The stress that comes with infertility and undergoing assisted reproductive treatment can be equivalent to that of someone dealing with cancer or heart disease. Depression, anxiety and stress are very common in those undergoing treatment (1). There are many reasons for this stress and these can relate to a sense of a loss of hope, the stress of constant appointments and invasive procedures such as the injections required and egg retrieval surgery, and the stress that follows an embryo transfer and waiting for a pregnancy test. Oh, and the financial stress, relationship stress, the side effects from all the drugs, the stress of treatment outcome….. you get the picture. It’s amazing that any of us come out the other end remotely normal!
Ironically, while the fertility treatment you are undergoing to get pregnant increases stress, stress is not conducive to a positive outcome for assisted reproductive treatment (2). Women with prolonged elevated levels of the stress hormone cortisol (measured from hair samples which provide a picture of exposure to stress over time) prior to treatment were 27% less likely to get pregnant (3).
How can you manage or even reduce this stress during your treatment? Exercise!
Move for your Mood
The right exercise prescription can increase your resilience, reduce depression and anxiety, help manage your mood and help you sleep instead of worrying about all the things that could keep you up at night. All of these benefits are great for you – but also for your assisted reproductive treatment. Bonus!
Exercise has been shown to increase your ability to bounce back from a stressful situation and to limit how much stress you experience. This is ESSENTIAL for riding the roller coaster of fertility treatments. If I did not have the opportunity to exercise during my treatment there is no way I would have been able to handle multiple cycles and pick myself up after a negative pregnancy test. Exercise was such an important tool to manage the stresses of all the poking and prodding and waiting.
Exercise is also a powerful antidepressant, thanks in part to increases in brain derived neurotrophic factor (BDNF) that come with exercise (4). Low levels of BDNF can be problematic and are seen in Alzheimer’s disease and obesity (5). With the right exercise, you can increase levels of this brain fertilizer which will protect your brain cells and even help makes new ones.
Want to improve your memory and learning so you can remember all those new drug names and doses and dates? Exercise can increase the size of your hippocampus, counteracting the negative effects of obesity and stress that have been shown to shrink the hippocampus (6, 7).
While you are looking after your physical health with your exercise program, you will also be looking after your mental health and wellbeing!
Are You at Risk?
With the stress that comes with fertility treatment it pays to increase your self-awareness of your mental well being and your ability to 'bounce back'. Knowing how you cope with stressful situations can help you recognise that you may need to develop strategies to keep you on track when faced with the challenges of fertility treatment. Take the brief resilience coping scale (8) quiz to find your resilience score:
Add up each score for each of the four questions. Your total score could range from 4 to 20. Higher scores indicate greater resilience in coping with adverse situations. As a general guide 'low' resilient copers would have a score 4-13, medium resilient copers 14-16 and high resilient copers would have a score of 17-20.
Exercise is one 'tool' in your resilience coping tool box and a morning walk on test day was my saving grace! Other coping strategies may involve:
1.Yusuf L. Depression, anxiety and stress among female patients of infertility; A case control study. Pak J Med Sci. 2016; 32: 1340-3.
2.An Y, Sun Z, Li L, Zhang Y, Ji H. Relationship between psychological stress and reproductive outcome in women undergoing in vitro fertilization treatment: psychological and neurohormonal assessment. Journal of assisted reproduction and genetics. 2013; 30: 35-41.
3.AJ M, BK C, N R-F, C P-A, J P, K V. Relationship between hair and salivary cortisol and pregnancy in women undergoing IVF. Psychoneuroendocrinology 2016; 74: 397-405.
4.Szuhany KL, Bugatti M, Otto MW. A meta-analytic review of the effects of exercise on brain-derived neurotrophic factor. J Psychiatr Res. 2015; 60: 56-64.
5.Levada OA, Cherednichenko NV, Trailin AV, Troyan AS. Plasma Brain-Derived Neurotrophic Factor as a Biomarker for the Main Types of Mild Neurocognitive Disorders and Treatment Efficacy: A Preliminary Study. Dis Markers. 2016; 2016: 4095723.
6.ten Brinke LF, Bolandzadeh N, Nagamatsu LS, Hsu CL, Davis JC, Miran-Khan K, et al. Aerobic exercise increases hippocampal volume in older women with probable mild cognitive impairment: a 6-month randomised controlled trial. Br J Sports Med. 2015; 49: 248-54.
7.Climie RE, Moran C, Callisaya M, Blizzard L, Sharman JE, Venn A, et al. Abdominal Obesity and Brain Atrophy in Type 2 Diabetes Mellitus. PLoS One. 2015; 10: e0142589.
8.Sinclair VG, Wallston KA. The development and psychometric evaluation of the Brief Resilient Coping Scale. Assessment. 2004; 11: 94-101.
9.Bleil ME, Pasch LA, Gregorich SE, Millstein SG, Katz PP, Adler NE, et al. Fertility treatment response: is it better to be more optimistic or less pessimistic? Psychosom Med. 2012; 74: 193-9.