Stress & Fertility
East Meets West - Reproductive Health Conversations
with Drs. Tarita Pakrashi, MD & Jennifer Surjana, L.Ac.
Q: How is stress viewed and how does it impact fertility?
Tarita: Writing about stress during an eventful time in history gave me pause as I scoured for the definition of “stress”. A research article by a group out of Italy describes it as an “evolutionary pressure at which humans keep on being subjected through ages.” While there is no universally agreed upon method to quantify the body’s response to stressors, we recognize the potential effect of these stressors on the hypothalamic pituitary adrenal axis and furthermore on the hypothalamic pituitary reproductive axis that can affect male as well as female fertility. A biologically plausible theory outlining a “fight or flight” response has been postulated to direct blood away from the gonads to the essential functions of the heart, brain and muscle instead.
A study by authors affiliated to the Harvard medical school suggested that psychopathology in their cohort of IVF couples was associated with a lower clinical pregnancy rate and live birth rate. Recognizing the insidious nature of stress during this extraordinarily challenging time in a couple/individual’s life is one of the first steps towards combating the downstream effects of the stressor.
Jennifer: It’s a catch-22, isn’t it? Stress can be a causative factor in infertility, and infertility certainly causes stress. So how can it be managed?
In Chinese medicine, there is no separation of body and mind - it’s all interconnected. Stress in the mind leads to stress in the body, and vice versa. From a Chinese medical viewpoint, stress impacts two major meridian systems; the Liver and the Heart. Associations are listed below:
When Liver energy is impeded, we often see menstrual irregularities arise clinically. These irregularities may include:
pain during menstruation
PMS leading up to the period
and breast discomfort
In chronic or more extreme cases we may see endometriosis, blockage of the fallopian tubes, and amenorrhea (no menstrual period).
According to Chinese medicine, the Heart is the emotional center of the body. When Heart energy is affected, we commonly see:
irregular sleep patterns
issues with ovulation
and improper development of sperm or eggs
Similar to the Liver, when patterns become chronic, stagnation in the Heart may lead to anovulation and amenorrhea.
Chrysanthemum flowers, or Ju Hua, are used in Chinese medicine and can help relax and maintain a healthy liver. Make a tea by steeping the flowers - add a slice of fresh ginger to your cup.
Q: So how do we correct imbalances caused by stress, and how do we eliminate stress from our routines?
Jennifer: Most people are impacted by stress to some degree. For some, these are day-to-day frustrations that leave us feeling irritable. For others, stress causes anxiety and mental anguish. Weekly acupuncture works, in part, to lower cortisol levels, regulate sleep patterns, and smooth blood flow. Over time, we see menstruation regulate and symptoms decrease. When not in the clinic, it’s important to develop and maintain a daily mindfulness routine.
Tarita: Some of the therapies that have been studied to combat stress in the setting of infertility include Cognitive Behavioral Therapy which has been demonstrated to decrease anxiety with an end goal of improving pregnancy rates. In addition, there are Mind-Body wellness programs that show promise in improving outcomes. Two reproductive psychologists who have published extensively in this field have developed a free app called Ferticalm that can be downloaded on your device. The app suggests coping techniques for a variety of situations during this rollercoaster of a journey.
Finally, there is value in sessions led by support groups such as “Resolve: The National Infertility Association” and group psychological interventions. There is also some evidence that complementary therapies such as Hatha Yoga and acupuncture can reduce stress in patients grappling with infertility.
"Breath is the power behind all things... I breathe in and know that good things will happen"
~ Tao Porchon-Lynch
Q: What active steps can we all take to minimize the influence of stress?
1. Practice Mindfulness/Meditation
It’s not the amount of time spent in your mindfulness routine, but rather the consistency that really makes the difference. Even a few minutes of quiet breathing, if practiced daily, will make a positive difference in your overall stress level. Try closing your eyes and visualizing your favorite vacation spot, or focus your attention on slowly inhaling and exhaling. Practice this every evening before you go to bed and you’ll feel the difference in no time. If you need help maintaining this practice, you might try an app like Headspace.
Exercise can improve blood flow and disengage the mind. Consider yoga or daily walking as forms of low impact exercise that can get things moving and bring balance to the body. High impact exercise, such as running or cross training, can take blood away from the uterus/pelvis, which can negatively impact fertility, so choose your exercise routine wisely.
3. Surround yourself with nature
Studies have shown that being out in nature helps reduce stress hormones. Forest bathing (Shinrin-Yoku) is a traditional Japanese practice where one visits a forest and breathes its air. A 2019 review found that cortisol levels could be significantly reduced with forest bathing, thereby reducing stress levels. If you can’t make time to get out into nature regularly, bring nature indoors with houseplants. Here is a list of easy to grow houseplants from The Spruce.
4. Get on a sleep schedule
Believe it or not, regulating your sleep patterns makes a big difference in your waking life. Schedule a bed-time and wake-time, and stick to it. Also, bringing your devices into the bedroom with you can create poor sleep habits. Plug in devices somewhere else in the house before turning in for the night to create a more restful sleep environment.
5. Make time for things you love
This one is easy, just do the things you love to do. Spend less time on your device and invest more time on your hobbies. What makes you feel creative? What makes you happy? Do these things - set aside a little time each day to enjoy life.
Tarita Pakrashi MD, MPH is a board-certified reproductive endocrinologist and infertility specialist who has a lifelong interest in the mind-body aspect of women’s health. Dr. Pakrashi’s own experiences with the healthcare system, as well as the privilege of participating in her patient’s lives have led her to explore other practices that enhance an individual’s wellness.
After graduating medical school from in Mumbai, India, Tarita earned a Master’s in Public Health degree at the University of North Carolina at Chapel Hill with a focus on Maternal and Child Health. She subsequently trained as an obstetrician and gynecologist at the University of Cincinnati, where she was inducted into Gold Humanism Honor Society. She stayed on at the University of Cincinnati as faculty in the division of Community Women’s Health. She worked with the divisional leadership to provide OBGYN care in Hamilton County to improve maternal and infant health outcomes in vulnerable populations.
Upon the completion of her fellowship in Reproductive Endocrinology and Infertility, Dr. Pakrashi was recruited to stay on as faculty at the Jones Institute of Reproductive Medicine in Norfolk, VA. Working with patients in different settings over the years, she believes there is a pressing need to improve upon status-quo and nurture the individual as a whole, especially during an individual’s journey to parenthood. She practices passage meditation, and after several years of hot yoga has come to appreciate the therapeutic benefits of Yin Yoga in her life.
Jennifer Surjana, L.Ac., DACM is a nationally board certified Traditional Chinese Medicine (TCM) doctor specializing in Reproductive Health.
Jennifer received her Master of Science degree in TCM from the Colorado School of Traditional Chinese Medicine in Denver, and her Doctorate of Acupuncture and Chinese Medicine degree from the Pacific College of Health and Sciences in San Diego. Since 2003, Dr. Surjana has spent her career immersed in reproductive and global maternal health and has had the privilege of working with specialists around the world. She completed a post-graduate program in Obstetrics and Pediatrics in Indonesia, where she had the honor of working alongside and learning from Midwife Robin Lim at Yayasan Bumi Sehat to deliver reproductive and maternal health services to the community. Dr. Surjana continues to travel to Indonesia as often as possible to provide healthcare to women and children there.
Dr. Surjana uses her advanced training and experience to assist couples who are trying to conceive, and to support women throughout pregnancy. She is honored to offer her services to couples in Hampton Roads, and to continue to build relationships with reproductive and maternal health experts near and far. Dr. Surjana currently serves on the Board of Directors for the Acupuncture Society of Virginia.