only on the day of, embryo transfer. A standardised questionnarie (the Perceived Stress Scale) found that women who had acupuncture in the lead up to embryo transfer had significantly lower stress scores than those who had acupuncture on the day of transfer.

This is not a randomised controlled trial, and therefore does not provide sufficient evidence for claims about stress management of IVF patients. However it indicates the way for future trials. And is of particular interest in showing the effect of dose in acupuncture treatments.

Relationship between psychological stress and reproductive outcome in women undergoing in vitro fertilization treatment: Psychological and neurohormonal assessment

Yuan An et al, J Assist Reprod Genet. 2013 Jan; 30(1): 35–41

Journal of Assisted Reproduction and Genetics

264 women undergoing IVF were tested periodically for cortisol and noradrenaline status. Additionally they completed assays to determine anxiety and depression. Lower levels of the stress hormones were found in women who were successful in conceiving and having a live birth. This is possibly one of the mechanisms whereby acupuncture may help to improve IVF outcomes.

Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study—the LIFE study

Lynch CD et al, Hum. Reprod. (2014) 29 (5): 1067-1075.
Human Reproduction 

When 400 women who were trying to conceive offered samples of saliva for stress marker analysis (alpha amylase) over a period of a year, it was found that those with the highest levels were twice as likely as those with the lowest levels to experience infertility. It is not clear exactly how stress reduces fertility but this study was able to show that it was not reduced sexual intercourse or interference with ovulation. However it is possible that there may be stress induced alterations in gamete transport or the development of an autoimmune state unfavourable for implantation. Higher levels of alpha amylase occur when there is elevated adrenalin in the blood stream. 

Effect of Acupuncture on Symptoms of Anxiety in Women Undergoing In Vitro Fertilisation

Isoyama D et al, Acupunct Med. 2012 Jun;30(2):85-8.
Acupuncture in Medicine (BMJ)

In this randomised controlled trial, the authors found that using acupuncture points that specifically reduce stress, significantly lowered anxiety levels of women undergoing IVF (as measured on the Hamilton Anxiety Rating Scale) when they were treated once a week before and during the IVF cycle. Other women who were also treated with acupuncture once a week but with non acupuncture points did not experience the same benefit.

The effect of medical clowning on pregnancy rates after in vitro fertilization and embryo transfer

Friedler S et al, Fertility and Sterility 2011, Vol 95, Issue 6 , Pg 2127
Fertility and Sterility  

In this partly randomised prospective trial, Dr. Friedler and colleagues tracked 219 women undergoing IVF treatment and treated half of them to a medical clown’s 15-minute routine of jokes, magic tricks and other clowning immediately after their embryos were implanted. Those women who had a good laugh after their transfer fell pregnant more often than did the control group. The authors note that ways to relieve stress at ET may be useful

Stress reduces conception probabilities across the fertile window: evidence in support of relaxation.

Buck Louis GM et al, Fertil Steril. 2011, 95, 7, pg 2184 – 2189
Fertility and Sterility

In a prospective cohort study involving 274 women, stress marker levels were assessed and related to conception rate. The study showed a clear relationship with higher stress levels (as measured by alpha-amylase) and reduced conception rates.

The relationship between perceived stress, acupuncture, and pregnancy rates among IVF patients: A pilot study

Balk J et al, Complement Ther Clin Pract. 2010 Aug;16(3):154-7).
Complementary Therapies in Clinical Practice 

In a small prospective cohort study of 57 IVF patients, some investigators aimed to determine if acupuncture affects the levels of perceived stress at the time of embryo transfer, and whether either acupuncture or changes in stress levels play a role in the success rate in IVF.  The patients who received acupuncture in this study had both higher rates of pregnancy, and lower levels of stress both before and after embryo transfer. They postulated that reducing stress at the time of embryo transfer could result in less vasoconstriction and improved uterine receptivity.