Doctors offer insights on how daily stress can disrupt fertility -- and how relaxation can help.

"You're just trying too hard."

"You're too stressed. Just relax and it will happen."

"You've got to calm down and let nature take its course."

If you've been trying six months or more to get pregnant, you've probably lost count of the number of times well-meaning friends and family offered this or similar advice.

Though the idea that "trying too hard" was once a popular notion, dramatic advances in infertility treatments -- particularly in the past decade -- all but did away with that idea.

Now, however, the wheel has turned yet again, and doctors are once more looking to the idea that stress -- and sometimes "trying too hard" -- may actually play a role in up to 30% of all infertility problems.

"It's becoming more and more important, in terms of what studies we do, to focus our efforts on the physiological effects of stress and how they may play a role in conception," says Margareta D. Pisarska, MD, co-director of Center for Reproductive Medicine at Cedars Sinai Medical Center in Los Angeles and editor-in-chief of the American Society for Reproductive Medicine News.

While doctors say that right now there aren't enough data to draw a clear and obvious link, many believe it's only a matter of time before we connect all the dots and see the bigger picture.

"What we do know now is that when stress-reduction techniques are employed, something happens in some women that allows them to get pregnant when they couldn't get pregnant before," says Allen Morgan, MD, director of Shore Institute for Reproductive Medicine in Lakewood, N.J.

While the exact pathways between fertility and stress remain a mystery, Morgan believes hormones like cortisol or epinephrine -- which rise and often remain high during times of chronic stress -- play a key role.

Morgan says that it's also possible that reducing stress may help enhance proteins within the uterine lining that are involved in implantation. She says that stress reduction may increase blood flow to the uterus, which also affects conception.

Pisarska tells WebMD that the effects of stress may be different for each woman.

"Stress may cause one set of reactions in one woman, and something else in another, so ultimately the reasons behind how or why stress impacts fertility may also be very individual," says Pisarska.

While doctors may not know the exact links between stress and fertility, a series of studies shows the impact is hard to ignore.

In research published in the journal Human Reproduction, doctors compared pregnancy rates in couples that reported being stressed and those who were not.

What they found: Pregnancy was much more likely to occur during months when couples reported feeling "good" -- happy and relaxed. It was less likely to occur during the months they reported feeling tense or anxious.

But it's not just natural (unassisted) pregnancies that are affected. In research published in Fertility and Sterility in 2005, experts at the University of California at San Diego reported that stress may play a role in the success of infertility treatments, including in vitro fertilization (IVF).

After administering a series of questionnaires designed to measure patients' stress levels, the researchers found that women who scored highest -- indicating the highest levels of stress -- had ovulated 20% fewer eggs compared with women who were less stressed.

Moreover, of those who were able to produce eggs, those who were most stressed were 20% less likely to achieve fertilization success.

Advances in infertility treatments are such that for nearly every block causing infertility, there is a 60% to 70% chance that a medical fix can turn those baby-making odds around, says Jamie A. Grifo, MD, PhD, director of the division of reproductive endocrinology at the NYU Medical Center in New York City. He says "even if stress is causing a problem -- such as poor-quality eggs -- there are medications and procedures that can help."

However, for up to 40% of couples, no discernable reason for infertility can be found. And it is in this group that Morgan believes the effects of stress are most profound.

"Twenty years ago the rate of unexplained infertility was between 10% and 20%. Today I see up to 40%. Women's bodies aren't different, but their stress levels are, and combined with the ticking of the biological clock, I believe it sets the stage for infertility," says Morgan.

Moreover, doctors say often the stress of actually undergoing infertility treatments can be so great it can stop even the most successful procedures from working.

"The whole process of undergoing fertility treatment is pretty nerve racking, partly because it's a series of hurdles that must be jumped at each step of the way. It's a period of time that in and of itself is very stressful," says Dorothy Greenfeld, MSW, director of behavioral services at the Yale Fertility Center of Yale University.

If you already have problems with stress, she says, the treatments themselves can definitely turn your tension up a notch or two.

While it may be a while before the pathway between stress and infertility is clear, what is known right now is that reducing stress levels seems to help.

Some research in this area shows that, for many women, acupuncture could hold the key.

In studies conducted in Germany and published in the journal Fertility and Sterility, women enrolled in an infertility program underwent acupuncture treatments just prior to and just after an embryo transfer into the uterus -- the final step in an in vitro fertilization procedure.

The result: Compared to women who did not have the acupuncture treatment, those who did had a significantly higher rate of pregnancy -- 42.5% compared with 26.3% in the group not having acupuncture.

"I don't think we know if acupuncture actually reduces stress but it may help counterbalance some of the effects of stress on the reproductive system," says Grifo, who indicates that at least three studies thus far have proven its benefits on fertility.

Other studies have found that for some women, massage may hold another key to reducing infertility stress. In research published in the International Journal of Neuroscience in 2004, doctors found that massage therapy worked to decrease the body's physical signals of stress, including heart rate and brain waves.

And while it wasn't tested on infertility patients, Morgan feels so strongly that it will make a difference, he recently launched his own study to test the impact of lower body massage therapy on women undergoing infertility treatments,

"The first group is receiving a gentle form of massage therapy on their feet and legs just prior to either an insemination or an embryo transfer; the matched group is going straight into treatment without any stress-reducing therapy," says Morgan.

While he says it's still too early to predict results, he suspects the outcome may definitely favor massage therapy.

At Grifo's center at New York University, infertility patients are routinely referred to in-house programs that offer both guided imagery and foot reflexology, all in an effort to reduce stress.

"We're not studying it in a scientific way, but we offer it and we recommend it, and the women who become involved seem to feel better, and that's what matters most to us. If it helps the quality of life for patients seeking fertility treatments, that's a very big thing," says Grifo.

Of course the one thing experts say probably won't help reduce stress in your life is hearing people tell you to relax. In fact, experts say it could even generate more stress.

"I never want to tell patients to just 'relax' because you can't tell a person who's already nervous to stop being nervous. That just isn't helpful," says Greenfeld.

What she does recommend, however, is for each woman to look into her own life and try to find tiny spaces where she can give her body and her mind a respite from the stresses of every day living.

Says Greenfeld: "Don't just try to relax because you think that it's going to help you get pregnant. But do relax just because it feels good, because it's comfortable, and because when you do feel good, you're healthier overall, and that can never be a bad thing for conception."

SOURCES: Margareta Pisarska, MD, co-director, Center for ReproductiveMedicine, Cedars Sinai Medical Center, Los Angeles; editor-in-chief,American Society for Reproductive Medicine News. Allen Morgan, MD,director, Shore Institute for Reproductive Medicine, Lakewood, N.J. Jamie A.Grifo, MD, PhD, director, division of reproductive endocrinology, NYU MedicalCenter, New York. Dorothy Greenfeld, MSW, director of behavioral services, YaleFertility Center of Yale University, New Haven, Conn. Sanders, K.A. HumanReproduction, Oct 1997; vol 12: pp 2324-2329. Klonoff-Cohen, H.Fertility and Sterility, April 2004; vol 8. Paulus, W. Fertilityand Sterility, April 2002; vol 77. Diego, M, Journal ofNeuroscience, 2004; vol 114: pp. 31-45.

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