Perceived stress and markers of ovarian reserve among subfertile women

Is there a link between perceived psychological stress and fertility? Increasing evidence suggests that psychological stress can have profound effects on our health. Fertility is no exception. Fertility problems can be associated with distress symptoms like anxiety and depression. Some evidence even suggests that reducing stress may even improve rates of conception. 

This study aimed to further examine this link. The authors enrolled 520 women seeking fertility care into their study. A validated questionnaire assessed perceived stress over the past 3 months. Following this, 3 clinical measurements were taken to determine fertility. These included:

• the AFC (the number of eggs visible on scan)
• day 3 FSH (a hormone that stimulates egg development)
• AMH (a hormone made by developing eggs in the ovaries)

The authors predicted that higher stress would be associated with lower fertility. Which means lower AFC and AMH levels as there are fewer maturing eggs. And higher FSH levels, indicating attempts to increase egg production. 

Results with AMH were as predicted. Higher stress scores were associated with lower AMH. But this link was only present in a subset of women. That is, those who were younger than 35, non-Caucasian, and had a higher education with an income of less than $100k. 

Why was this the case? The authors posited on reason may be because AMH declines with age. Younger women having more AMH to begin with would have made it easier to see the impact of any stress. In older women, lower levels may have made the effects of stress harder to see. 

The other factors - ethnicity, income and education level - could also have affected stress. This could then have made associations with AMH more obvious in this subset of women. 

Results were similar for AFC. As stress scores increased, AFC was lower. Indicating reduced fertility. Again, this link was only present in the same subset of women above. Except this time it was also found in Caucasian women too. 

As for FSH, results showed no associations with stress score for any group. 

Limitations with the study exist. For example, the study only included women seeking fertility treatment. So we cannot make conclusions about how stress affects people without fertility problems. Also most participants were Caucasian of high socioeconomic status. This limits how applicable the results are to the wider female population. Women were also only asked about their stress at once. This may have affected results with FSH. As FSH(unlike the other measurements) varies throughout the menstrual cycle. 

These results add more evidence of the possible health effects of psychological stress. More studies are needed to confirm these results. But what these results do is reinforce the importance of stress on our health. And they highlight the need to find a way to deal with stress effectively on a daily basis.