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What is the impact of stress on fertility?

There is growing evidence that lifestyle choices, including stress and quality of life, can impact female fertility.

The relationship between stress, quality of life, and reproductive function in women is more likely reported in infertile rather than fertile women, and a vicious circle makes them support each other.

However, a precise cause-effect relationship is still difficult to demonstrate due to conflicting results and the lack of objective measures/instruments of evaluation.

There is a biological explanation as to why emotional stress may lead to fertility issues. It all comes down to the hypothalamic-pituitary-adrenal axis (the HPA axis). Whenever your body perceives stress, the hypothalamus gland in your brain sends a signal to the pituitary gland—the signal indicates that you are under stress and need assistance.

The pituitary gland then releases adrenocorticotropic hormone (ACTH) into the bloodstream, which travels to the adrenal glands and stimulates them to release cortisol, the primary stress hormone.

Cortisol helps your body respond to stress by increasing blood sugar levels, suppressing the immune system, and altering metabolism. However, prolonged exposure to cortisol can have negative effects on the body, including decreased fertility.

Stress can also impact libido, ovulation function, and semen which can become compromised the longer the infertility endures and during IVF.

Neurobiology may provide a link. Ghrelin is a gut-derived hormone and a key regulator of the endocrine response to stress and of reproduction and is believed to play a substantial role linking stress and infertility.


  1. Palomba, S., Daolio, J., Romeo, S. et al. Lifestyle and fertility: the influence of stress and quality of life on female fertility. Reprod Biol Endocrinol 16, 113 (2018).

  2. Trolice, M.P. Linking stress and infertility-more than a chicken and egg conundrum. J Assist Reprod Genet 38, 873–875 (2021).

  3. Luba Sominsky and others, Linking Stress and Infertility: A Novel Role for Ghrelin, Endocrine Reviews, Volume 38, Issue 5, 1 October 2017, Pages 432–467,

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