Stress and Fertility - 2015.pptx

Stress & Fertility Dr. Syd Miller Stephane Jette, Cindy Lucio, Andrea Tkalec 1 S Outline  What is fertility & infertility for male and females?   Gonads Biology HPA & HPG  Animal studies   Environmental (psychosocial)  Infertility causes stress leading to more infertility  Mis...

Stress & Fertility Dr. Syd Miller Stephane Jette, Cindy Lucio, Andrea Tkalec 1 S Outline  What is fertility & infertility for male and females?   Gonads Biology HPA & HPG  Animal studies   Environmental (psychosocial)  Infertility causes stress leading to more infertility  Miscarriage/spontaneous abortion 2  https://www.youtube.com/watch?v =_5OvgQW6FG4 3 Fertility  What is Fertility:  Capacity to reproduce (entails both getting pregnant and carrying to term)  What is Infertility: 12 months trying with no pregnancy  Inability to carry to term  4 Gonads  A sex gland in which gametes are produced; gonad: ovary / testis produce egg/sperm  Production is regulated by various hormones.  The hypothalamus releases a releasing hormone which travels to the anterior pituitary  In the anterior pituitary, LH and FSH are released  Gonads are released 5 HPG Axis Hypothalamus Gonadotropin-releasing hormone (GRH) Anterior Pituitary Luteinizing hormone (LH) Follicle-stimulating hormone (FSH) Gonads 6 Gonads cont’d Luteinizing hormone (LH) Too high: premature menopause/ testicular failure  Too low: failure of gonadal function  Females:  LH surge: acute rise of LH which triggers ovulation Males:  Production of testosterone and affects spermatogenesis 7 Gonads cont’d Follicle-stimulating hormone (FSH)  Stimulates production of germ cells  Too high: premature menopause/ testicular failure  Too low: failure of gonadal function Females  Growth and recruitment of ovum  Promotes pregnancy continuation Males  Stimulates maturation of seminiferous tubules and spermatogenesis. 8 9 Stress suppresses reproduction function in male rats  Acute and Chronic immobilization stress   Glucocorticoids =  RFRP expression in the dorsomedial hypothalamus (DMH)  Increase in RFRP is associated with inhibition of downstream HPG activity   Reproductive function (Kirby, Geraghty, Ubuka, Kaufer, 2009) 10 Chronic stress condition  Immobilized for 3 hrs / day for 14 days  Led to up- regulation of RFRP (Kirby, Geraghty, Ubuka, Kaufer, 2009) 11 Stress suppresses reproduction function in male rats Stress  HPA axis  release of gonadotro pinreleasing hormone (GnRH)  LH  HPG axis  implantati on sites and viable fetuses in female mates (Kirby, Geraghty, Ubuka, Kaufer, 2009) 12 Fertility of male adult rats subjected to stress  Procedure: Wistar rats forced to swim for 3 mins in water at 32°C daily for 15 days  Tested for: testicular weight, seminal vesicle weight, ventral prostate weight  Fertility assessment: control and stressed males were mated with sexually mature normal females  Stress caused by forced swimming did not affect fertility 13 (Mingoti, Pereira, Monteiro, 2003). Fertility of male adult rats subjected to stress  Stress caused by forced swimming did not impair fertility  Significantly  spermatid production  Prolonged stress effects spermatogenesis, (seen after a cycle of sperm production) 14 (Mingoti, Pereira, Monteiro, 2003). Fertility of male adult rats subjected to stress  Stress (immobilization) during pre-puberty  Procedure: rats were 40 days old rats  Immobilized for 6 hrs/day for either 15 or 60 days  55-day-old were placed with receptive adult females to examine sexual behaviour  100-day-old rats were mated with sexually mature females to assess fertility rates 15 Almeida, Kempinas, Lamano Carvalho, 2000). Fertility of male adult rats subjected to stress Results  Adult rats presented a significant  in fertility rates  Enhances sexual performance at the onset of puberty  Decrease fertility during adulthood in male rats 16 Almeida, Kempinas, Lamano Carvalho, 2000). Prenatal stress (rats) Prenatal stress :  Fewer conceptions, more spontaneous abortions and fewer viable young.  Offspring = low birth weight + less likely to survive the neonatal period.  Influence the balance of adrenal and gonadal hormones during a critical stage of fetal hypothalamic differentiation,  Producing a variety of reproductive dysfunctions in adulthood 17 Herrenkohl, 1979. Environmental Aspect Overview: Men and Women Stress Related Disorders in Women Stress Related Disorders in Men Chronic anovulation Decreased sperm count Hypothalamic amenorrhea Decreased sperm motility Pseudocyesis Altered sperm morphology Stress-related eating disorders Impotence Exercise and menstrual dysfunction Ejaculatory disorders Hyperprolactinemia Decreased serum luteinizing hormone and testosterone Early pregnancy failure 18 (Negro-Vilar, 1993) Workplace Hazards  Infertile Men (255) vs. Fertile Men (273)  Large Batteries of Questionnaires  Extensive Questionnaires: Socioeconomic, medical, occupational and environmental factors (Ed-Helaly et al. 2010) 19 Workplace Hazards  Infertile Men Selection Criteria:  No female reproduction problem  No underlying organic medical cause  Fertile Men:  Pregnancy in < 12months 20 Workplace Hazards  Results:  Solvents & paintings materials, Stress, VDTs, Shift Work Stress effect in dose-response manner  Sperm Motility and Morphological Index  21 Infertile Months vs. Fertile Months  Research Question  Do women have less stress in the months they actually conceive?  Hypothesis: Less Stress = Months with Conception  More = Months without  (Ed-Helaly et al. 2010) 22 Infertile Months vs. Fertile Months  13 Women desiring to get pregnant  Questionnaire reports (twice) on stress for each cycle  Hormonal assays  Comparing Conception with non-Conception months (Boivin et al., 2006) 23 Infertile Months vs. Fertile Months  Questionnaires:  A-State form of the State-Trait Anxiety Inventory (Spielberger et al., 1970)  Profile of Mood States (POMS; McNair and Lorr, 1982)  Assays:  Urinary Cortisol, and Adrenaline and Epinephrine (Boivin et al., 2006) 24 Infertile Months vs. Fertile Months  Self-Reports: YES  Hormone Assays: NO  Retrospective limitations:  Collections at night  Normal population: negligible difference (Boivin et al., 2006) 25 Age & Social Position Summary:  Sample: Already those with Fertility Problem (but considered reproductively able medically)  Comparison: “Success” vs “Fail”  Age and Social Position: Moderators (Boivin et al., 2006) 26 Age & Social Position  Age:  Age up = Less effect of stress on fertility  Social Position: Lower Social Position = More effect of stress on fertility  Higher Social Position = More effect of stress on Fertility  (Boivin et al., 2006) 27 Sperm Quality and Stress  Sample: Fertile Men (n = 744)  Questionnaire:   Major stressful event past 3 months Goal: Is sperm quality affected by major stressful events? (Sanders & Bruce, 1997) 28 Sperm Quality and Stress  Outcomes: the experience of two or more life events was associated with…  decreased sperm concentration, TC, and percent motile sperm  increased likelihood of classification below WHO thresholds for ‘‘normal’’ for concentration, motility, and morphology (Sanders & Bruce, 1997) 29 Effects of stress on sperm quality  Emotional stress plays a detrimental role on fertility  The ejaculate of 20 men was studied the number of “healthy” sperm was significantly reduced in participants who were depicted as being stressed  The participants were divided into 2 groups, where one group received Conveyer of Modulating Radiance (CRM) therapy  The results show that the number of “healthy” sperm was significantly higher after the therapy Collodel et al. 2008 30 Infertility which causes stress which leads to more infertility Infertility Stress Stress Infertility 31 Stress, gender & fertility • Women experiencing social pressure for motherhood view infertility as more stressful • Research has shown that working out of the home is beneficial to women • Women whose roles are limited pending motherhood, may experience infertility experience more distress than women engaged in multiple roles (Morse & Van Hall, 1987). 32 Inability to conceive  The inability to reproduce has been depicted as role failure (Greil et al., 1988) and as socially stigmatizing (Miall, 1985). This produces stressors on the need to conceive  If a women cannot conceive a child she will become increasingly more stressed which will reduce her chances of conceiving  33 Stress and gender and fertility  Infertile wives perceive their fertility problem as much more stressful than their husbands  Infertile wives felt themselves as being more responsible for the infertility  Husbands also attributed the responsibility to their wives  This feeling of inadequacy led the women to stress even more about getting pregnant which isn’t beneficial to fertility 34 Abbey, Andrews & Halman (1991) Stress Fertility Problems  Excessive emotional stress can cause chronic anovulation  Elevated cortisol levels are associated with amenorrhea 35 Distress & Fertility  Potential predictors of distress  Gender role identity and infertility Career role salience and infertility  Social pressure for motherhood and infertility  36 Predictors of distress in women being treated for infertility  Study by Miles, Keitel, Jackson, Harris & Licciardi (2008)  Sample consisted of 119 women  Participants’ ages ranged from 23 to 49 years  42% of the participants in this study experienced clinically significant levels of distress  62% were considered to be clinically symptomatic  Participants tended to view infertility as very stressful 37 Stress & Miscarriage  Stress may lead to miscarriage in pregnant women  Compared with women with an intermediate level of psychological stress during pregnancy, women with a high level of stress had 80% increased risk of stillbirth Wisborg, Barklin, Hedegaard, & Henriksen (2008) 38 Differing Outcomes  Women reporting high stress did not have an higher risk of miscarriage when looking at stress alone  Women under stress were more likely to use drugs, which might be risk factors for miscarriage independently Nelson et al. in 2003 39 Summary  Stress influences the HPG axis leading to a decrease in gonad functioning  Environmental factors seem to play a role in stress related to reproductive difficulties  Difficulty conceiving or carrying to term, leads to stress about infertility which leads to increased future fertility problems 40 References  Abbey A., Andrews F., Halman J. (1991) Gender’s role in response to infertility. Psychology of Women Quarterly. 15 : 295-316  Almeida, S. A., Kempinas, W. G., & Lamano Carvalho, T. L. (2000). Sexual behavior and fertility of male rats submitted to prolonged immobilization-induced stress. Brazilian Journal of Medical and Biological Research, 33(9), 1105-1109. doi:10.1590/S0100-879X2000000900019  Boivin, J., Sanders, K., & Schmidt, L. (2006). Age and social position moderate the effect of stress on fertility. Evolution and Human Behavior, 27(5), 345-356 doi:10.1016/j.evolhumbehav.2006.03.004  Collodel G, Moretti E, Fontani V, Rinaldi S, Aravagli L, Saragò G, Capitani S, Anichini C. (2008) Effect of emotional stress on sperm quality. Indian J Med Res.128(3):254-61.  Ed-Helaly, M, Awadallla, N, Mansour, M, & El-Biomy. (2010). Workplace Exposures and Male Infertility – A Case Control Study. International Journal of Occupational Medicine and Environmental Health, 23(4), 331–338. doi:10.2478/v10001-010-0039-y  Gollenberg, A.L., Liu, F., Brazil, C., Drobnis, E.Z., Guzick, D., Overstreet, J.W., Redmon, J.B., Sparks, A., Wang, C., Swan, S.H. (2010). Semen Quality in Fertile Men in Relation to Psychological Stress. Fertility and Stress, 93(4), 1104-1111  Greil, A. L., Leitko, T. A., & Porter, K. L. (1988). Infertility: His and Hers. Gender & Society, 2(2), 172-199. doi:10.1177/089124388002002004  Herrenkohl, L. R. (1979). Prenatal stress reduces 41 fertility and fecundity in female offspring. Science, 206(4422), 1097-1099. doi:10.1126/science.573923 References cont’d  Kirby, E. D., Geraghty, A. C., Ubuka, T., Bentley, G. E., & Kaufer, D. (2009). Stress increases putative gonadotropin inhibitory hormone and decreases luteinizing hormone in male rats. PNAS Proceedings of the National Academy of Sciences of the United States of America, 106(27), 11324-11329. doi:10.1073/pnas.0901176106  Miall, C. E. (1985). Perceptions of informal sanctioning and the stigma of involuntary childlessness. Deviant Behavior, 6(4), 383-403.  Miles L., Keitel M., Jackson M., Harris A., Licciardi F. (2009) Predictors of distress in women ebing treated for infertility. Journal of Reproductive and Infant Psychology. 27(3) : 238-257  Mingoti, G. Z., Pereira, R. N., & Monteiro, C. R. (2003). Fertility of male adult rats submitted to forced swimming stress. Brazilian Journal of Medical and Biological Research, 36(5), 677-681. doi:10.1590/S0100-879X2003000500016  Morse, C. A., & Van Hall, E. V. (1987). Psychosocial aspects of infertility: A review of current concepts. Journal of Psychosomatic Obstetrics & Gynecology, 6(3), 157-164. doi:10.3109/01674828709019419  Negro-Vilar, A. (1993). Stress and Other Factors Affecting Fertility in Men and Women: Overview. Environmental Health Perspectives Supplements, 101(Suppl. 2), 59-64  Nelson, D. Does Stress Influence Early Pregnancy Loss. (2003)Annals of Epidemiology. 13(4): 223-229.  Sanders K.A., Bruce N.W. (1997). A Prospective Study of Psychosocial Stress and Fertility in Women. Human Reproduction,12(10), 2324-2329  Wisborg, K., A. Barklin, M. Hedegaard, and T.B. Henriksen. Psychological stress during pregnancy and stillbith: prospective study. (2008) BJOG. 115(7): 882-885. doi: 10.1111/j.14710528.2008.01734.x 42