The Mind-Body Connection in Fertility and Mental Health

At Hope Affirm Thrive, we are committed to providing evidence-based, trauma-informed support to individuals navigating infertility. Our practice is guided by a deep understanding of the connection between psychological wellbeing and fertility outcomes, with special attention to the unique experiences of neurodivergent individuals undergoing fertility treatments. Below is a comprehensive list of peer-reviewed studies that substantiate our approach, ensuring alignment with the Australian Health Practitioner Regulation Agency (AHPRA)'s requirements for evidence-based practice.

Core Concepts and Supporting References

1. Neuroception: "Your Body's Own Security Scanner"

Neuroception is a term coined by Dr. Stephen Porges, referring to the unconscious detection of safety and threat, which influences autonomic nervous system responses.

Porges, S. W. (2003). The Polyvagal Theory: Phylogenetic substrates of a social nervous system. International Journal of Psychophysiology, 42(2), 123-146.
Key Finding: Porges explains how neuroception enables the body to detect danger and safety cues without conscious awareness. This process impacts autonomic regulation, emotional responses, and social engagement, all of which are critical during stressful experiences like infertility treatments.

Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.
Key Finding: This book explores how neuroception influences physiological states, affecting a person’s ability to socially engage or withdraw in response to perceived threats, which is essential for understanding emotional regulation during fertility challenges.

2. The Mind-Body Connection: "The Body Keeps the Score Got It Right!"

Research demonstrates how trauma and chronic stress can impact physical health, including reproductive health.

McEwen, B. S. (1998). Stress, adaptation, and disease: Allostasis and allostatic load. Annals of the New York Academy of Sciences, 840(1), 33-44.
Key Finding: McEwen's research on allostatic load explains how chronic stress impacts the body over time, potentially affecting hormonal balance, immune function, and reproductive health.

van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, mind, and body in the healing of trauma. Penguin Books.
Key Finding: Van der Kolk presents evidence on how trauma impacts both the brain and body. He highlights how the autonomic nervous system and hormonal responses can influence physical health, including fertility.

3. Autonomic Nervous System Responses to Trauma and Stress

Understanding the body's response to stress and trauma is essential for recognising the physiological impact on fertility.

Sapolsky, R. M. (2004). Why Zebras Don't Get Ulcers: The acclaimed guide to stress, stress-related diseases, and coping. Holt Paperbacks.
Key Finding: Sapolsky discusses how the body’s stress response, while useful in acute situations, can be harmful when chronically activated. Prolonged stress can disrupt hormonal balance, affecting fertility.

Thayer, J. F., & Lane, R. D. (2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders, 61(3), 201-216.
Key Finding: Thayer and Lane’s work highlights the link between autonomic regulation and emotional processes, emphasising how safety and threat cues could impact reproductive health.

4. Vagus Nerve and Trauma Responses

The vagus nerve plays a significant role in regulating the body’s stress response.

Bremner, J. D. (2006). Traumatic stress: Effects on the brain. Dialogues in Clinical Neuroscience, 8(4), 445-461.
Key Finding: Bremner discusses the impact of trauma on the brain and autonomic nervous system dysregulation, highlighting the importance of vagus nerve regulation in managing stress responses.

Porges, S. W., & Dana, D. A. (2018). Clinical Applications of the Polyvagal Theory: The emergence of polyvagal-informed therapies. W. W. Norton & Company.
Key Finding: This text outlines practical applications of Polyvagal Theory, showing how understanding neuroception and vagus nerve regulation could improve therapeutic outcomes for individuals experiencing infertility-related stress.

5. Trauma and Psychosomatic Symptoms

Psychological trauma can manifest in physical symptoms, impacting fertility.

Scaer, R. C. (2007). The Body Bears the Burden: Trauma, dissociation, and disease. Routledge.
Key Finding: Scaer discusses how traumatic experiences are stored in the body and can lead to chronic physical symptoms, such as hormonal imbalances and immune system disruptions, which could affect fertility.

Shalev, A. Y., Liberzon, I., & Marmar, C. (2017). Post-traumatic stress disorder. The New England Journal of Medicine, 376(25), 2459-2469.
Key Finding: This article provides a comprehensive overview of PTSD and its impact on both psychological and physiological health, with implications for reproductive health.

6. The Mind-Body Connection and Fertility

Research demonstrates the impact of psychological distress on fertility outcomes.

Aimagambetova, G., Issanov, A., Terzic, S., Bapayeva, G., Ukybassova, T., Baikoshkarova, S., Aldiyarova, A., Shauyen, F., & Terzic, M. (2020). The effect of psychological distress on IVF outcomes: Reality or speculations?PLOS ONE, 15(12), e0242024. https://doi.org/10.1371/journal.pone.0242024

Key Finding: This study demonstrated that higher levels of psychological distress were associated with lower IVF success rates, emphasizing the need for psychological interventions during infertility treatments.

Chrousos, G. P., & Gold, P. W. (1992). The concepts of stress and stress system disorders: Overview of physical and behavioral homeostasis. JAMA, 267(9), 1244-1252.

Key Finding: Stress-related hormonal changes can disrupt female reproductive function, impacting the menstrual cycle and ovulation.

Ebbesen, S. M. S., Zachariae, R., Mehlsen, M. Y., Thomsen, D., Højgaard, A., Ottosen, L., Petersen, T., & Ingerslev, H. J. (2009). Stressful life events are associated with a poor in-vitro fertilization (IVF) outcome: A prospective study. Human Reproduction, 24(9), 2173–2182. https://doi.org/10.1093/humrep/dep185
Key Finding: Stressful life events were found to significantly reduce IVF success rates, suggesting psychobiological mechanisms may influence treatment outcomes.

Grinion, P. E. (2005). The biopsychosocial stress of infertility: Grappling with the ethical and moral concerns vis-à-vis assisted reproductive technologies. Presented at NACSW Convention 2005, Grand Rapids, Michigan.
Key Finding: Infertility can cause significant psychological stress, requiring ethical and holistic approaches to care.

Miller, N., Herzberger, E. H., Pasternak, Y., Ghetler, Y., Berkovitz, A., & Shavit, T. (2019). Does stress affect IVF outcomes? A prospective study of physiological and psychological stress in women undergoing IVF. Reproductive BioMedicine Online, 39(1), 93–101. https://doi.org/10.1016/j.rbmo.2019.03.205
Key Finding: This study found no significant negative impact of stress on IVF outcomes but noted that higher follicular cortisol levels were associated with improved pregnancy rates, indicating a complex stress-response relationship.

Nicoloro-SantaBarbara, J., Busso, C., Moyer, A., & Lobel, M. (2018). Just relax and you’ll get pregnant? A meta-analysis examining women’s emotional distress and the outcome of assisted reproductive technology.

Social Science & Medicine, 213, 54–62. https://doi.org/10.1016/j.socscimed.2018.06.033

Key Findings: The meta-analysis found that while emotional distress is often linked to lower success rates in assisted reproductive technology (ART), the evidence is mixed and does not establish a definitive causal relationship. The study calls for further research to better understand how emotional factors influence ART outcomes.

Rooney, K. L., & Domar, A. D. (2018). The relationship between stress and infertility. Dialogues in Clinical Neuroscience, 20(1), 41-47.
Key Finding: Chronic stress can disrupt hormonal balance, affecting ovulation and implantation, ultimately reducing fertility.

Roozitalab, S., et al. (2020). The relationship between infertility, stress, and quality of life with posttraumatic stress disorder in infertile women.Journal of Psychosomatic Obstetrics & Gynecology, 41(2), 128-135.
Key Finding: Infertile women are at a higher risk of developing PTSD, highlighting the need for trauma-informed care.

Simionescu, G., et al. (2021). The complex relationship between infertility and psychological distress: A review. Experimental and Therapeutic Medicine, 21(3), 1-12.
Key Finding: This review highlights the bidirectional relationship between infertility and psychological distress, underscoring the importance of addressing mental health to improve fertility outcomes.

Yahyavi Koochaksaraei, F., et al. (2020). Interventions promoting mental health dimensions in infertile women: A systematic review. BMC Women’s Health, 20(1), 1-12.
Key Finding: Mental health interventions, such as cognitive-behavioral therapy, can significantly improve mental wellbeing and fertility outcomes.

Zanettoullis, A. T., Mastorakos, G., Vakas, P., Vlahos, N., & Valsamakis, G. (2024). Effect of stress on each of the stages of the IVF procedure: A systematic review. International Journal of Molecular Sciences, 25(2), 726. https://doi.org/10.3390/ijms25020726
Key Finding: This review found that stress, particularly chronic stress, negatively impacts IVF outcomes, with the egg retrieval stage being the most affected. While acute stress fluctuated during the process, its impact on fertilization, embryo transfer, and pregnancy rates was less significant, highlighting the importance of stress management at critical stages.

Explanation of Contradictory Findings:

Miller et al. and Nicoloro-SantaBarbara et al.'s findings might differ because stress affects people in complex ways. A little stress can sometimes help the body adapt, like boosting hormones that support egg quality, while too much stress may have the opposite effect. Miller et al. measured stress using biological markers like cortisol, which might tell a different story than surveys used in other studies. It’s also possible that the timing of stress matters—stress at certain points in the IVF process might help or harm depending on when it happens. Everyone’s body responds differently, too; for some, stress hormones might improve outcomes by reducing inflammation or supporting implantation, while for others, it could have a negative impact. Finally, differences in study design, sample size, or how people cope with stress could all contribute to these contradictory results.

7. Autistic Experiences and Fertility

Neurodivergent individuals may experience unique challenges in fertility treatments, requiring a more tailored approach to care.

Gray, L. J., & Durand, H. (2023). Experiences of dysmenorrhea and its treatment among allistic and autistic menstruators: A thematic analysis. BMC Women’s Health, 23, 288.
Key Finding: Autistic individuals may have heightened sensitivity to pain and unique healthcare needs, requiring tailored approaches in fertility treatments.

Schieve, L. A., et al. (2018). Maternal and paternal infertility disorders and treatments and autism spectrum disorder. Journal of Autism and Developmental Disorders, 48(4), 1260-1273.
Key Finding: There is a potential link between infertility treatments and autism spectrum disorder, highlighting the need for monitoring and support for neurodivergent families.

Simantov, T., & Pohl, A. (2019). Medical symptoms and conditions in autistic women. Journal of Autism and Developmental Disorders, 49(12), 4889-4898.
Key Finding: Autistic women report higher rates of gynecological and reproductive health issues compared to non-autistic women.

8. The Role of Psychological Support and Infertility Treatment Outcomes

Psychological distress can impact fertility outcomes by disrupting hormonal balance and affecting key processes like ovulation and implantation. Research shows that psychological support can improve fertility treatment outcomes.

Bleil, M. E., et al. (2020). Fertility treatment response: Is it better to be more optimistic or less pessimistic?Fertility and Sterility, 114(5), 1039-1045.
Key Finding: Optimism and reduced psychological distress can improve fertility treatment outcomes.

Frederiksen, Y., et al. (2015). Psychological interventions and IVF outcomes: A meta-analysis. Human Reproduction Update, 21(5), 577-593.
Key Finding: Patients receiving psychological support during fertility treatments had significantly higher pregnancy rates compared to those without support.

Warne, E., Oxlad, M., & Best, T. (2021). Consulting patients and providers of assisted reproductive technologies to inform the development of a group psychological intervention for women with infertility. Psychology and Health, 36(7), 781-799.
Key Finding: Psychological interventions tailored to infertility patients' needs can improve mental health and fertility outcomes.

How This Evidence Supports Our Practice

At Hope Affirm Thrive, we integrate this body of evidence into our group coaching program to provide comprehensive, trauma-informed psychological support. By addressing both emotional and physiological aspects of infertility, we aim to improve wellbeing and fertility outcomes for our clients.

Remember, your body is listening to what your mind is saying. Our goal is to help you speak to yourself with kindness, patience, and hope. You’re not alone in this journey—we’re here to help you reconnect with your mind, body, and spirit for a thriving fertility experience.