Can stress make you infertile?

In infertile men, cortisol levels (a stress hormone) are measurably higher than in fertile men. In a group of 376 men, every increase of 7 units of cortisol was associated with a 3% greater chance of infertility. Testosterone was also lower in infertile men. This is a cross-sectional study, so which comes first, stress or infertility, has not been established.

Another biological cause of male infertility is oxidative stress. This is a physical process in which free radicals damage cells and is unrelated to psychological stress. It damages the sperm cell membrane, reduces sperm motility, and can also affect sperm DNA. Oxidative stress plays a role in approximately half of all infertile men, making it one of the most thoroughly studied mechanisms in this field.

In women, the relationship between psychological stress and infertility is harder to untangle. What is certain is that infertility itself causes a great deal of stress, anxiety, and low mood. Whether that stress also reduces fertility is less clear. There are some indications in that direction: women who participated in a cognitive behavioural therapy group programme to reduce stress subsequently had significantly higher chances of pregnancy. However, methodological complications, such as participant expectations at the start of a treatment, make firm conclusions difficult.

Stress also affects the relationship. Infertility-related stress is associated with emotional estrangement between partners. Social concerns and relationship pressure together account for 45% of that emotional distance, in both men and women. In women with polycystic ovary syndrome (PCOS), being overweight further worsens the impact of infertility stress on emotional wellbeing.