Stress-female infertility link

The Hindu - http://www.hindu.com/
Researchers say women with high levels of stress may stop ovulating. Women who are under a tremendous amount of stress could end up with fertility problems.

(GUARDIAN NEWS SERVICE): Women who are struggling to get pregnant could improve their chances of conceiving by having stress-reducing therapy sessions, scientists claimed on Tuesday.

Researchers in the US found that rising levels of stress can lower awoman's fertility by disrupting her menstrual cycle, and in some casesprevent ovulation completely. But a pilot study of women who had not had aperiod for at least six months found that psychotherapy had a dramaticeffect, lowering stress levels and restoring fertility in 80% of cases.

Scientists believe between 5% and 10% of women experience a loss ofperiods at some time, and in most cases the cause is poor nutrition orover-exercising. But a much larger number of women are believed to suffer amild disruption to their periods that adversely affects their fertility.

Professor Sarah Berga, who led the study at Emory University in Atlanta,Georgia, said psychotherapy could be a viable alternative to expensive andoften complex fertility treatment. She said that people often tried to dealwith stress by exercising, but experiments showed that this only raisedstress levels further. Likewise, lounging around at home was not enough toreduce anxiety.

In the study, the scientists monitored women with a condition calledfunctional hypothalamic amenorrhea (FHA), which is caused by a drop inGnRH, a hormone that stimulates ovulation. None of the women had had aperiod for more than six months. Tests on the women revealed that they hadhigh levels of the stress hormone cortisol. Professor Berga split the womeninto two groups of nine. Half received 20 weeks of cognitive behaviourtherapy (CBT), a form of psychotherapy that was designed to adjust theirway of thinking and reduce their stress levels. The other half did notreceive any therapy.

Prof Berga said: ``A staggering 80% of the women who received CBTstarted to ovulate again, as opposed to only 25% of those randomised toobservation.'' Tests showed that those who had become fertile again had farlower levels of cortisol and higher levels of GnRH.

Although none of the women, who were aged 20-35, were asked whether theywere trying for a baby, two became pregnant within two months of thetherapy sessions ending. ``People are disbelieving that stress is a causeof infertility. The nail in the coffin is that reducing cortisol causes theGnRH signal to ramp up,'' Prof Berga said.

Speaking at the annual meeting of the European Society of HumanReproduction and Embryology in Prague, Prof Berga said that peoplesuffering stress often do not notice or admit to it. ``These women didn'treport feeling stressed. But when we spoke to them it was clear that theytend to have a loss of perspective, they think they can get more done in aday than is realistic and their sense of self-worth is linked to theirachievements at work,'' said Prof Berga. ``The therapy was targeted to whatwas bothering them. We teach them to love themselves.''

Prof Berga is beginning a study of between 2,000 and 4,000 women to furtherinvestigate the link between stress and fertility. ``If the larger scalestudy confirms our earlier results, we will have very strong evidence foroffering stress reduction as an effective therapy for a significant groupof infertile women,'' she said.

At a fertility clinic in Israel, an experiment suggests that laughtercan help boost pregnancy rates significantly.

Dr Shevach Friedler, at Assaf Harofeh Medical Centre in Zerifin,graduated from a school of movement and mime in Paris before becoming a physician. ``We know that laughter is good at reducing stress and IVF canbe a very stressful experience, so I wanted to see if clowning couldhelp,'' he said. In the study, a trained clown was sent to entertain womenfor 10-15 minutes shortly after they had received IVF treatment. Theresearchers found that the clowning boosted pregnancy rates considerably,from 20%-35%.