Deborah Howell (Host): We know that fertility challenges can be stressful, but how much does stress really matter? In this episode of the Time to Talk Fertility podcast, Dr. Arlene Go, a reproductive endocrinologist here at FCI, joins us to discuss the connection between stress and reproductive health and what it could mean for your fertility journey.

 From understanding the effects of stress on the body to finding ways to cope during treatment, Dr. Go offers expert insights, helpful strategies, and words of encouragement for anyone feeling overwhelmed. This is the Time to Talk Fertility podcast. I'm your host, Deborah Howell. Dr. Go, it's so nice to have you with us today.

Arlene Go, MD: Yeah. Thank you for having me. It's great to be able to chat about such an important topic.

Host: Well, we appreciate you taking the time. So if you're willing, let's dive right in. How does stress physiologically affect the reproductive system?

Arlene Go, MD: So when we're under stress, whether it's emotional, physical, psychological, the body activates what we call the hypothalamic-pituitary-adrenal axis, which is a big fancy term for kind of like the mind-body connection, right? And this leads to the release of stress hormones, especially cortisol, adrenaline. And this can interfere with our reproductive system.

Host: Got it. Now, can chronic stress actually cause infertility or does it just make the journey harder?

Arlene Go, MD: Chronic stress doesn't directly cause infertility in most cases, but it certainly can make it harder to conceive. So, stress can lead to irregular menstrual cycles or skipping periods, right, where you don't ovulate. It can also cause lower libido, disrupted sleep, and basically make it harder to follow through with timed intercourse or treatment plans when you have stress.

Host: Certainly. And what role do cortisol and other stress hormones play in ovulation and implantation?

Arlene Go, MD: So, cortisol is probably the main stress hormone that we think of. So, higher levels over time can start to prevent the release of what we call GnRH or a hormone that is really important for triggering ovulation with your LH surge. So, elevated cortisol can also impact the endometrium and potentially make it less receptive to an embryo implanting.

Host: Okay. That makes sense. I'm curious, can stress alter the results of fertility treatment like IUI, IVF or egg freezing?

Arlene Go, MD: Kind of like stress doesn't actually cause infertility. Stress doesn't typically make treatments like IVF fail, right? But high levels of stress can lead to poor sleep, missed medications, challenge sticking to protocols, again, all of which can definitely influence outcomes. There's been lots of studies looking to investigate the relationship between stress and assisted reproductive technology outcomes. And I will say mixed data. So, as of now, my answer is no definitive evidence that stress can harm fertility treatment outcomes.

Host: That's really interesting. I would've thought it would be the opposite. So, are there any studies that definitively link stress reduction to higher pregnancy rates?

Arlene Go, MD: Yeah. So, there are several studies that have looked at stress reduction interventions like, mindfulness practices, cognitive behavioral therapy, even acupuncture. And there has been some data saying that maybe these can help with higher pregnancy rates. I will say no randomized control trials. So, hard to really nail down the cause and effect relationship. But definitely, I think reducing stress can make the process overall easier.

Host: Yes. I really think we do need more studies. So, what are some effective strategies for managing stress during fertility treatments?

Arlene Go, MD: I love this question. I think it's so important for patients to utilize things like mindfulness, meditation, yoga, journaling, therapy, talking with a friend, right? Grabbing coffee with a friend and catching up, acupuncture. And then, another really important thing, I think, through fertility treatments is setting boundaries around certain social interactions, right? Maybe while you're in the middle of an IVF cycle, maybe it's not the best time to attend five baby showers or turn off the Instagram notification so you're not seeing constant pregnancy announcements. But really, kind of putting yourself at the forefront and kind of creating some space for just resting and focusing on this journey.

Host: No doom scrolling till midnight.

Arlene Go, MD: Exactly.

Host: How about lifestyle changes like diet or exercise or sleep that can help reduce stress and maybe boost fertility?

Arlene Go, MD: Absolutely. I always encourage my patients to partake in regular exercise. I always say avoiding the high intensity exercise during treatments, but like moderate aerobic activities can help to reduce cortisol levels. Also, kind of anti-inflammatory diet, so plenty of whole foods, less processed foods, that can support both stress and fertility. Try to cook at home as much as possible. Less takeout, less fast food during this time. And then, sleep is huge, right? So, aim for those golden seven to nine hours a night. I know it sounds unattainable, but truly sleep is important, and can help regulate your cortisol, your insulin, and all those reproductive hormones, so truly foundational to this process.

Host: Sure. And, you know, you know yourself. I was horrified. I was watching like one of those HGTV shows. And a pregnant woman was like doing demo with a big old ax, and I was like, "Whoa." But she knew herself and she was just fine and they showed the baby a couple months later. And so, you know your own strengths and weaknesses. But I mean, during this time, it's such a crucial time. Just do try to take it easy, right?

Arlene Go, MD: Yes, absolutely. And like you said though, I think patients, if they are used to doing a lot of activity and that's their baseline, then I say keep doing it. But definitely, as we start going through fertility treatments, it's not the best time to book a CrossFit session or all of a sudden you know, marathon training.

Host: Yeah. Start weightlifting, you know, 300 pounds. It's not the time. So, Dr. Go, how important is mental health support, like therapy or support groups for patients going through infertility?

Arlene Go, MD: It's essential, right? We all need someone to lean on. So, this process is intensely emotional. So, therapy can help you develop the tools to cope, reframe your experience. Support groups can remind you that you're not alone. But again, even just like grabbing a coffee and catching up with a friend, talking to your partner, sharing this journey, because it can feel incredibly isolating otherwise. So, having that safe space is really important.

Host: I've been doing gentle online workouts with friends. And it's just been great. We just set up a zoom call and we just do some stretches. One day we do just abs. The next day, maybe some arms. And it's social and it's nice and I always feel so good after we disconnect.

Arlene Go, MD: Yes, community. Community is huge.

Host: And what advice do you have for partners who want to support each other through the stress of infertility?

Arlene Go, MD: Really, it's all about communication. So, I think checking in regularly, and not just about the fertility side, right? Not just about like, "Hey, when are meds due? Or when are your next appointments?" Obviously, that's important, right? Show up for the appointments, help with the injections, but also check in with like how they're feeling. Try to maintain other aspects of the relationship that have nothing to do with the fertility and treatment. That can be stressful. So like, still go on dates, try to laugh, catch a movie, watch your shows, send each other memes, do whatever you do, as a couple that is separate from the fertility world.

Host: Should patients consider pausing treatments if they know that their stress levels feel out of control?

Arlene Go, MD: Definitely taking a short break sometimes to maybe like regroup emotionally, physically, or even financially—that can bring on stress—can be restorative. And just know that you're not necessarily giving up. Like you said, we're taking a pause, we're just hitting pause, and we can kind of come back stronger. But it's a very personal decision, right? Because life is stressful. So, I think it's impossible to say, like, come back and we'll do treatment when you have no stress. Because I don't know that that time will ever come. But obviously, if there's a really recent event that's bringing on stress, maybe waiting a little bit of time can be helpful. But I think the biggest thing is making sure you have the tools to cope and the support system in place.

Host: Even something as silly as seasonal stuff is important. Like, I went through three rounds. The second round, it was really, really hot, and I was in New York City and I was taking the subway. And you couldn't control the temperature and it was broiling hot down under there, and I did not have a successful result. But I learned from that the next time not to do that.

Arlene Go, MD: Yes, absolutely. And no one wants to have to do multiple rounds of fertility treatments, but the benefit of it is you've done multiple rounds, right? And we have that data from the other treatment cycles to keep improving and get better outcomes each time.

Host: Exactly. What final message would you share with patients feeling overwhelmed by the stress of trying to conceive?

Arlene Go, MD: I think the biggest thing is you're not alone. Your feelings are valid. This journey can really test our limits, but it doesn't necessarily define who you are. And so, kind of be gentle. Give yourself grace through this process and really seek the support when you need it.

Host: That's really wonderfully said, because what you're doing is you're trying to create a miracle after all, so...

Arlene Go, MD: It's a pretty awesome job we get to do.

Host: Yeah. Well, such wonderful information, Dr. Go. Thanks so much for being with us today to share your expertise and all that you do. We thank you.

Arlene Go, MD: Thank you for having me.

Host: That was Dr. Arlene Go, a reproductive endocrinologist here at FCI. Visit fcionline.com for more info or call 877-324-4483 to book an appointment with a fertility specialist. If you enjoyed this podcast, you can find more like it in our podcast library and be sure to give us a like and a follow if you do. This has been the Time to Talk Fertility podcast. I'm your host, Deborah Howell. Have yourself a terrific day.