An extreme case of infertility caused by continued exposure to stress

From Marcelo Garzon, Richmond Hill, first year student CCHM.

Abstract: A couple presented with severe symptoms of stress. On repeated questioning, they admitted to having a life style surrounded by daily stress, which looks to them to be the cause of their fertility problems. This case demonstrates the potent effect of stress on our wellness as well as the effective treatment when initiated early.

1.  Introduction

                Who does not know stress? Who has not ever met with stress? And Who likes to live with stress?

Stress in moderate doses is needed in order for us to occasionally survive potentially dangerous situations (like driving in bad weather or flying a combat airplane) but long periods of stress will lead to body dysfunction or to function in ways that will affect our mood, relationships and our health. Stress will cause our body to create or to stop creating chemicals that support our body’s needs in order to function routinely throughout the day. As a consequence, individuals and couples will find difficulties in maintaining relationships and possibly face fertility problems.

2. Stress - Anatomy and Physiology Discussion

                Continuous periods of stress can be interpreted as a toxic intruder that is threatening our body. In response, our body will activate the stress response system that involves the endocrine, the nervous and the immune system. This reaction of the body will create physiological changes like increase of heart rate, respiratory rate and feeding dysfunction. In addition to these changes, we will also experience psychological behavior changes. The anatomical structure that activates the stress response is referred as the hypothalamic-pituitary-adrenal axis (HPA). The HPA is a complex set of interactions between the hypothalamus (a part of the brain), the pituitary gland (also part of the brain) and the adrenal or suprarenal glands (at the top of each kidney.) The HPA axis helps regulate things such as the body temperature, digestion, immune system, mood, sexuality and energy usage. It's also a major part of the system that controls the reaction to stress and is involved in depression and burnout as well.

The Hypothalamus sends messages from the brain to the adrenals, the pituitary and other organs, so it is usually considered to be the starting point in the HPA axis. It is ultimately responsible for things like the circadian rhythm, the body temperature and the energy levels. The pituitary gland produces an extraordinary number of hormones that the body needs.  For example, this gland produces vital hormones like growth hormone, anti-diuretic hormone and luteinizing hormone. It is physically connected to the hypothalamus and sits at the base of the brain. Lastly, we have the adrenal glands. We each have two of them, and they sit just above the kidneys. Although physically separate from the hypothalamus and pituitary glands, they are deeply connected. The adrenals produce even more hormones than the pituitary gland does – steroid hormones like cortisol, sex hormones like DHEA a precursor that is converted to testosterone (a male hormone), and is a precursor to estrogen (a female anabolic hormone), and stress hormones like adrenaline and dopamine. The hormones produced by the adrenals control chemical reactions over large parts of the body, including something you might have heard of called our ‘fight-or-flight’ response. The sex hormone estrogen is in a delicate balance with progesterone. In men, low testosterone may also present with estrogen dominance, or estrogen dominance can present without low testosterone symptoms. In our case of infertility, the low progesterone (or high estrogen) will show symptoms of low libido, fatigue and depression. Due to low level of testosterone, men who feel stress are more likely to have lower concentrations of sperm in their ejaculation, and the sperm they have are more likely to be misshapen or have impaired motility(6)

The physiological interaction between these organs is very simple to describe. When we face a stress situation, the stressor starts working, and the hypothalamus releases corticotrophin-releasing hormone, which sends a message to the pituitary. This stimulates the pituitary’s ACTH production, which then prompts the adrenals to make cortisol. Among other things, cortisol raises the sugar in your bloodstream and prepares your body for the high-energy ‘fight-or-flight’ response that it is anticipating. The adrenals also release adrenaline, which raises the heart rate and increases the blood pressure. These interactions continue until the hormones reach the levels that the body needs, and then a series of chemical reactions begins to switch them off. For example, the cortisol released by the adrenals actually inhibits the hypothalamus and pituitary (so they stop sending signals to produce more cortisol!). This is just one of the automatic switches that we call negative feedback loops.

Exposure to extended situations of stress will create the HPA axis to over work and although the signal to the adrenal will continue flowing, the adrenal will become depleted and will not be able to produce and release more hormones. This is what we call adrenal fatigue.

In fact, our body constantly needs the hormones that the adrenal glands produce. When the stress continues, the endocrine system continues to release hormones but it comes with a price, the DHEA and the testosterone may drop. This is because the resources needed to produce the sex hormones are being diverted to produce stress hormones like cortisol. During the stage of adrenal fatigue, an individual can suffer from extreme tiredness, lack of sex drive and therefore infertility, irritability, depression, anxiety, weight loss, apathy and disinterest in the world around him/her.

3. Back to our couple discussion

After a long discussion with the couple, a few more details were revealed. The man showed that in the blood test the cholesterol is at very low levels. This can be a sign of low adrenal hormones level. This individual mentioned that he is overworked and mentally strained, preventing him from having enough nutrition during the day and because of his work he is constantly anxious of the future. The woman, on the other hand, was too worried about the husband’s situation and was depressed and did not have enough rest and sleep. The combination of this couple’s symptoms caused them irritability, lack of concentration on their situation, nervousness, and general weakness. As a result of their situation, their sexual relationship was compromised and in addition, the husband might have been in a state of low concentration or low mobility of sperm as well.

The suggested treatment was in the areas of nutrition, mental and physical support.

In nutrition, there are basic healthy habits they need to regain, like stop consuming white carbs and sugars, eat less fatty foods, eat small meals or snack every three to four hours, eat a nutritious breakfast, eat a small snack near bedtime, reduce the amount of coffee intake per day and especially in the afternoon and always eat before becoming hungry. Consuming more vegies, nuts and fruits throughout the day will definitely help their intake as well.

As physical and mental treatment the recommendation was to exercise a few hours a week (this will also help to reduce fat), gain muscles, take warm baths, meditate, seek counseling, find a hobby and consume natural calming herbal teas.

4.  Conclusions

Prolonged periods of stress can make the body malfunction and create physical and mental disturbances. The reverse process can be achieved but it will take a long time and effort. This paper has described the anatomy and physiology of the stress mechanism in the body and explained the various chemical reactions that will occur in the body and as a consequence the effect of them on our daily routine, physically and emotionally.

As much as stress can be our savior, we can and must be able to control the amount of stress we intake and be aware of the consequences of not dealing with the treatment to help the stress go away.An extreme case of infertility caused by continued exposure to stress