The worst fertility advice you’ll ever get, "just relax"
If you’ve been through IVF, someone has told you to relax. A well-meaning relative, a colleague, possibly even someone in a clinical setting. The implication is always the same: that stress is the obstacle, and if you could just manage it better, things might go differently.
It’s not entirely wrong. But the way it gets said puts the burden entirely on the patient, strips out all the physiology, and leaves women feeling like their emotional response to an enormously difficult situation is somehow sabotaging their chances.
So let’s talk about what’s actually happening in the body, because the mechanism is real, it’s well-studied, and it has nothing to do with not trying hard enough to be calm.
The HPA axis and why it matters for fertility
When you’re under sustained stress, your hypothalamic-pituitary-adrenal axis (the HPA axis) stays activated. This is your body’s stress response system, and in short bursts, it’s completely appropriate.
The problem arises when it runs chronically, which is exactly what happens during a prolonged fertility journey.
The HPA axis drives the release of cortisol from the adrenal glands. And cortisol, when chronically elevated, doesn’t stay neatly in its own lane. It shares a hormonal precursor pathway with your reproductive hormones.
When the body is under sustained demand, it can prioritise cortisol production at the expense of progesterone, a pattern sometimes called the “cortisol steal,” though the mechanism is more nuanced than that phrase implies.
The downstream effects on fertility are significant. FSH and LH (the hormones driving follicle development and triggering ovulation) can be suppressed by high cortisol. Progesterone production in the luteal phase can be compromised. And the immune and vascular environment of the uterus, which needs to be precisely calibrated for implantation to occur, can be disrupted.
What this means during an IVF cycle
IVF is already physiologically demanding. Your body is being pushed to produce more follicles than it would in a natural cycle, on a compressed timeline, with medications that your system has to respond to effectively. Layering chronic HPA activation on top of that creates real physiological noise.
Research has shown associations between elevated stress markers and lower fertilisation rates, poorer embryo quality, and reduced implantation success.
This doesn’t mean stress causes IVF failure! The relationship is more complex than a direct cause and effect. But it does mean that the nervous system is not irrelevant to the outcome, and that supporting it is a legitimate clinical consideration, not just a wellness afterthought.
What actually helps
Acupuncture has a reasonable body of evidence behind it in this context, not for relaxation in the general sense, but for specific physiological effects. It has been shown to reduce cortisol levels, modulate the autonomic nervous system, and improve uterine blood flow. These are measurable outcomes. The Paulus trial and subsequent research on acupuncture around embryo transfer showed statistically significant improvements in pregnancy rates, and while the research landscape is mixed, the mechanistic basis is sound.
Other things worth considering: sleep quality matters more than most people realise, because cortisol regulation is closely tied to circadian rhythm.
Blood sugar stability affects cortisol too, skipped meals and high-sugar diets create their own HPA activation. Targeted adaptogenic herbs can support adrenal function, though what’s appropriate depends on the individual and where they are in their cycle.
The point isn’t to hand you a list of things to add to an already overwhelming situation. It’s to reframe the conversation from “you need to stress less” to “here’s what we can actually do to support your nervous system during this cycle.”
Those are very different things.
Whether endometriosis is already part of your picture or you’ve spent years wondering why your periods are this bad, this is worth looking into. Not because there’s a magic fix, but because there are drivers that can be identified and addressed, and most women I see haven’t had anyone actually look at all of them together.
If you found this useful, sharing it with someone else going through IVF is genuinely one of the best things you can do. This kind of information doesn’t reach people unless it gets passed along.