I have been trying to conceive for the last five years, without success. We have had all kinds of tests done. My husband's sperm count varies between 20 million and 60 million, and the rest seems all right. But I feel that stress is playing a major role. When I near my time of ovulation, I start becoming tense. What can I do to reduce my stress?

Noni

Infertility -- and its treatment -- are stressful by nature. At the same time, stress is certainly a factor in fertility. Stress can interfere with normal function of the hypothalamus and the pituitary, glands involved in regulating ovulation. In severe situations, this may block ovulation completely; in other cases, stress may merely interfere with hormone production. Stress may also interfere with the immune system, which plays an important role in implantation and the body's recognition of the pregnancy.

The magnitude of this adverse effect varies from individual to individual. As such, testing for stress does not tell us whether your stress levels are affecting your fertility. The best thing to do is to take steps to minimize the role stress plays in your life, such as the following:

• Strive for more open communication with your partner and other important people in your life. Ask your partner what she or he needs rather than assuming that you can or cannot give it.
  
• Realize there's no right or wrong way to feel. Getting in touch with your feelings will help you know what you need. Once you can identify your needs, explain them clearly and specifically to your partner.
  

• Recognize the differences between men and women. See if you can teach each other some of the skills you've learned from your own life experiences as man or woman.
  
• Share as much as possible in the process of treatment. Share both the burdens and joys of your different perceptions and experiences of infertility. It will help to balance the intensity and bring you closer, with a deeper respect for each other.
  

• Plan an infertility holiday, to take time off from your treatment if it is getting you down.
  
• Find ways to put the fun back in your relationship. Make a date night during which you can put the troubles of infertility behind you for just a few hours.
  
• Consider couples counseling to address your needs and minimize stress.