Sakshi Chopra, MBBS DGO DNB (Gynaecologist)
Hina Garg PT, MS, PhD, NCS, CEEAA (Physical therapist)
Is there a link between stress and infertility?
What are different lifestyle factors causing infertility in men and women?
At some point, every couple wants to become a parent and infertility can have a devastating effect on their lives. Infertility can take an emotional toll in an individual’s life and affect their relationship with the spouse, therefore, making this journey of becoming a parent long and winding for some. Infertility is defined as one year of unprotected, regular intercourse without conception. 85-90% healthy, young couples conceive within 1 year. Therefore, infertility affects approximately 10-15% of couples.
Nowadays infertility is on the rise and has become a very common issue among couples. Common behavioural factors related to infertility both in men and women include:
- History of depressive disorder
- Depression is typically described as feelings of sadness and/or a loss of interest in activities once enjoyed which lasts for more than 2 weeks. It can cause a range of emotional and physical problems.
- History of active or passive smoking
- Cigarette smoke contains toxic reactive oxygen species and can damage a woman’s egg causing risk of miscarriage, early menopause and infertility. In males, it affects sperm motility, concentration and morphology. Smoking >100 cigarettes in the entire lifetime is considered a risk.
- Age > 35 years
- In women, fertility peaks between 20-24 years of age and subsequently decreases Follicular depletion, genetic abnormalities in egg, poor embryo quality and increases in uterine pathologies (fibroids, polyps, adenomyosis) are seen with progressing age. In males, poor sperm quality, quantity, and genetic abnormalities are seen.
- Stress
- It can have a negative impact on male fertility (i.e., on sperm concentration, mobility, and morphology) and increase the time to pregnancy or accelerate ovarian reserve exhaustion in females.
- Weight gain or obesity
- In females, it may result in ovulation disorders, longer time to conceive, increased risk of miscarriages and decreased chances of achieving pregnancy after fertility treatments.
- In males, it may affect sperm production, sperm DNA integrity and poor success with fertility treatments.
- Menstrual cycle irregularities
- Poor nutrition including decreased folate or increased alcohol consumption
- Strong evidence for deleterious effects of certain eating behaviours on male and female reproductive functions are seen. Insufficient intake of vegetables and fruits, cereals with sufficient fibre, foods rich in omega 3 (e.g., fatty fish, avocados), poultry, foods rich in antioxidants, and low-fat dairy products increases the risk of infertility. High rates of consumption of high-fat dairy products (cheese), potatoes, soy-based foods, red or processed meat, saturated fatty acids and sugars, coffee are harmful.
- According to American College of Obstetrician and Gynaecologists, women who are at risk of alcohol use are those who have >3 drinks/ occasion (binge drinking) or >7 drinks/week and any amount of drinking for woman who are pregnant. It also increases the risk of sexually transmitted illnesses and affects the egg quality. In males, alcohol can affect the sperm count, size, shape and motility. Heavy drinking affects fertility by lowering testosterone, FSH and LH level and increases estrogen level which reduces sperm production.
- Physical inactivity, sedentary behaviour or intense physical activity
- Physical inactivity (< 150 minutes per week of moderate to vigorous physical activity) in males and prolonged sitting (>5hours/day) in females are risk factors for infertility.
- Poor sleep
- Difficulty falling asleep in males, and additional factors of less than 7-8 hours of sleep in females were found to be significantly associated with infertility.
- Medical conditions such as fallopian tube blockage, sexually transmitted infections, diabetes, cancer or other immunological or endocrinological conditions which can cause damage to fallopian tubes and increase the risk for ectopic pregnancy in females, and affect sperm motility in males.
For a couple to get pregnant four things have to happen:
- A woman must produce and release a healthy egg from one of her ovaries (ovulation)
- A man must produce viable sperm which can successfully fertilize the egg (fertilization)
- The egg must travel through a fallopian tube towards the uterus (transportation)
- The fertilized egg must attach to the inside of the uterus (implantation)
Any problem in these steps can affect your chances of getting pregnant. Fertile period is 3 days prior to ovulation, on the day of ovulation and 2 days after ovulation.
Recommendations:
1. Behavioural interventions: A global preconceptional evaluation and personalised face-to-face counselling has been shown to be effective. Common components include:
- Weight management: Evidence suggests that this treatment component can significantly increase the natural pregnancy rate
- Alcohol or smoking cessation/reduction
- Micronutrient supplementation
- Diabetes control
- Stress and sleep management (see self-management of stress blog)
2. Medical management of conditions including fallopian tube blockage, sexually transmitted infections, diabetes, cancer or other immunological or endocrinological conditions
3. Assisted reproductive technology including fertility treatments for both woman’s egg and a man’s sperm. Common and effective treatment includes the In-Vitro Fertilization (IVF).
Behavioural factors can be easy to identify but difficult to control due to the long-term nature of such habits and behaviours. An open and honest conversation with the healthcare provider and a lifestyle and behavioural intervention plan prior to any assisted fertility treatments can provide a holistic view to the rising infertility concerns in both men and women. Hope you enjoyed reading this article. Feel free to leave us some comments and feedback below.
References –
Charlotte Dupont, Philippe Aegerter, Aude-Marie Foucaut, et al. Effectiveness of a therapeutic multiple-lifestyle intervention taking into account the periconceptional environment in the management of infertile couples: study design of a randomized controlled trial – the PEPCI study. BMC Pregnancy and Childbirth. 2020;20(1):1-13.
Bianchi E, Boekelheide K, Sigman M, et al. Spermatozoal large RNA content is associated with semen characteristics, sociodemographic and lifestyle factors. PloS one. 2019;14(5):e0216584.
L. L, C.L. H, M. M, et al. Systematic review and meta-analysis of the impact of preconception lifestyle interventions on fertility, obstetric, fetal, anthropometric and metabolic outcomes in men and women. Human Reproduction. 2017;32(9):1925-1940.
Crawford S, Smith RA, Kuwabara SA, Grigorescu V. Risks Factors and Treatment Use Related to Infertility and Impaired Fecundity Among Reproductive-Aged Women. Journal of Women’s Health (15409996). 2017;26(5):500-510.
Hull M, North K, Taylor H, Farrow A, Ford W. Delayed conception and active and passive smoking. F&S 2000;74(4):725-733
Naimi TS, Lipscomb LE, Brewer RD, Gilbert BC. Binge drinking in the preconception period and the risk of unintended pregnancy: implications for women and their children. Pediatrics 2003;111:1136-41.