Preconception stress and infertility: a Q&A with Dr. Courtney D. Lynch

Does preconception stress increase the risk of infertility? Dr. Courtney D. Lynch will be presenting the results from a couple-based prospective cohort study, the LIFE study, at this year’s Human Reproduction Keynote Lecture in Lisbon. We meet Dr Lynch to learn more about how she came to specialise in reproductive medicine and the findings of her research.

What encouraged you to pursue a career in the field of reproductive medicine?

Shortly after I graduated from college, I saw the movie Outbreak and was introduced to the field of epidemiology. As I researched the discipline, I learned that maternal and child health epidemiology was a subspecialty that would allow me to marry my interest in pregnancy with my desire to be a disease detective.

You have been chosen to present the key note lecture at this year’s annual ESHRE Congress. Can you tell us a bit about the paper you are presenting on?

The paper about which I will be speaking addresses the issue of whether or not there is a prospective association between stress and fecundity as defined by time to pregnancy and infertility. It has long been known that the experience of infertility is extremely stressful for affected couples. What has remained unclear, however, is whether stressed individuals take longer to get pregnant, thereby leading to higher rates of infertility in this group.

We enrolled 501 couples in the United States who were discontinuing contraception with the intent of getting pregnant. Each partner of the couple completed a baseline questionnaire and collected biospecimens and was then asked to complete separate structured daily diaries for up to a year and through pregnancy if it occurred. Women collected saliva specimens, once the morning following enrolment, and once the morning following their first study-observed menses for the measurement of salivary cortisol and alpha-amylase.

While we found no association between salivary cortisol and fecundity, we found that women in the highest tertile of salivary alpha-amylase exhibited a 29% reduction in fecundity (i.e., a longer time to pregnancy) compared to women in the lowest tertile after adjustment for confounders, which translated into a more than two-fold increased risk of infertility among these women.

What inspired you to start researching this particular topic?

When I began my career as a post-doctoral fellow at the National Institutes of Health, I originally thought I wanted to focus on the comparative effectiveness of obstetric interventions. However, during my time there, many of my friends and colleagues were getting married and it seemed like more than a handful of them were experiencing difficulty getting pregnant. I was approached by several friends who asked if I thought stress was impacting their ability to get pregnant and when I looked to the literature to find an answer, I quickly learned that the topic (i.e., does stress impact time to pregnancy) had not received adequate attention. I became very concerned, as it was distressing to see otherwise healthy young women be moved to tears when they experienced difficulty getting pregnant. I decided that something needed to be done and that I wanted to be part of the solution.

Were there any findings in the study which particularly surprised you?

There weren’t really any surprising results in this study, as what we found mirrored what we had found several years prior in a smaller and shorter study of women in the UK who were trying to get pregnant.

What do you see as the next steps for this kind of research?

There are really two main directions that we are going with this work now that our initial papers have been published. First, in the coming year, we hope to obtain funding to further examine the methodological issues that impact the validity of this work. First, we wish to affirm that salivary alpha-amylase levels do not vary substantively throughout the menstrual cycle. Also, while we have yet to find a measure of self-reported stress that correlates well with salivary alpha-amylase levels, the search continues.

At the same time, we are currently attempting to obtain funding to conduct a randomized controlled trial of a proven stress reduction technique to see if its use decreases time to pregnancy. While we now know there is a consistent prospective association between stress and time to pregnancy, what remains unknown is whether the use of stress reduction techniques can help couples get pregnant faster.

How does it feel to be selected as the key note speaker at this year’s ESHRE Congress?

It is extremely humbling to be selected as the keynote speaker for ESHRE this year. More than anything, we are simply happy to continue the conversation with our reproductive medicine colleagues regarding this issue. The impact of stress on reproduction is complex and will only be able to be adequately addressed through the expertise of multidisciplinary teams.

What do you think are the challenges being faced in the field today?

The biggest challenges impacting the study of natural fertility today are the cost and logistics of conducting prospective pregnancy studies with preconception enrolment. First, it is time-consuming and expensive to find couples who are currently trying to get pregnant. Then, once couples are identified and enrolled, it can be costly to retain them long-term in a study that requires daily journal completion. However, through the use of novel online recruitment and follow-up methods, we hope to make these issues less of a concern in the future.