Preparing to conceive – stress management

Acupuncture-Pregnancy-88

Stress, for most of us living and working in modern cities, is part of life. However it can get a lot worse when you are not conceiving as easily as you thought you would. And in a cruel vicious cycle, stress can have a negative impact on fertility. Women who are more stressed have reduced fertility, and during IVF procedures have lower embryo implantation rates. Stress has also been shown to affect semen quality. This is why we do specific acupuncture treatments at particular times of the IVF cycle.

Acupuncture is well known as an excellent stress reduction therapy. Its ability to raise endorphin levels and reduce adrenalin and cortisol levels allows the body and mind to relax immediately and learn a different way of being. Our patients frequently comment on how relaxed they feel after their treatments and that they don’t know how they would cope without that support.

Schedule; acupuncture once or twice a week or as required.

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For those of you who are interested to know more about how stress affects fertility and how acupuncture and other methods can help relieve it please read on ……

Different kinds of stress

The sort of stress that pushes you to meet a challenge successfully leaving you with a sense of achievement is a good type of stress. It allows you to have a sense of control.
A more damaging sort of stress is the type over which you have no control. Inability to fall pregnant falls into this category, and because reproducing is one of our most compelling biological urges this stress can affect us profoundly. If the stress is ongoing, then the body produces chemicals and hormones like adrenalin and cortisol and inflammatory cytokines. In a cruel vicious cycle this can further affect fertility.
The stress associated with infertility and fertility treatment is comparable to the stress we asssociate with serious illness like cancer or heart disease.
In particular, doing IVF is stressful and affects quality of life. And if attempts to conceive continue over a period of time this stress increases markedly.

Do stress and mood affect fertility ?

The answer from a number of studies appears to be YES.
We know that stress is a component in PCOS and in other ovulatory disorders such as FHA (functional hypothalamic amenorrhoea). (1)
We also know that stress can have a negative impact on IUI outcomes, (2) IVF outcomes, (3) and that women who have taken active measures to reduce their stress have had better results with IVF than those who don’t, especially if they are doing their second or more cycles. (4,5,6)

Women who are more stressed during IVF procedures (measured by raised heart beat and high systolic blood pressure) have significantly lower implantation rates.(7) Men are not immune either. During an IVF cycle semen quality is affected by stress (23)

High anxiety states can also contribute to increased miscarriage rates (2)
Depression affects IVF outcomes too; women who do not feel depressed before starting IVF treatment conceive twice as often as women who are depressed before treatment. (8)

How does stress affect fertility?

We dont know exactly but we do know that stress chemicals can affect a myriad different aspects of physiology that can impact on fertility and IVF outcomes.
It appears that an accumulation of multiple small stressors none of which on their own would affect fertility, can cause ovulatory dysfunction; cortisol levels are seen to be elevated in such women. (9)  Going through IVF increases levels of stress regulated hormones like cortisol and prolactin, as well as increasing anxiety. (10)
This stress and anxiety can reduce the number of eggs collected in an IVF cycle (6). Women with elevated levels of adrenalin have less success with IVF (11)  and some researchers have suggested that raised adrenalin may hinder natural conception by slowing the passage of the fertilized egg to the uterus, meaning the embryo does not reach the uterus at an appropriate time to implant. (12) High resting levels of cortisol are linked with elevated markers of inflammatory processes in the body which may affect implantation of the embryo. (7) Studies suggest that acupuncture can modulate immunity and can modify an inflammatory response. (13) Stress also affects the immune system, elevating levels of activated T cells which can reduce implantation rates of embryos.(7) 
Examining the effect of acupuncture on stress and immune markers is an area of interest and current research in our clinics.

How do I reduce stress?

An acupuncture session is one of the best ways to allow your body and mind to experience what a deeply relaxed state feels like. Then it is a matter of repetition and training your nervous system to maintain this state. The secretion of adrenalin is reduced after acupuncture (14), and so is cortisol.(15)
In one acupuncture study on women doing IVF they reported feeling relaxed, less stressed and had an increased capacity to cope for about a week after treatment.(16)
Some stress management programmes which include methods such as acupuncture and psychological stress reduction techniques have been shown to help restore ovary function in infertile women with PCOS and FHA (9, 17),  and improve IVF outcomes for women who have had previous unsuccessful cycles. (5)

Laughter is another proven method which reduces stress and may help improve IVF outcomes.(18)
Exercise is an excellent way to manage stress. Some people find that team sports are particularly diverting. Swimming, if you can do it for 20 minutes or more, is a wonderful way to get the body into a steady even meditative breathing pattern.
Yoga and Tai Chi work with the mind and the body and are well known for their ability to calm the mind. Tai Chi is associated with reducing stress, anxiety, and depression symptoms and improving self-esteem and mood.(19) Meditation is a direct way to calm the mind and reduce stress. Guided meditation tapes are helpful and easily available (20)

Some of those studies that have shown that acupuncture reduces stress related to infertility and IVF are shown here.

FInally getting on top of your stress levels is not only important in your quest to fall pregnant but also for the health of your baby when you do fall pregnant. There is a strong correlation between mothers and fetus’s cortisol levels and the functioning of the placenta. (21)  Increased stress levels in pregnancy can increase anxiety and hyper activity in the baby or child. (22)

 References
1 Kisdon W, 2011 Autralian Doctor June 24th.
2 Demyttenaere K et al. J Psychosom Obstet Gynaecol. 1988; 8: 175-181
3 Ebbeson S et al,  Human Reproduction. 2009; 24(9):2173-2182.
4 De Liz T,  Strauss B  Hum Reprod 2005;20:1324-32.
5 Domar A et al, presented at ASRM October 19th, 2009
6 Klonoff-Cohen H, Fertil Steril. 2004 Apr;81(4):982-8.
7 Gallinelli A et al Fertil Steril.2001, 76, 1, Pg 85-91
8 Thiering P, et al J Psychosom Res. 1993 Jul;37(5):481-91.
9 Berga SL, et al Fertil Steril 2003; 80:976-981
10 Csemiczky G et al Acta Obstet Gynecol Scand. 2000, 79:113-118.
11 Smeenk J et al , Hum Reprod 2005;20:991-6.
12 Buck Louis GM et al, Fertil Steril. 2011, 95, 7, pg 2184 – 2189
13 Zijlstra FJ, et al Mediators of inflammation 2003,12:59-69
14 Jensen L and Jensen S, Scand J Dent Res. 1982; Oct;90(5):397-403
15 So et al, Hum Reprod. 2009 Feb;24(2):341-8.
16 De Lacey S et al, BMC Complementary and Altern Medicine 2009, 9:50
17 Stener Victorin E et al, Acta Obstet Gynecol Scand 2000; 79: 180-188
18 Friedler S et al, Fertility and Sterility 2011, Vol 95, Issue 6 , Pg 2127
19 Wang et al. BMC Complementary and Alternative Medicine 2010, 10:23
20 (http://www.truewisdom.com.au).
21 Teixeira J, et al .BMJ 1999; 318, 153-157.
22 O’Connor TG, et al  Brit J Psychiat 2002; 180, 502-508.
23 Clarke RN et al, Human Reproduction 1999 vol.14 no.3 pp.753–758,