By Kerry Hinds and Dr. Alison Zimon.
Originally published in RESOLVE New England Magazine, March 2020
The effect of stress on our health has become a major topic of conversation over the last few decades. Our lives are continuously becoming more stressful. We live in a society that values ‘busyness,’ and believes that success is tied to action. Do do do. Do more. Do even more. The harder you work, the more success you will have. This is one of many reasons that makes navigating fertility challenges so stressful. We work so hard at it, invest so much energy, time, and money – we expect success because that is what we’ve been conditioned to expect. So when pregnancy doesn’t happen and we feel we are doing everything we can, we begin to feel powerless. This lack of control can be frustrating and difficult.
Enter STRESS. Decades of research on the associations between stress and infertility have made this connection well-known and accepted. Encouragingly, there is as much data that suggests that mind body practices can effectively reduce stress, mitigate the infertility experience, and perhaps even enhance reproductive outcomes. This was shown in repeated studies by Dr. Alice Domar and colleagues.
As Maté outlined in “When the Body Says No: Understanding the Stress-Disease Connection”, stress can be characterized as having four major causes: 1) lack of control, 2) uncertainty, 3) emotional isolation, and 4) inability to express emotions (. 2003). If you’ve had or are experiencing fertility challenges, you’re probably nodding your head thinking that these stressors pretty well sum up a life with infertility. When you’re told to relax, this often has the opposite effect, increasing our stress response. We are often left without the knowledge or tools to deal with stress. Also, the situations that cause stress will not go away and tend to cycle monthly.
If these stressors are inherent to the fertility journey and cannot be reduced, how can you minimize stress so you can support your fertility efforts? The prescription of staying stress free, although based in truth, is extremely over-simplified and almost impossible. Let’s dig a little deeper into the biology of stress.
Stress has a profound impact on our biology. An acute stressor triggers our natural survival response which is essential for us to withstand potentially harmful insults. This flight-or-flight response is the activation of our sympathetic nervous system and a subsequent cascade of biological responses that ultimately heighten our awareness and protective instincts. In this state of hyperarousal, our brain triggers the release of neurotransmitters such as epinephrine (adrenaline) and norepinephrine (noradrenaline) which makes us feel alert and focused. The hypothalamus and the pituitary induces the adrenal gland to release more cortisol, the quintessential “stress hormone.” Blood flow is shunted away from the gut and focused on the brain, skeletal system, and muscles to make us hyper-attentive and ready for action.
While the body’s natural arousal and relaxation to acute stress is natural and healthy, chronic stress becomes problematic. This is when the flight-or-fight response remains in effect, and our bodies remain in this hyperarousal state. Over time, this can have cumulative negative effects through our system. The constant action of the sympathetic system keeps our blood pressure high, which can lead to hypertension and blood flow can be diverted away from the reproductive organs. The constant stimulation leads to high cortisol levels and adrenal output. The immune system is suppressed, and this makes us susceptible to illness and infection. In extreme and unrelenting cases, the hypothalamus and pituitary gland become over-suppressed, which can cause the reproductive system to shut down all together leading to the absence of menstrual cycles all together.
Encouragingly however, once the stressor is relieved, the body can amazingly unwind and restore a normal equilibrium from both acute and chronic stress. The parasympathetic or relaxation nervous system is activated, blood flow returns to the gut and the reproductive organs, our heart rate and blood pressure normalize, our cortisol surge subsides, and we return to rest mode. Our thyroid and adrenal glands function again, maintaining baseline metabolism and our reproductive system is optimized for fertility potential, preconception, and pregnancy.
Now knowing the biology of how stress and relaxation affects our reproductive biology, we can begin to take action to reduce stress by increasing relaxation. The goal is not to try to remove stressors (they happen!) but rather to minimize chronic stress.
The good news is that we can definitely control the way we deal with stress and thus the effects that it has on the body. We can periodically take our bodies out of the stress response and into the relaxation response. But first we need to be able to identify stress in our own bodies. Let’s break down the 3 stages of stress, known as the General Adaptation Syndrome, as described by Hans Seyle.
Stage 1 of stress: Alarm. When our bodies are in stress response, our body sends us warning signals that things are getting out of control. These warning signals can wear a variety of faces: a) physical – headaches, insomnia, loss of appetite or binge eating, teeth grinding; b) behavioral – alcohol or drug abuse, compulsiveness, restlessness; c) emotional – aggression, irritability, frequent crying; d) cognitive – impaired concentration, judgmental thoughts, racing mind, blaming, and distortions in thoughts like all or nothing thinking, or jumping to irrational conclusions.
Stage 2 of stress: Resistance. This is when the alarms are going off, but we choose to ignore them.
Stage 3 of stress: Exhaustion. After ignoring the symptoms, our bodies take control and slam on the brakes. This usually comes in the form of falling ill as our immune systems are compromised from being in heightened stress response for too long.
Now we know how stress works, why we get stressed, and what it looks like. So let’s do something about it by coming up with a stress management plan or ‘relaxation plan’. The 3 A’s of Change can be a useful framework to begin.
Step 1: Awareness. Become aware of your warning signs. What are your alarm bells? Behavioral, Cognitive, Physical, Emotional? Look at the list in Stage 1 above.
Step 2: Acceptance. Acceptance does not mean giving in. Recognizing and accepting is key to moving on. By saying, “I am sad, and sadness is a normal human response. It’s ok”, we acknowledge the warning signals and can begin to process our stress.
Step 3: Action. This is the step is often the hardest because it involves changing our old habits. Rather than reaching for a bottle of wine or the TV remote, find what brings you genuine ease (often bringing the attention inward). List a few options that you can follow to deal with the stress: take a bath, go for a walk, take a RESTORATIVE yoga class, meditate, or simply stop and breathe deeply. Be preemptive in your action – when you know you have a particularly stressful procedure or appointment coming up, begin a few days before to deep breathe, meditate, and visualize positive outcomes.
Ask yourself (and be totally honest with yourself), do you actually make the time needed to increase your relaxation with mind/body practices? If your honest answer is no and you think you need a little help or motivation, start looking for that support. Find nice short walks in nature nearby and locate restorative or fertility yoga classes. Find classes online for meditation or yoga and schedule this time into your calendar. Make a promise to yourself to do it, and don’t break that promise. Relaxation takes practice – it’s not as easy as saying, “I am now going to be a relaxed person.” Just like any other skill, this takes time and commitment to make it part of your life. You can’t expect to relax on cue after spending weeks, months, or years in a state of chronic stress.
And finally, let’s reframe our view on relaxation from ‘doing nothing’ and make it more accessible to our ‘doing’ mindset. You are doing something totally profound, nurturing, and supportive to your fertility that does not involve huge amounts of money, medication, time, or energy. Relaxation is a proactive activity to support your fertility that you can control. You are preparing your body to be as receptive as possible to whatever measures you are taking to conceive.
Kerry Hinds is a E-RYT, RPYT, Relax and Renew® Certified Teacher, Fertility Yoga Teacher, and Reiki Practitioner. She is the founder of Fertile Body Yoga and teaches a regular scheduled fertility yoga class at Down Under School of Yoga in Boston. Kerry’s own experiences with infertility and background in psychology and experiential education adds perspective and experience to her classes. Check out her YouTube channel.
Dr. Alison Zimon is the Co-Founder and Co-Medical Director of CCRM Boston. She is Board Certified in Reproductive Endocrinology and Infertility and in Obstetrics and Gynecology. In addition to her role at CCRM Boston, Dr. Zimon is a Clinical Instructor in the Department of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School and is a Staff Physician in OB/GYN at Beth Israel Deaconess Medical Center and Newton Wellesley Hospital in Boston.