The scene plays out daily in my fertility clinic office: a woman distraught and tearful enumerates how many people have blamed her infertility on her stress level. She then describes all of the ways she has tried to reduce her stress and yet still has not conceived.
Feeling shamed and broken, she suffers in silence.
This month marks the 40th anniversary of the conception of the first baby, Louise Joy Brown, from in vitro fertilization. Advancements in IVF have resulted in the birth of millions of babies worldwide.
However, we have not made sufficient progress in emotionally supporting women who undergo these procedures. We continue to blame them for their failure to conceive. As one of the oldest forms of victim blaming, women throughout history have been shamed or punished for being infertile.
Ann Boleyn was beheaded by her husband, Henry VIII, allegedly in part because she was unable to give birth to a son following multiple miscarriages. In countries such as Ghana, women who are infertile have been accused of being witches, while some are divorced by their husbands.
It is well known that psychological stress (researchers use the term “distress” instead of “stress”) is a consequence of infertility.
However, few are aware that psychological distress has not been reliably shown to cause infertility.
Some hypothesize that the exposure to stressors leads to a cascading response in the body resulting in increased stress hormones, such as alpha amylase, which are assumed to negatively affect reproduction.
Although research led by Dr. C.D. Lynch of The Ohio State University College Of Medicine and colleagues on alpha-amylase has found a correlation between high elevations of this hormone and a longer time to conception, critics claim this research is irreparably flawed.
For instance, despite elevated hormone levels, nearly all women, or 87 percent, conceived during the 12- month study period. This pregnancy rate and time to conceive was consistent with normal pregnancy chances.
These study participants were also not formally assessed for infertility and all had presumed exposure to environmental toxins. Indeed, in 2016, exposure to environmental toxins in this sample was found to be associated with infertility. It may be that exposure to toxins caused the increased time to conceive as well as elevations in alpha-amylase.
Additional research on the relationship between distress and infertility has examined the effect of “relaxing” on pregnancy rate with psychological interventions or methods such as acupuncture. Again, research in this area fails to find a strong relationship between distress and pregnancy.
A recent review of 39 randomized control trials on psychological interventions in fertility patients found that all studies were so seriously flawed that their findings were not reliable.
The American Society for Reproductive Medicine stated in 2017 that research did not support a relationship between acupuncture and pregnancy rates.
Just as there are many studies which do not show a relationship between distress and fertility, there are others which do show such a relationship. It is important to remember though that correlation does not equal causation. For example, distress and infertility could simply be correlated not because one causes the other, but rather because they may both be caused by certain medical conditions such as PCOS or endometriosis.
So why is it such a popular myth that stress causes infertility?
It seems that everyone knows someone who allegedly relaxed — quit her job, went on vacation, adopted a child—and then got pregnant. The answer for why these women conceived is simple: they were not sterile in the first place. It is also likely that the pregnancy rate after “relaxing” is simply equal to the woman’s normal chances of conceiving.
It seems as if few share the stories of the many women who relax and do not get pregnant.
Perhaps we only share the stories we want to hear, and we want to hear these stories because we want to believe they are true.
We want to believe that contrary to reality, it is easy to get pregnant and that we have absolute control over our fertility.
Because if it is not easy to get pregnant and if our fertility is largely determined something we cannot control – our biology — then that would mean that fertility is unfair.
This would mean that some who would be kind parents could struggle to conceive whereas some who are child abusers might have an easier time conceiving.
But it is unfair.
So instead of accepting this unfairness, we blame women’s stress levels, something we can theoretically control, in order to pretend we can control our fertility.
Telling a woman to relax so she can get pregnant is offensive. Helping her cope with infertility is a more fair response to her and to all of us.
Dr. Angela Lawson
Dr. Angela Lawson is a clinical psychologist and Associate Clinical Professor in the Departments of Obstetrics and Gynecology & Psychiatry at Northwestern University and is a Public Voices Fellow. She is a past Chair of the national Mental Health professional Group of the American Society for Reproductive Medicine.