My doctor dismisses stress as a cause of infertility, but I know others who say relaxation exercises helped them achieve pregnancy. Is stress a cause of infertility or not?

In my mind, there's no doubt that stress is a contributing factor for couples dealing with fertility problems. In women, stress can affect hormone levels and even block ovulation. In men, high levels of stress may cause sperm problems.

Stress can adversely affect the hypothalamus, the brain area charged with controlling hormonal stimulation of the gonads. Stress can also bring about changes in the immune system that may interfere with implantation and growth of the early pregnancy.

If stress is a factor in infertility, then it stands to reason that stress reduction promotes fertility. A variety of studies suggest that this is true. As such, I recommend an assessment of stress levels--and intervention to reduce stress--as important components of any fertility treatment plan.

Unfortunately, I have seen marriages end over the stress of fertility problems. So when patients say they are stressed out, or when I perceive they are stressed out, I pay particular attention. First, I try to evaluate potential causes: our treatment, financial aspects of infertility care, work, marriage, family or other factors. In many cases, I suggest counseling to ensure that husband and wife both recognize the family that exists and to give them the tools and skills to grow together as they seek to grow their family.