When you’ve been trying to get pregnant for months or years, stress seems unavoidable.  The longer it has been, the more stressed out you might get because time is getting shorter.  However, understanding how stress can affect fertility allows you to proactively manage its effects.

Say you see a tiger crouching in the brush next to the trail — or nearly get sideswiped in rush hour traffic! Both situations cause your body to activate your two stress response systems by releasing adrenaline and cortisol from your adrenal glands.

You will immediately produce norepinephrine (adrenaline) and get a rush of energy that lets you run from that tiger. Your body also will produce more cortisol. Cortisol will help your body deal with the stressor by increasing blood glucose levels for quick energy, increasing blood pressure, and decreasing immune response.

This is exactly what you need when there is a tiger chasing you. The problems come with chronic stress…

Chronic stress comes from driving daily in rush hour traffic, trying to balance a marriage and home life with a career, and dealing with emotional turmoil.  Chronic stress can also come from a physical illness, lingering viruses, exposure to toxins, or eating foods you are slightly allergic to.

The problem with chronic stress is that it raises cortisol levels all the time.  Your body has a natural rhythm that controls cortisol production at different times of the day. Constantly elevated cortisol levels can cause depression, weight gain, and elevated blood pressure. It also can interfere with trying to conceive.

How your body makes cortisol

The stress response starts in the brain – in the hypothalamus.  This area of the brain starts the signaling process to create cortisol.

The hypothalamus produces a signaling molecule called corticotrophin-releasing hormone (CRH).  CRH then travels to the pituitary gland, located near the middle of your brain. This causes the pituitary to produce ACTH (adrenocorticotropic hormone).  From the pituitary, ACTH travels to the adrenal glands which sit on top of the kidneys, signaling for the production of cortisol. (study)

This whole process of producing cortisol is actually a feedback loop. High cortisol levels signal to the hypothalamus to stop the production of CRH.

When does your body make cortisol?

Normally, your body produces cortisol rhythmically throughout the day and night. This base level of cortisol helps to regulate:

• Body temperature
• Digestion
• Blood glucose levels
• Immune function
• Mood
• Energy

Cortisol helps to keep your body in homeostasis – everything in balance.  Without the right amount of cortisol, things can get out of balance.

Your body has two types of cortisol receptors:

• cortisol binds to mineralocorticoid receptors (MRs) when the levels are low and normal
• glucocorticoid receptors (GRs) are activated when there is high cortisol, in times of stress

When cortisol binds to the glucocorticoid receptors, it suppresses the inflammatory system, influences memory, changes blood glucose levels, and increases heart function. Again, this is what is supposed to happen when you have been chased by a lion. But you can see that long-term elevation of cortisol can cause problems!

HPA axis dysfunction

When the cortisol response is out of balance – either chronically high or chronically low – it can result in what is known as HPA (hypothalamus-pituitary-adrenal) axis dysfunction.

HPA axis dysfunction can cause:

• Tiredness along with difficulty sleeping
• Stress and feelings of being overwhelmed
• Difficulty concentrating
• Menstrual irregularities
• Weight changes
• Blood sugar regulation problems
• Depression

Your body needs cortisol in the right amount and at the right time.

HPA axis dysfunction can be due to the glucocorticoid receptors not functioning as they should. Altered cortisol rhythms also cause HPA axis dysfunction.

Studies show that depressed women have both reduced glucocorticoid receptor function and altered cortisol rhythms. (study)(study)

Women naturally have a higher cortisol response to stress than men do. This is due, in part, to men having higher androgen hormone levels. The androgens (such as testosterone) decrease ACTH levels, while estrogen increases ACTH. This may be why some of the chronic stress disorders, such as depression, anxiety, and PTSD, are more common in women than in men. (study)

Childhood trauma

Many studies have shown that trauma during childhood can alter your cortisol levels even as an adult.

Some people are resilient to childhood trauma (more on this in the genetics section below), but for others, the impacts can be life-long.

Childhood trauma can alter your stress response, which increases the risk of anxiety or depression in adulthood. For a lot of people, this results in higher overall cortisol levels, but a lower cortisol response to acute stress. (study) (study)(study)

Infertility and HPA axis dysfunction

It intuitively makes sense that a time of high stress would be the wrong time to reproduce.

Many studies have shown that chronic activation of the HPA axis inhibits fertility. ACTH, the hormone that tells the adrenals to produce cortisol, also causes the adrenals to produce some of the androgen hormones. This changes the balance of certain hormones that are important when trying to get pregnant. It causes a change in the ratio of FSH:LH (follicle stimulating hormone to luteinizing hormone), which impact egg quality. Chronic stress activation can eventually inhibit estrogen secretion. (study)(study)

Stress, whether physical or mental, can thus cause the perfect storm for fertility challenges. Not only does the initial stress cause physical changes in your body, but each month that you don’t get pregnant ramps up that mental and physical stress.

Genetics and HPA axis dysfunction

Some people simply seem to be more resilient to stress.  It turns out that genetics plays a role in how your body responds to chronic stress.

Several genes involved in cortisol production can impact your response to chronic stress including:

• the receptor for CRH, the hormone that starts the cortisol release process
• the receptor for ACTH, which takes the signal from the pituitary to the adrenal glands

The receptor for CRH is coded for by the CRHR1 (corticotropin-releasing hormone receptor 1) gene.

If you have genetic data from 23andMe or AncestryDNA, you can check to see if you carry variants of the CRHR1 gene.

Check your genetic data for rs242924:

• G/G: elevated cortisol in people exposed to childhood trauma (study)
• G/T: slightly increased risk of depression in childhood trauma
• T/T: normal

Check your genetic data for rs110402:

• G/G: elevated cortisol in people exposed to childhood trauma (study)
• A/G: slight increased risk of depression in childhood trauma
• A/A: normal

The glucocorticoid receptor (GR) that receives the signal from cortisol plays a big role in how the body responds to stress.  Some people carry genetic variants that make them more likely to be resistant to higher cortisol signal.

More severe GR mutations can cause resistance to that ACTH signal, thus causing higher circulating cortisol levels. Symptoms include high blood pressure and increased androgen hormones which can cause hair loss and menstrual irregularities (in women). (study)

More common genetic variants in the glucocorticoid receptors have been linked to an increased risk of depression and metabolic syndrome.

If you have genetic data from 23andMe or AncestryDNA, you can also check to see if you carry variants of the NR3C1 gene which codes for the glucocorticoid receptor.

Check your genetic data for rs6189:

• C/C: normal
• C/T: cortisol resistance
• T/T: cortisol resistance (study) (study)

Check your genetic data for rs6191:

• A/A: increased risk of depression, some resistance to cortisol (study)
• C/A: normal
• C/C: normal

Lowering your cortisol levels with lifestyle changes

The first place to start for lowering your cortisol levels is sleep.  Cortisol follows your body’s circadian rhythm so keeping that on track with a good sleep routine is important. Try to go to bed at a consistent time each night. (study)

In addition to consistent sleep timing, getting enough sleep each night is also important. A study showed that restricting sleep to 4 hours per night raised cortisol levels the next day by 21%. (study)

When trying to get pregnant, get at least 8-9 hours of sleep each night.  Your goal is to wake up refreshed and ready for the day.

Studies show that both yoga and meditation decrease cortisol levels. (study)(study)(study)

Chewing during stressful conditions decreases the cortisol stress reaction. So try some chewing gum sweetened with xylitol the next time you are going into a stressful confrontation. (study)

Get outside! Forest bathing, popular in Japan, reduces cortisol levels. Go for a hike in a nearby natural area. (study)

Lowering your cortisol with herbs or supplements

Studies show that certain herbs help with HPA axis dysfunction by moderating cortisol response levels. Some commonly used herbs include Ashwagandha and Rhodiola. (study)

Holy Basil, taken either as a supplement or as Tulsi tea, has been shown in studies to inhibit the release of cortisol. (study)