Kyle: Dr. Oreck, how does stress affect the body from a physiological level?
Dr. Oreck: Yeah, so when we’re stressed, especially that fight, fight, or freeze response…there’s some hormones and those are called stress hormones like cortisol, adrenaline that really pump through our body.
They make our blood pressure rise. So we’re ready to run from that tiger that might be coming to attack us, biologically, evolutionarily, but sometimes for some people that sort of stress reaction stays in their system and those stress hormones sort of act in a similar place where sex hormones do as well. So we can have a downstream reaction where those kind of get out of whack because there’s a relationship there.
Now, exactly how that happens and for who it happens, we don’t know the exact science behind it.
Kyle: There is a relationship between stress hormones and sex hormones?
Dr. Oreck: Yes.
Kyle: But what is that relationship?
Dr. Oreck: So our brain works in a way where some are released at some time and from a similar place. And so when some are high, it stops others from releasing.
For some women, high levels of stress can mean missed periods or they don’t ovulate during that time, which can of course affect conception. But for some women that’s not the case. So again, I do think that there’s variables for each person and it’s really an individual issue.
Because you see women having babies in famine, in times of war, of incredibly high stress. If not, like the human race wouldn’t have survived.
Kyle: True.
Dr. Oreck: I do think that there’s more nuance and a lot here that we don’t understand about the exact connection.
Kyle: Overall, would you say that a woman who is trying to get pregnant should be aware of her stress levels?
Dr. Oreck: Because everyone should, right? Who wants to live stressed out and anxious? I don’t necessarily think that we need to say, oh, if you have some stressor in your life, there’s not a chance you’re gonna get pregnant. That doesn’t make so much sense.
But another sort of downstream reaction, for example, that I was just thinking about is being obese, right? That might be due to an anxiety or depressive symptom. You might be eating more. Increasing your obesity does increase levels of estrogen in the body, which decreases ovulation. So there’s an indirect way.
Another thing is if you have an eating disorder, which a lot of eating disorders…also comorbid mood and depressive disorders, substance use…if you’re underweight, you’re probably not getting a period if you’re very underweight.
And so you’re not gonna conceive. But do you need to be worried if you’ve had some moments of stress? I don’t think so.
Kyle: Don’t stress out about being stressed.
Dr. Oreck: No. But let’s like work on your stress because who doesn’t want a better quality of life?
Kyle: Yes. I like looking at our health that way. Just because it’s the right thing to do. What other behaviors do stress and anxiety lead to that might further negatively impact the ability to conceive?
Dr. Oreck: So overeating or undereating…that definitely affects conception. Smoking is a big one that we know.
Drugs, especially like cocaine and stimulants…not all stimulants, but definitely cocaine can interfere with conception, but actually more so with increase in rates of miscarriage. So those are all things that we can try to figure out how to improve in order to really increase the chances of conception and to carry a pregnancy to term.
Kyle: Are there drugs or medications that people could be taking for depression or anxiety or bipolar disorder that would make a conception difficult or impossible?
Dr. Oreck: So none of the ones that I’m thinking about that I use on an everyday basis with patients. That’s what I mostly do.
Of course, every medication, whether psychiatric or not, has a risk attached and it’s so important that you have this risk-benefit analysis with your doctor to really discuss, does this make sense?
Kyle: Yeah.
Dr. Oreck: For me, I think part of the difficulty with this and why it’s become a field unto itself is that we don’t have so much research in pregnant women for a variety of ethical reasons.
And so we really have to put together a lot of different data and figure out what’s best. But having that conversation for a lot of women, is on the side of well, what does my mental health issue do to my life?
I’m not going to work. I’m staying in bed. I’m incredibly unhappy. I’m not going to my appointments. I’m not taking my fertility medications to help me conceive.
Where are you gonna get there? And so for a person like that, maybe therapy and medication is the right answer. And a lot of the ones that I work with most commonly do not interfere with conception.
Kyle: Do not.
It’s good to know, and I know a lot of women particularly are concerned about that. I sat down with Dr. Sarah Oreck to talk about perinatal anxiety. It’s a fantastic series. Here’s an inside look to that.
Dr. Oreck: We know generally, for most women, after giving birth, 80% have something called baby blues. Which means that in the second or third day after they deliver to about two weeks, there’s a lot of emotional sensitivity, irritability, or just a lot of sort of mood swings. People sometimes describe it as the worst PMS they’ve ever had, but it’s really important to note that this happens for a lot of women, and it doesn’t mean you’re mentally ill, but it’s great to know that this is something that goes away.
And if it persists, then it’s maybe something else that we have to look into. But that’s really important for families to know so they can know what to expect. In the same way that we know that when an adolescent is going through puberty, you’re gonna expect some mood swings.
Kyle: You can watch that entire series at medcircle.com. Dr. Oreck, other thoughts on medications?
Dr. Oreck: Yeah, so in terms of sort of quality of eggs or quality of sperm, in terms of conceiving, nothing directly that I can think of affects those, especially with the very common antidepressant and anti-anxiety medications.
My only thought there was, there are some medications that decrease your interest in sex.
Kyle: Kind of crucial if you wanna get pregnant.
Dr. Oreck: Kind of crucial. Yeah. So that might be an issue. Severe anxiety can also sort of drive people to avoid sex as well. So that’s one that needs to be discussed with your physician to figure that out.
There’s also some medications that aren’t safe in pregnancy or in the sort of short postpartum period. One is Depakote. And that’s a mood stabilizer that can be fantastic for bipolar disorder. Not really a medication I use for a lot of my reproductive-aged women. Just because of the high risks of neural tube defects during pregnancy, which can be catastrophic.
Kyle: And if you’re treating someone who has bipolar disorder and they have no plans of becoming pregnant, would that medication come into play or you just avoid it all together just in case?
Dr. Oreck: It would. So I like to avoid it all together and use some other medications that we have.
In Europe, for example, some places in Europe, it’s not allowed to be given to reproductive-aged women because it carries such a high risk, but here I see it done and if I’ve gone through a lot of mood stabilizers and that works, I’m gonna go for it.
But knowing and having a very clear conversation that this is a really big problem if they’re on it and they become pregnant.
Kyle: Really important to know.
We’re talking about stress and how that can affect infertility. You have a private practice, women are coming to you all the time. What are the stressors in their life that you hear about?
Dr. Oreck: Oh, so many.
So there’s that pressure, especially for women that are in professional careers that have really tried for so long to not get pregnant and then all of a sudden they’re ready and they wanna get pregnant that month. So it’s a little bit…this is a generalization alert…but millennials want their instant gratification.
Kyle: Me, I want it, I wanted it five minutes ago. Yeah.
Dr. Oreck: And pregnancy just isn’t as predictable sometimes.
And it’s not in our control. And so that can be really challenging for people who do have more sort of anxious personalities because that lack of control can be really challenging.
Kyle: If you’re on birth control or you have a ring or all of the different ways, and then you decide you want to get pregnant, does your body need a moment to reset? Because we’ve been telling it – don’t do this.
Dr. Oreck: So there’s really some inconsistent studies. I’ve seen some studies where there’s an increase in fertility in the three months after stopping birth control.
But for other women, they do have difficulty starting to get normal cycles and there’s a lot of irregularity for a couple of months.
Kyle: Got it.
Dr. Oreck: So it really depends on every body and every brain.
Kyle: Yes. Everybody and every body. Okay. Do you have final thoughts on stress and infertility?
Dr. Oreck: Sure. Just that…I think we need to work on stress generally for our quality of life.
We don’t know that connection. We don’t know that it’s direct yet. We know that there’s some indirect behaviors that we can engage in that do interfere with conception and carrying a pregnancy successfully. And so those are really the ones that I think are so important to tackle.
So if you are really anxious, stressed at work and you’re smoking a pack of cigarettes, I think the one to target is like, “Hey, what’s going on with those cigarettes? What’s happening before I smoke?” And that feels, I think, easier to tackle than I need to eliminate all stress from my life.
Kyle: And that’s impossible.Dr. Oreck: Yeah. Impossible.
