Does stress cause infertility? A look at a painful subject

‘Having a fertility problem can be a really lonely and miserable place to be. Fertility treatment and the fertility journey are, without doubt, some of the most stressful experiences that any of us can go through.”

So says Dr Mary Wingfield in her new book, The Fertility Handbook, which is primarily written for the one-in-six couples who are unlucky enough to experience difficulty conceiving.

A fertility expert and consultant obstetrician and gynaecologist at the National Maternity Hospital, Mary and I were in medical school together. What struck me just a few pages into the book is how I could hear her voice clearly in the prose and was reminded of her gentle but determined disposition.

In a familiar voice, reflecting on the couples she has met over the years, she says: “As I am sharing information, I often think – wouldn’t it be wonderful to be able to capture this in writing so that people could take it home, study it and truly empower themselves?”

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One of the strengths of the book is the number of actual patient stories that are liberally peppered throughout. These are the voices of real people who Wingfield has treated and who have  consented to have their stories retold.

Recent evidence seems to indicate that stress can reduce fertility but only if it interferes with the frequency of sex or if it's stops people going for treatment when they need it

As you would expect, the book covers fertility problems and fertility treatments in detail. Interestingly, she devotes an entire chapter to lifestyle and tackles the old chestnut of “does stress cause infertility?” Being told to just relax or think positively is well-meaning but unhelpful.

While the relationship between psychological stress and fertility problems is complex, Wingfield concludes that “recent evidence seems to indicate that stress can reduce fertility but only if it interferes with the frequency of sex or if it’s stops people going for treatment when they need it”.

And, reassuringly, she says there is no correlation between pre-treatment emotional distress and the likely success of infertility treatment.

There are a number of vignettes describing how challenging the infertility journey can be.

Some of the men’s reflections are especially interesting, mirroring research that shows men experience greater social isolation than women during an in vitro fertilisation (IVF) treatment cycle.

A thoughtful chapter considers what happens to the minority of couples who are ultimately unsuccessful in having a family despite their best efforts and those of the treating professionals. Closure is important in order to move on, as this quote from a patient suggests:

“Your journey may be successful. That success may be a family. Or that success may be accepting that you have tried your best to get what you both wanted and life has decided that you are going to follow another path.”

Ireland has the dubious distinction of being just one of three EU countries (along with Romania and Lithuania) that does not fund fertility treatments in their public health systems

Fertility treatment is an area replete with legal and ethical challenges which are dealt with comprehensively in the book.

Ireland has the dubious distinction of being just one of three EU countries (along with Romania and Lithuania) that does not fund fertility treatments in their public health systems.

Yes you can have surgical treatment to unblock your Fallopian tubes, but when it comes to the cost of drugs and procedures central to IVF, Irish couples are on their own.

And at sums in excess of € 20,000, it means some couples are denied the chance to have a family.

Wingfield says it is unacceptable that health care should be preferentially available to any group in society.

“I am not aware of any other valid medical treatment that is not provided in our public health system. Certainly, as a gynaecologist and doctor, I can provide free care for public patients for any gynaecological complaint, but I cannot provide fertility treatments.”

This book is an essential read for couples facing infertility. Ideally, it would also land on the desk of our new Taoiseach to help him put flesh on his stated vision for a health service that has better access and outcomes for patients.

"The Fertility Handbook," by Prof Mary Wingfield, Gill Books €16.99

mhouston@irishtimes.com      @muirishouston