Chelsea Brimble felt like she'd put her whole life on hold while trying to get pregnant.
"Infertility really became a dark cloud over so many areas of our lives," the 34-year-old from Melbourne says.
Well-meaning but unhelpful comments about needing to relax didn't help.
"I had a few people imply that surely the stress of trying to conceive is only making it harder."
It's not uncommon for couples, women especially, to be told by loved ones and near strangers that if they could "just relax", they'll get pregnant.
But is there any truth to it?
Why we are telling women to 'just relax'
Women being "hysterical" and "emotional" has been blamed for many things throughout the centuries, including not being able to have a baby.
In the 1940s, for example, doctors attributed women's unexplained infertility on psychological problems.
Studies and advertising during that time suggested women quit work and "focus on home making" so they could be "less masculine", less stressed, and therefore become pregnant.
Claire Byrne is a psychologist and counsellor at Monash IVF and says "humans like to have control" and like to believe "there is a reason for everything", which could play into the focus on stress during infertility.
"When it comes to infertility, a reason can't be found sometimes — and sometimes it feels better to blame ourselves.
"This idea of elusive stress that we can't really pin down, being the factor, is part of looking for an explanation for the unexplainable."
What the research says
There have been many studies over the years looking at whether stress can cause infertility, with mixed findings.
They often rely on self-reported data which can be unreliable.
A 2018 meta-analysis of 20 studies involving 4,308 women, however, found "anxiety, depressive symptoms, or perceived stress pre-treatment, and anxiety or depressive symptoms during treatment, were not associated with less favourable assisted reproductive technology outcomes".
The authors wrote that the results cast doubt on the belief that stress impedes the success of infertility treatment, "offering hope and optimism to the many women who feel emotionally responsible for the outcome".
A 2017 review of research that looked at about 75 studies concluded the relation between stress and infertility "remains elusive".
Author Joann Paley Galst says the most "prudent conclusion" would seem that stress can disrupt fertility, but rarely to permanently prevent conception in humans.
"Indeed, women have conceived during wars and famine," she writes.
Regarding stress and its association with negative IVF outcomes, she writes there is "insufficient causal proof".
Dr Manuela Toledo, the medical director of TasIVF and board member of the Fertility Society of Australia and New Zealand, says stress is difficult to study.
"What I find stressful, you might not, and vice versa," she says.
While the link between stress and infertility may remain unclear, Dr Toledo says she does talk her clients about managing it.
She suggests that intense stress can disrupt a woman's menstruation cycle, and therefore impact ovulation.
"If you're not [releasing] an egg, then it's unlikely you will fall pregnant."
Anecdotally, Dr Toledo says she sees an increase in patients becoming pregnant over the holiday break, but adds that could also be because they are having more sex.
Infertility and IVF is stressful
Another reason the connection between infertility and stress is difficult to measure is because the experience of infertility is taxing in and of itself, as are treatments such as IVF, explains Ms Byrne.
"There are financial costs, emotional costs, physical costs — that's stressful.
"The whole world doesn't stop because [someone is] doing IVF; they still have to work and take care of family [for example]."
Dr Toledo says the longer you are trying to conceive, the more stressed you may become.
She says managing that is important, regardless of its potential impact on fertility.
"I talk to my patients about carving out stress-free bubbles in their days, weeks, and months.
"All of us have a go-to that helps us de-stress, like massages or turning off social media, and if you don't, then you might need to sit down with a psychologist or interested GP to talk about what works for you."
A 2021 Australian study found alternative therapies such an acupuncture did help women manage the IVF process better.
Why 'just relax' comments can be harmful
Dr Toledo says comments around stress from loved ones, even when well-meaning, can trivialise the situation and place unnecessary blame.
Medical investigations revealed no reason why Chelsea and her husband weren't conceiving naturally. They eventually became pregnant through IVF, and have two children.
She says comments about needing to stress less were "really insulting" when she was "spending thousands of dollars" and putting her body and mental health "through terrible things".
"It places the blame on the person who is struggling to conceive.
"I can appreciate that people felt like they were saying the right thing [but] nothing says 'I have no experience or empathy with what you're going through' like telling someone to just relax and they'll get pregnant."
This is general information only. For detailed personal advice, you should see a qualified medical practitioner who knows your medical history.
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