Stress, Miscarriage & Infertility;

by Jill Irwin

We all know that miscarriage and infertility can be two of the most stressful situations that a woman can encounter. However, recent studies are beginning to show a causal link between stress and miscarriage and infertility.

Infertility

      In order to discuss infertility, first we must define it. Fecundity is the ability to bear children. The overall fecundity rate of American couples is 85-90% after twelve months. However, at least 30% of individual couples fail to conceive in any twelve month period.
      Infertility is defined as the inability to conceive after twelve months of trying. 10 - 15% of all couples are considered infertile. This problem is attributed to the woman 40-60% of the time, affecting up to 10 million women.
      There are two main causes of infertility in women; anatomical defects or hormonal imbalances. Anatomical defects include problems such as blocked tubes and endometriosis. These are easily found, and are sometimes repairable. Hormonal imbalances, on the other hand, are often overlooked and are ill-defined. This is where stress can become a factor.
      First, we must understand the normal hormonal system. The hypothalamus is the regulatory gland in our brain. It controls mood, libido, thirst, appetite, sleep, body temperature and blood pressure. Every month the hypothalamus normally releases gonadotropin releasing hormone (GnRH). This signals the pituitary to release two other hormones, follicle stimulating hormone (FSH) and luteinizing hormone (LH). These two stimulate the ovaries.
      This process can be affected by our emotional state. GnRH is also affected by other brain chemicals such as norepinephrine (which speeds up its release) and serotonin and dopamine (which inhibits it). As these brain chemicals change, so does the menstrual cycle. Once the sequence becomes totally disrupted anovulation can occur.
      A second hormonal problem deals with prolactin levels. Prolactin is a natural birth control that the body produces following a pregnancy. Prolactin works by inhibiting the secretion of FSH, so follicles do not mature and ovulation does not occur. However, studies have shown that prolactin levels are also high in times of acute or chronic stress. Thus, women with high stress levels often have irregular cycles or no ovulation at all.
      The third problem deals with the so called "stress hormones". When the body's "fight or flight" response takes over, the hormones adrenaline and noradrenaline are released. This interferes with the release of GnRH, thus changing or inhibiting the ovulatory cycle. By one estimate, women experience up to 50 brief "fight or flight" episodes each day! These can be as threatening as an attempt on our lives, or as innocuous as the alarm going off in the morning, but our bodies respond in the same way. Once the adrenaline is released, it takes many hours to dissipate. So, if you are subjected to many stressful moments in your day, it could severely disrupt your cycle.
      Many couples who suffer from infertility endure incredible amounts of stress when they undergo their treatments. Many of the various methods for treating infertility are expensive and painful. Then, they all involve waiting. Women begin to feel depressed and not in control of their lives. All of this leads to more stress, and the cycle continues.

Miscarriage

      Miscarriage, also known as spontaneous abortion, is surprisingly common, but not very much spoken about. Approximately 20% to 40% of all pregnancies end in miscarriage, most of these during the first trimester. Only about half of these are because of confirmed genetic abnormalities of the fetus.
      Having one miscarriage does not place a woman at increased risk for another. However, women who have had three or more fall into a category known as habitual loss. These women should undertake testing for genetic abnormalities as well as evaluations on their endocrine systems and ovarian function, including the corpus luteal phase (last two weeks) of their menstrual cycles.
      Women who have had miscarriages suffer tremendous stress. First, they must deal with the grief and guilt that accompany any loss. There are too few support systems for women who have lost babies in this way. Most people do not know how to deal with someone else's grief. They may say insensitive things, such as "everyone has had one", or "you'll get pregnant again". Even telling someone "it was meant to be" doesn't ease the pain that these women feel. Emotionally, they are on a roller coaster ride.
      Women who have had multiple miscarriages live with almost constant fear and sorrow. They may actually fear becoming pregnant. Watching for bleeding or spotting becomes an overwhelming cycle of moment to moment anxiety. They monitor every symptom (or lack of one), and miss out on the day to day joys of a normal pregnancy.
      A variety of animal and human studies have linked extreme stress and emotional upset to miscarriage. They have shown that the stress hormones adrenaline and noradrenaline can decrease blood flow through the uterus, compromising fetal blood supply. Drops in fetal blood pressure and heart rate have been documented in animal studies when mothers are exposed to environmental stressors such as loud noises. Stress can also lead to increased use of caffeine, alcohol and tobacco. These have all been shown to be detrimental to a developing fetus.
      It has been shown that stress leads to a drop in LH. LH is needed to stimulate the the corpus leuteum to release progesterone. If sufficient progesterone is not released, the fertilized ovum will not be able to implant, or if implanted, will not be sustained for the full term.

Resolutions

      What can be done about the link between stress and infertility and miscarriage? First of all, more studies need to be undertaken to further understand the exact workings of stress on our endocrine systems. While we have established that this link exists, we need to understand more just how these systems fit together.
      In the meantime, there are outlets available to help women control the stress in their lives. The Mind/Body Medical Institute of Deaconess Hospital in Boston has a branch at Morristown Memorial Hospital in Morristown, New Jersey. There they teach women how to invoke the "relaxation response" and lower their stress levels. While they do not claim that their program cures infertility or prevents miscarriage, close to 30% of the women in their groups have become pregnant and carry to term.
      RESOLVE is a national group dedicated to helping couples deal with infertility. They have many meetings in the tri-state area. They also have a hotline with a registered nurse available to answer questions. They feature focus workshops, symposia, and pre-adoption meetings.
      INCIID (pronounced "inside")is the International Council on Infertility Information Dissemination. They offer information on all types of infertility issues and assisted reproductive procedures (ART) such as GIFT (gamete intrafallopian transfer) and DE (donor egg). They also offer fact sheets and article reprints, as well as two weekly on-line chats on the on line service Prodigy.
      One of the things I found helpful were the news and mailing list groups on the Internet. These groups are comprised of women who have been through everything! There is always someone out there to assist with answers to questions or just reassurance. There are three groups in particular that I found helpful. The first one is Fortility. This is a listserve of women who are near or over forty and are facing primary or secondary infertility and/or multiple miscarriage. The two Usenet groups are <alt.infertility> and <alt.soc.support.pregnancy.loss>. In all of these groups I have found support, compassion, and hope for the future.

Resources

RESOLVE Inc
1310 Broadway
Somerville, MA 02144-1731
(617) 623-1156
Helpline (617) 623-0744
E-mail: resolveinc@aol.com
URL: RESOLVE, Inc.

INCIID
P.O. Box 6836
Arlington, VA 22206
(520) 544-9548
E-mail: mlad79e@prodigy.com
URL: www.inciid.com

Fortility
URL: www.surrogacy.com/fortility/

Bibliography

Domar, Dr. Alice. Healing Mind, Healthy Woman. New York: Henry Holt & Co. 1996.

Liebman-Smith, Joan. In Pursuit of Pregnancy. New York: Newmarket Press, 1987.

Healy, Dr Bernadine. A New Prescription For Women's Health. New York: Viking Press, 1995.

Pizer, Frank and O'Brien Palinski, Christine. Coping With a Miscarriage. New York: Dial Press, 1980.

Schenker, Joseph, Meirow, Dror, and Schenker, Eran. "Stress and Human Reproduction, " European Journal of Obstetrics & Gynecology and Reproductive Biology, November 1992.

Negro-Vilar, Andres. "Stress and Other Environmental Factors Affecting Fertility in Men and Women: An Overview, " Environmental Health Perspectives Supplements, #101, 1993.

Wasser, Samuel K., Sewall, Gretchen, and Soules, Michael. "Psychosocial Stress as a Cause of Infertility," Fertility and Sterility, Vol. 59, No. 3, 1993.

Fenster, Laura et al. "Psychologic Stress in the Workplace and Spontaneous Abortion," American Journal of Epidemiology, Vol. 142, No.11, 1995.