Stress and fertility

How stress affects the inherently narrow fertile window

Stress can do unwanted things to a woman and her menstrual cycle. In a nutshell, stress can make a woman completely infertile in this menstrual cycle (e.g., LPD, see below), or it can change the position of her fertile window (the time of ovulation included) within the menstrual cycle. Any of this can cause problems and lead to more stress…

The medical term is stress response, and it refers to the overall reaction of the organism to any adverse stimulus, whether it be of physical, mental or emotional kind, internal or external. The purpose is to adapt to challenge, and this goes on all the time. (C’est la vie! Real life is a never-ending series of stress responses.) Should the compensating reaction of the organism be inadequate or inappropriate, a pathological disorder may result.

The HPA axis, the immune system and the sympathetic nervous system are involved in the stress response. Don’t get stressed by some undecipherable abbreviations or unknown words — look up The Alphabet of bioZhena, you may find it or them there!

Just remember, this is no Alphabet of Ben Sira!

( /2007/11/28/the-alphabet-of-biozhena/)

021r from The Book of Urizen

It is a matter of conventional wisdom that perturbations in the external or internal environments – that is stress – can interfere with the normal course of the menstrual cycle. To further quote the expert, disturbances in the menstrual cycle occur in response to exercise and physical demands, stress and emotional demands, and diet and nutritional demands [citation below, as ref. 17].

As Michel J. Ferin writes, with reference to the brain component of the female reproductive control system, “with minimal reduction in (GnRH) pulse frequency, small undetected defects in the follicular maturation process may occur, whereas with a higher degree of pulse inhibition the follicular phase may be prolonged, and luteal phase deficiency, anovulation, and amenorrhea may develop.”

A micro-glossary: The follicular maturation process is also called folliculogenesis. GnRH is a brain-produced hormone involved in folliculogenesis. A maturing follicle is a small, protective sac, gland, or cluster of cells in the ovary, in which an egg (ovum) develops towards ovulation, in order to have a chance to be fertilized. For visualization see http://images.google.com/images?hl=en&q=ovarian+follicles&btnG=Search+Images&gbv=2

Results obtained with our Ovulona prototypes to date lead to the conclusion that the technique appears to detect such phenomena as referred to by Dr. Ferin. This is not so much or merely the different rates of follicular maturation in different menstrual cycles, but more seriously the delayed ovulations in those cycles where it takes longer than 1 day to reach the ovulation marker trough (minimum), as observed in some non-baseline subjects’ cyclic profiles.

This is the detection of Ferin’s “minimal reduction in (GnRH) pulse frequency, small undetected defects in the follicular maturation process may occur”. Whereas, “with a higher degree of pulse inhibition the follicular phase may be prolonged, and luteal phase deficiency [LPD], anovulation, and amenorrhea may develop” – and, indeed, we have seen the LPD, the extended follicular phase and short luteal phase, and various other aberrations in the cyclic profiles of different women over the years.

bioZhena is basically involved with non-pathological stress responses through monitoring certain end-organ effects. Abnormal cyclic patterns of the end-organ effects may serve as an early warning of pathological disorders. This remains to be systematically investigated. Anecdotal evidence in non-baseline cyclic profiles to date is compelling.

For a hint of this, refer to these 5 slides: Five slides selected for bioZhena weblog

The non-baseline cyclic profiles present certain quantitative deviations from baseline: e.g., their post-ovulation (luteal) phase can be not of the normal length of about 14 days (12 to 16). In such abnormal cycles with short luteal phases (<11 days), observed more often in older women, there is a lack of synchrony due to a luteal-phase mismatch between the ovarian steroids and the pituitary peptides [S.K. Smith et al., J. Reprod. Fert. 75:363, 1985].

Here is an example of a non-baseline cyclic profile of a woman with a short luteal phase (8 days):

Short luteal phase cyclic profile

A woman’s history of amenorrhea and/or of ovarian cysts is pertinent to the case of short luteal phase, but so is stress and its effect on the GnRH hormone generator in the hypothalamus of the brain, which affects the output of the pituitary peptides.

For example, it is known in a general way that norepinephrine and possibly epinephrine in the hypothalamus increase the GnRH pulse frequency. Conversely, the endogeneous opioid peptides, the enkephalins and beta-endorphin, reduce the frequency of the GnRH pulses. These interactions are particularly important at the time of the “mid-cycle” LH surge, affecting its timing and intensity [W.F. Ganong, Review of Medical Physiology, 17th edition, Appleton & Lange, 1995, Chapter 23].

The slow rate of descent of the Ovulona signal – in slides 1 and 2 – from the short-term predictive peak to the ovulation marker trough (minimum) is a useful diagnostic feature that is indicative of an extended period of time required for the two “clocks” (the circhoral and the circamensual) to become synchronized as a precondition of ovulation.

Activation of the hypothalamus-pituitary-adrenal (HPA)-axis by physical, chemical, and psychological perturbations is known to result in elevated levels of serum corticosteroid hormones. Corticosteroids are the principal effectors in the stress response and are thought to be responsible for both adaptational and maladaptational response to perturbing situations. They have profound effects on mood and behavior, and affect neurochemical transmission and neuroendocrine control.

Cortisol, the predominant corticosteroid in primates, is often regarded as the “stress hormone” and consequently serves as a marker of stress. Cortisol can be measured in blood, urine, and saliva. For information about the adrenal gland and stress, go to http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/adrenal/index.html .

We logically mentioned stress in the post on Sub-fertility (or Reduced Fertility), in the following reminder. The endocrinologist professor Brown may be quoted: “Failing to conceive when wanted is stressful and therefore favours infertility. It should be remembered that, apart from a few conditions such as blocked fallopian tubes, absent sperm and continued anovulation, most couples will conceive eventually without help. However, the modern expectation is one of immediate results, and the main function of assisted reproduction techniques is therefore to shorten the waiting time for conception.” To which we would add that bioZhena aims to offer a more affordable and safer alternative to the A.R.T. approach.

References as excerpted from our White Paper:

[17] Michel J. Ferin, “The menstrual cycle: An integrative view”, Chapter 6 in [2], pages 103 – 121.

[2] Eli Y. Adashi, John A. Rock, and Zev Rosenwaks, editors, “Reproductive Endocrinology, Surgery, and Technology”, Lippincott – Raven, 1996.

Terminology reminder:

Luteal phase is the phase after ovulation. Follicular phase is the phase before ovulation. Referencing the phases of the menstrual cycle. Amenorrhea = abnormal absence of menstrual bleeding. GnRH = gonadotropin releasing hormone. See The Alphabet of bioZhena at /2007/11/28/the-alphabet-of-biozhena/

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6 Responses to “Stress and fertility”

  1. Jeremy Says:

    Wow. Thanks so much for the comment and link to your blog. I always appreciate when I can start or join in on a discussion. Can a person learn to take adverse stimulus in stride? Some and not others?

  2. biozhena Says:

    Jeremy, I am not the right person to answer that question/those questions you pose. I only respectfully suggest that they are possibly not quite right (questions).

    If you re-read the original language… “stress response … refers to the overall reaction of the organism to any adverse stimulus … The purpose is to adapt to challenge, and this goes on all the time…”

    The best expert to answer and explain would be a psychoneuroimmunoendocrinologist (such as I would dearly like to involve with us).

    Now. Since we are in the middle of a presumed merry and happy season, let me merely paste here for you a citation from http://cogweb.ucla.edu/Abstracts/NeuroLove_98.html

    Introduction to psychoneuroendocrinology volume: is there a neurobiology of love? [- of course there is!]

    Psychoneuroendocrinology 1998 Nov;23(8):863-75
    Effects of early stress on adult affiliative behavior.
    Henry JP, Wang S Department of Nephrology/Hypertension, Charles Drew
    University, Los Angeles, CA 90059, USA.

    The recently evolved mammalian species preservative behavior as opposed to the ancient self preservative behavior involves parental care, nursing, social interaction, pair bonding and mutual defense. Gonadal steroids together with oxytocin are critical for this affiliative, attachment behavior.
    When there is stressful loss of control, gonadotrophins are diminished, and the self preservative, fight-flight catecholamine coping response takes priority.
    It is suggested that self preservation is associated with left hemispheric brain function and that species preservation is associated with right hemispheric function.
    Stress during infancy that is severe enough to create insecure attachment has a dissociative effect, disrupting right hemispheric emotional functioning and species preservative behavior, and a permanent bias towards self preservation can become an adult trait. In such a person with impaired affiliation, corticoid responses may be deficient. The coronary type A behavior pattern common in our society exhibits some of this deficiency in species preservative activity.

    If I try to recall the thrust of your post that started this, we are probably beginning to suspect what the circumstance may be with that over-stressed entrepreneur? Or, should I say, maybe, a would-be entrepreneur?

  3. Variability of menstrual cycles and of ovulation timing « bioZhena’s Weblog Says:

    […] of a problem that our modern lifestyle presents to the biology of our women. More often than not, the challenge is stress, which I discussed in this blog earlier in at least two posts. Our FIV technology (aka the Ovulona personal monitor) […]

  4. biozhena Says:

    Reblogged this on bioZhena’s Weblog and commented:

    This blog post appears as the third result in Google search on “bioZhena” (without the quote marks).

  5. What is the mechanism of stress and how does it affect reproduction. An update. « bioZhena's Weblog Says:

    […] This paper is related to our finding of delayed ovulation in some of the experimental subjects of two pilot studies of Ovulona™ prototypes – an important monitor feature, considering our way of life, full of stress – and not only the psychological kind. […]

  6. The Ovulona is not another ovulation kit, my dear | bioZhena's Weblog Says:

    […] other fertility monitors cannot detect either delayed ovulation (which happens due to stress) or when ovulation does not occur at all despite the LH hormone signaling that ovulation should go […]

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