Daily perceived stress and time to pregnancy: A prospective cohort study of women trying to conceive

Abstract

Background: Prior studies among women with impaired fecundity have consistently demonstrated a positive association between daily perceived stress and the ability to conceive. However, the effects of daily stress on time to pregnancy (TTP) among women with proven fertility is not known.

Materials and methods: One hundred and forty-three women ages 18-35, in a relationship of proven fertility, who desired to conceive were included in the analysis. Daily diaries recording perceived stress (scale 0-10) were completed for up to 7 menstrual cycles or until pregnancy. Cox proportional hazards regression models were used to estimate the association between time-varying perceived stress tertiles (high [>4.1-7.2], moderate [>2.7-4.1], and low [0.1-2.7]) and adjusted fecundability odds ratio (aFOR), 95% confidence intervals (CI), after taking into account age, parity, education, time-varying caffeine and alcohol intake, fertility awareness tracking, and cycle intent to conceive.

Results: Among the 111 participants who completed daily diaries, 90 (81.1%) conceived. Women reporting high or moderate stress, versus low stress, had no difference in probability of achieving pregnancy (aFOR: 1.11 [95% CI: 0.58, 2.14]; and aFOR: 1.37 [0.71, 2.67]), respectively. Additional adjustment for intercourse frequency during narrow fertile window, or narrowing exposure focus to pre-ovulatory or pre-implantation stress did not appreciably alter the estimates.

Conclusion: Daily perceived stress was not adversely associated with TTP among women with proven fertility. While a growing body of evidence supports adverse effects of more severe stressful life events on female reproductive function, moderate psychological stress, commonly referred to as eustress, among relatively healthy women with proven fertility does not appear to adversely impact TTP.

Keywords: Fecundability; Fecundity; Perceived stress; Psychological stress; Time to pregnancy.

Fig. 1.

Mean (95% CI) variation in daily diary reported perceived stress over the menstrual cycle. The variation of repeatedly measured stress level in daily diary was assessed, both across the menstrual cycle and between menstrual cycles. Pairwise comparisons of self-reported stress exposures were made.

Fig. 2.

Mean (95% CI) variation in daily diary reported perceived stress over the study period. The variation of repeatedly measured stress level in daily diary was assessed and pairwise comparisons of self-reported stress exposures were made.