Stress and human reproduction

      This paper is only available as a PDF. To read, Please Download here.


      The interaction between emotional stress and infertility has been investigated for many years. Many infertile couples show marked stress during infertility evaluation and treatment. Most of the investigations that were performed during the last two decades show that in the majority of cases stress is the result and not the cause of infertility.
      The biological interaction between stress and infertility is the result of the action of stress hormones at the brain level, especially on the hypothalamus-pituitary and on the female reproductive organs. Stress hormones such as catecholamines (adrenalin, nonadrenaline and dopamine) and the hypothalamic-pitui-tary-adrenal axis interact with hormones which are responsible for normal ovulatory cycles: i.e., gonadotropin releasing hormone (GnRH), prolactin, LH and FSH. Endogenous opiates and melatonin secretion are altered by stress and interfere with ovulation. Sympathetic innervation of the female reproductive system provides routes by which stress can influence fertility at the of the sex organs level.
      Infertility causes stress which is aggravated as time passes and the couple remains infertile. Among the causes of stress are the couple's isolation, life with unrealized potential and unborn child, disruption of day-to-day life during infertility evaluation and treatment, and the couple's feeling that they do not have control of their own lives. The IVF program is considered by many as the final step for the evaluation of the couples fertility potential, hence, couples participating in an IVF program are highly stressed, especially after a failed IVF cycle.


      To read this article in full you will need to make a payment


        • Rivier C
        • Rivier J
        • Yale W
        Stress-induced inhibition of reproductive functions: role of endogenous corticotropin-released factor.
        Science. 1986; 231: 607-609
        • Axelrod J
        • Reisine TD
        Stress hormones: their interaction and regulation.
        Science. 1984; 224: 452-459
        • Schwartz JH
        Biochemical control mechanism in synaptic transmission.
        in: Kandel ER Schwartz JH Principles of Natural Science. Elsevier, Amsterdam1982: 129-130
        • Bhattacharya A
        • Dierschke O
        • Yamaji T
        • Knobil E
        The pharmalogic blockade of the circhoral mode of LH secretion on the ovariectomized rhesus monkey.
        Endocrinology. 1872; 90: 778
        • Jarry H
        • Leonhardt S
        • Wuttke W
        Biochemistry of the LHRH pulse generator: a concept for induction of synchronous, phasic activity of LHRH neurons.
        in: Pirke KM Wuttke W Schweiger U The menstrual cycle and its disorders. Springer-Verlag, 1989: 17-25
        • Rosner J
        • Nagle C
        • deLaborde N
        • et al.
        Plasma levels of norepinephrine (NE) during the periovulatory period and after LH-RH stimulation in women.
        Am J Obstet Gynecol. 1976; 124: 567
        • Larry V
        • Klawans H
        On the role of dopamine in the pathophysiology of anorexia nervosa.
        J Neural Transm. 1976; 38: 107
        • Demling J
        • Fuchs E
        • Baumert M
        • Wuttke W
        Preoptic catecholamine, GABA and glutamae release in ovariectomized and ovariectomized estrogen-primed rats utilizing the push-pull cannula technique.
        Neuroendocrinology. 1985; 41: 212-218
        • Jarry H
        • Perschl A
        • Wuttke W
        Further evidence that preoptic anterior hypothalamic GABA-ergic neurons are part of the GnRH pulse and surge generator.
        Acta Endocrinol. 1988; 118: 573
        • Domar AD
        • Seibel MM
        Emotional aspects of infertility.
        in: Seibel M Evaluation of infertility. Infertility: a comprehensive text. Appelton & Lange, 1988: 23-35
        • Yen S
        Neuroendocrine control of hypophyseal function.
        in: 2 edn. Endocrinology. Saunders, Philadelphia1986
        • Genazzani AR
        • Petraglia F
        • Monzani A
        • Fabbri G
        • Genazzani AD
        • Di Domenica P
        • Volpe A
        Ovulation and stress: Pathophysiology.
        in: Mashiach S Advances in assisted reproductive technologies. Plenum Press, New York1990: 195-199
        • Quigley ME
        • Sheehan KL
        • Casper RF
        • Yen SSC
        Evidence of an increased dopaminergic and opiod activity in patients with hypothalamic hypogonadotropic amenorrhea.
        J Clin Endocrinol Metab. 1981; 50: 949
        • Quigley M
        • Sheehan K
        • Casper R
        • Yen S
        Evidence for increased dopaminergic and opioid activity in patients with hypothalamic hypogonadotropic amenorrhea.
        Clin Endocrinol Metab. 1980; 50: 949
        • Damyttenaere K
        • Nijs P
        • Evers-Kiebooms G
        • Koninckx PH
        The effect of a specific emotional stressor on prolactin, cortisol, and testosterone concentrations in women varies with their trait anxiety.
        Fertil Steril. 1989; 52: 942-948
        • McCann SM
        The role of brain peptides in the control of anterior pituitary hormone secretion.
        in: 4th edn. Neuroendocrines Perspective. vol. 1. Elsevier, Amsterdam1972
        • McNatty K
        • Sawers R
        • McNeilly A
        A possible role for prolactin control of steroid secretion by the human graafian follicle.
        Nature. 1974; 250: 653
        • Lu K
        • Meites J
        Effects of serotonin precursors and melatonin on serum prolactin release in rate.
        Endocrinology. 1973; 93: 152
        • Cumming DC
        • Wheeler GD
        Opioids in exercise physiology.
        in: 4th edn. Sem Reprod Endocrinol. 5. 1987: 171
        • Gindoff PR
        • Ferin M
        Brain opioid peptides and menstrual cyclicity.
        in: 4th edn. Sem Reprod Endocrinol. 5. 1987: 125
        • Blankstein J
        • Reyes FY
        • Winter SD
        • Faimen C
        Endorphines and the regulation of human menstrual cycle.
        Clin Endocrinol. 1981; 14: 287
        • Reiter EJ
        The pineal and its hormones in the control of reproduction in mammals.
        Endocrinol Rev. 1980; 1: 109-131
        • Brzezinski A
        Possible roles of melatonin in disturbances of the menstrual cycle.
        in: Pirke KM Wuttke W Schweiger U The menstrual cycle and its disturbances. Springer-Verlag, 1989: 110-118
        • Lewy AJ
        • Wehr TA
        • Goodwin FK
        • Newsome DA
        • Markey SP
        Light suppresses melatonin secretion in humans.
        Science. 1980; 210: 1267-1269
        • Carr DB
        • Reppert SM
        • Bullen B
        • Skrinar G
        • Beitins IZ
        • Arnold M
        • McArthur JW
        Plasma melatonin increases during exercise in women.
        J Clin Endocrinol Metab. 1981; 53: 224-226
        • Beitins IZ
        • Barkan A
        • Klibaski A
        • Kyung N
        • Reppert SM
        • Badger TM
        • McArthur JW
        Hormonal responses to short-term fasting in postmenopausal women.
        J Clin Endocrinol Metab. 1985; 60: 1120-1124
        • Brzezinski A
        • Lynch JY
        • Seibel MM
        • Deng MH
        • Wurtman RJ
        The circadian rhythm of plasma melatonin during the normal menstrual cycle and in amenorrheic women.
        J Clin Endocrinol Metab. 1988; 66: 891-895
        • Bittman EL
        • Karsch FJ
        Nightly duration of pineal melatonin secretion determines the response to day length in the ewe.
        Biol Reprod. 1984; 30: 585-590
        • Martin J
        • Sattler C
        Selectivity of melatonin pituitary inhibition for luteinizing-hormone releasing hormone.
        Neuroendocrinology. 1982; 34: 112
        • Bittman E
        • Kaynard A
        • Olster D
        • et al.
        Pineal melatonin mediates photoperiodic control of pulsatile luteinizing hormone secretion in the ewe.
        Neuroendocrinology. 1985; 40: 409
        • Brzezinski A
        • Seibel MM
        • Lynch HJ
        • Deng HM
        • Wurtman RJ
        Melatonin in human preovulatory follicular fluid.
        J Clin Endocrinol Metab. 1987; 64: 865-867
        • Burden HW
        The adrenergic innervation of mammalian ovaries.
        in: Ben-Jonathan N Bahr JM Weiner RI Catecholamines as hormone regulators. Academic Press, New York1985: 261-278
        • Coleman AJ
        • Paterson DA
        • Somerville AR
        The β-adrenergic receptor of rat corpus luteum membranes.
        Biochem Pharmacol. 1979; 28: 1003-1010
        • Jordan AW
        Changes in ovarian β-adrenergic receptors during the estrous cycle of the rat.
        Biol Reprod. 1981; 24: 245-248
        • Edwards R
        The female reproductive tract.
        in: Edwards R Conception in the Human Female. Academic Press, London1980
        • Berg BJ
        • Wilson JF
        Psychiatric morbidity in the infertile population: a reconceptualization.
        Fertil Sterol. 1990; 53: 654-661
        • Seibel MM
        • Taymor ML
        Emotional aspects of infertility.
        Fertil Steril. 1982; 37: 137
        • Rosenfeld D
        • Mitchell M
        Treating the emotional aspects of infertility: counselling services in the infertility clinic.
        Am J Obstet Gynecol. 1979; 135: 177-180
        • Menning ECK
        Effect of infertility on psychosexual function.
        Br Med J. 1975; 5: 295
        • Mahlstedt P
        The psychological component of infertility.
        Fertil Steril. 1985; 43: 335
        • Daniels K
        • Gunby J
        • Legge M
        • Williams T
        • Tynn-Williams D
        Issues and problems for the infertile couple.
        NZ Med J. 1984; 97: 185
        • Paulson JD
        • Haarmann BS
        • Salerno RL
        • Asmar P
        An investigation of the relationship between emotional maladjustment and infertility.
        Fertil Sterol. 1988; 49: 258-262
        • Keye W
        Psychosexual response to infertility.
        Clin Obstet Gynecol. 1984; 27: 760
        • Cook E
        Characteristics of the biopsychological crisis of infertility.
        J Counsel Dev. 1987; 65: 465
        • Birman Z
        • Lewin A
        • Soskolnie V
        • Greenspan D
        • Laufer N
        • Schenker JG
        Psycho-social profile of IVF patients.
        in: Mashiach S Ben-Rafael Z Laufer N Schenker JG Advances in Assisted Reproductive Technologies. Plenum Press, 1990: 985-990
        • Berger D
        The role of the psychiatrist in a reproductive biology clinic.
        Fertil Steril. 1977; 28: 41
        • Walker H
        Psychiatric aspects of infertility.
        Urol Clin North Am. 1978; 5: 481
        • Berger D
        Impotence following discovery of azoospermia.
        Fertil Steril. 1980; 34: 154
        • Harrison KL
        • Callan VJ
        • Hennessey JF
        Stress and semen quality in an in vitro fertilization program.
        Fertil Steril. 1987; 48: 633-636
        • Wright J
        • Allard M
        • Lecours A
        • Sabourin S
        Psychological distress and infertility: a review of controlled research.
        Fertil Steril. 1988; 34: 126-142
        • Glezerman M
        Two hundred and seventy cases of artificial donor insemination: Management and results.
        Fertil Steril. 1981; 35: 180-187
        • Mahlstedt PP
        • Macduff S
        • Bernstein J
        Emotional factors and in vitro fertilization and embryo transfer process.
        JIVF/ET. 1987; 4: 232-235
        • Newton CR
        • Hearn T
        • Yutzpe A
        Psychological assessment and follow-up after in vitro fertilization: assessing the impact of failure.
        Fertil Steril. 1990; 54: 879-885