How stress and cortisol contribute to infertility

How Stress and Cortisol Influence Infertility and IVF Outcomes: What Recent Research Shows

Infertility is a deeply personal and often stressful experience for couples trying to conceive. For many women, the emotional toll of infertility compounds the physical demands of fertility treatments such as in vitro fertilization (IVF). Recent research published in Frontiers in Endocrinology has shed new light on how dysregulation of the stress hormone cortisol — particularly when influenced by anxiety — may intersect with infertility and IVF outcomes. This study importantly moves the conversation beyond abstract ideas about stress and fertility into measurable biology, offering insights that could eventually reshape clinical care for women undergoing fertility treatment.

Cortisol: More Than a “Stress Hormone”

Cortisol is best known as the body’s primary stress hormone, produced by the adrenal glands as part of the hypothalamic–pituitary–adrenal (HPA) axis response. It plays a critical role in energy mobilisation — influencing glucose metabolism, immune responses, and even reproductive hormone balance.

Under normal conditions, cortisol follows a predictable daily rhythm — peaking in the morning and gradually declining throughout the day — helping the body respond to day-to-day physiological demands. But when stress becomes chronic or overwhelming, this pattern can be disrupted, leading to “cortisol dysregulation.” This can interfere with processes essential for ovulation, hormonal balance, and potentially embryo development.

What the Study Found: Cortisol, Anxiety, and Infertility

The research team measured morning serum cortisol levels in 110 women diagnosed with infertility and compared them with 112 age-matched healthy women not experiencing fertility issues. Participants also completed a validated anxiety assessment, the Self-Rating Anxiety Scale (SAS) - see more here Frontiers in Endocrinology . 

Key findings included:

• Higher cortisol in infertile women:Women facing infertility had significantly higher morning cortisol levels compared with controls. This suggests a biological signature of stress dysregulation in this population. 

• Cortisol closely linked to anxiety:There was a strong correlation between physiological cortisol levels and perceived anxiety scores. In practical terms, women who reported greater feelings of anxiety tended to have higher cortisol that morning. 

• A cortisol threshold predicted anxiety:Using a cutoff value of 22.25 μg/dL, researchers could diagnose anxiety with 95% accuracy — indicating that cortisol measurement could supplement psychological questionnaires in clinical assessments.

Does Stress Affect IVF Success?

One of the most clinically relevant questions was whether cortisol levels and anxiety influence the success of IVF treatment. The researchers tracked IVF outcomes among the infertile participants. They found:

• Lower pregnancy rates in women with higher anxiety or cortisol:Women with higher SAS scores (>50) or morning cortisol levels above the 22.25 μg/dL threshold tended to have lower pregnancy rates (8–10%) and required more IVF cycles to achieve pregnancy compared with less stressed peers. 

However — and this is important — because IVF involves many variables and interventions, the study could not conclusively say that anxiety alone caused poorer outcomes. Still, the associations are strong enough that they warrant serious clinical attention.

Why Cortisol Matters in Reproductive Health

The connection between stress and fertility is not merely psychological; it has a measurable physiological basis. Cortisol influences reproductive hormones by interacting with sex steroid pathways and feedback loops in the hypothalamus and pituitary gland.

When cortisol is dysregulated:

• Follicular development can be disrupted, because cortisol can antagonise luteinising hormone support in the ovary. 

• Ovulation and steroidogenesis may be impaired, interfering with the menstrual cycle and reproductive timing.

• HPA axis disruption may interfere with successful conception and implantation due to altered endocrine signalling.

This interaction underscores why measuring cortisol offers more than a psychological snapshot — it reflects an integrated endocrine response that could affect the very biology of reproduction.

Infertility affects around 10–15% of couples worldwide, and women facing fertility challenges have higher rates of anxiety and stress compared with the general population. 

Despite this prevalence, psychological stress is often under-assessed in fertility clinics, and stress hormones like cortisol are rarely measured as part of standard care. This study suggests that incorporating tools such as anxiety questionnaires and rapid cortisol testing into routine protocols could improve care, help personalise treatment plans, and ultimately support better outcomes.

Translating Research Into Practice

There are several potential clinical applications that arise from this research:

• Early stress screening:Including both psychological assessment and cortisol measurement early in fertility evaluations could help identify women at risk of stress-mediated reproductive disruption.

• Integrating stress management:If high cortisol and anxiety are identified, targeted interventions — including cognitive behavioural therapy, mindfulness-based stress reduction, lifestyle modification, and possibly biofeedback — could be deployed as part of an IVF preparation programme.

• Tailored treatment protocols:Understanding an individual’s stress biology may guide timing of interventions, adjustment of stimulation protocols, or even decisions around cycle pacing to optimise outcomes.

Limitations and Next Steps

While this study provides compelling evidence of an association between cortisol dysregulation and infertility, it is cross-sectional and observational. As such: It cannot establish cause and effect between cortisol and IVF failure.

• Cortisol sampling was limited to morning levels — fuller circadian profiling might offer richer insight.

• Larger, longitudinal studies are needed to confirm whether interventions that lower cortisol or anxiety improve IVF outcomes.

• Nonetheless, this research represents a critical step toward integrating endocrine biomarkers like cortisol into fertility care pathways — moving beyond subjective

---

• symptom reporting to objective biological assessment.

Conclusion: Stress Matters — and It’s Measurable

This study reinforces a central truth: stress is not “just in the mind,” and its hormonal signatures can influence reproductive physiology. Elevated cortisol associated with anxiety in infertile women is common and correlates with IVF treatment complexity. Recognising and measuring this dysregulation offers clinicians a new lens through which to optimise fertility care.

By combining validated psychological tools with rapid cortisol testing, fertility clinics can provide more nuanced, holistic support — addressing both the emotional and biological dimensions of infertility. That is a powerful step forward for women navigating one of the most emotionally charged medical journeys of their lives.

If you are worried, you can easily have your cortisol measured using this link - https://www.metabolic-health.co.uk/about-5-1

Useful links and papers 

Zhang, Y., et al. (2023). Cortisol dysregulation in anxiety infertile women and the influence on IVF treatment outcome. Frontiers in Endocrinology, 14:1107765.https://www.frontiersin.org/articles/10.3389/fendo.2023.1107765/full

Joseph, D. N., & Whirledge, S. (2017). Stress and the HPA axis: Balancing homeostasis and fertility. International Journal of Molecular Sciences, 18(10), 2224.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664031/

Nepomnaschy, P. A., & Flinn, M. V. (2009). Early life influences on the endocrine system and implications for reproductive function. American Journal of Human Biology, 21(1), 29–40.https://pubmed.ncbi.nlm.nih.gov/18802117/

Li, Y., et al. (2021). Stress-related hormonal changes and female infertility. Gynecological and Reproductive Endocrinology & Metabolism, 3(2).https://gremjournal.com/journal/0203-2022/female-infertility-as-a-result-of-stress-related-hormonal-changes/

Smeenk, J. M. J., et al. (2001). The effect of anxiety and depression on the outcome of in vitro fertilization. Human Reproduction, 16(7), 1420–1423.https://pubmed.ncbi.nlm.nih.gov/11425829/

Gameiro, S., et al. (2015). Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility care. Human Reproduction Update, 18(6), 652–669.https://pubmed.ncbi.nlm.nih.gov/23096932/

Chrousos, G. P. (2009). Stress and disorders of the stress system. Nature Reviews Endocrinology, 5, 374–381.https://pubmed.ncbi.nlm.nih.gov/19488073/

#Stress #Cortisol #Anxiety #Infertile #Infertility #Cortisoltest