It has been widely demonstrated in humans, that stress adversely effects fertility and fetal development.  Highly stressed individuals have increased difficulties with ovulation, fertilization, implantation and a healthy full-term pregnancy.  Women attempting conception are experiencing stress in their day to day lives from the challenges of life, work and responsibility, and for women trying to have a baby, the concern that they will not be successful.  Stress affects fertility in a profound way but is most often under-appreciated.  Stress is Nature’s own birth control method. But fortunately stress can be fairly easily modulated in the office setting using acupuncture, heat therapy and massage.

In a large federally funded study, it was demonstrated that women who were trying to conceive that participated in stress-reduction had a 55% “take home baby rate” compared to 20% in women who did not participate.

Excessive stress has also been shown to affect how your baby develops in utero.  The mother’s own stress hormones affect the temperament of the baby after birth because the baby is exposed to these hormones during growth and development in the womb.  The fetus grows itself under the influence of excess stress hormones, and can be born with an increased risk of stress related pathologies such as developmental delays, learning disorders, lower IQ, depression and irritability. As adults these babies are at increased risk for heart disease, high blood pressure and diabetes.

Traditional Chinese Medicine is particularly effective at reducing the chronic or the acutely stressful state of mind.  An on-line article published by the Texas Fertility Center, a Western Medical Treatment Center that incorporates Acupuncture into their protocols, explained the mechanism by which stress can inhibit a woman’s capacity to conceive, and goes on to suggest that acupuncture relieves stress by stimulating the release of naturally occurring endorphins, our “happy” hormones.

There is a basic demonstrable biological axiom that women’s bodies (and all mammals for that matter), are physiologically impacted by their environments, and are less receptive to ovulation, fertilization, implantation and maintenance of pregnancy while experiencing unrelieved stress.

Modern causes of stress are complex and varied, but our bodies still react to stress in any form, in the same way as our progenitors.  If you’re stressed, your genetic memory signals to your body that it is not a safe time to be pregnant, and your body will take steps to delay pregnancy until life becomes less stressful.

And so if you’ve decided that you want to have a baby and are feeling a lot of stress, it’s important that you receive stress reduction treatment and make efforts in your daily life to reduce stress.  A little bit goes a long way.  See your acupuncturist once or twice a week to reduce your stress.  And please see below the section “Extra Credit: 13 Things You Can Do”.

Another way some women signal to their bodies that times are tough, is by over-exercising and under-eating.  Throughout humanity’s history, if we were having to run excessively, it was probably because we were being threatened.  Gentle to moderate exercise is great when you’re trying to conceive and throughout pregnancy.  But running as if your life depended on it is sure to give your body the wrong idea, even if it makes you feel good.  Take a break to have a baby!  Once you do, you’re sure to be lifting, carrying, and running like you were training for the Navy Seals, and you won’t even need a gym!

Likewise, throughout humanity’s history, a low BMI was seen in undernourished populations, and healthier BMI’s reflected well-fed prosperous and harmonious living.  When a woman’s BMI falls too low, nature takes over, and shuts down ovulation in order to protect a mother against the stresses of pregnancy during famine, as well as protecting a baby from malnourishment.  Having a little “baby fat” tells your body that times are stable enough with plenty to eat – good baby-making times.  At the other end are women with BMI’s that are high enough that fertility becomes effected.  A high enough BMI  is reflected by a 50% decrease in fertility.

Luckily Traditional Chinese Medicine works even if you don’t have an ideal BMI.  But saying that, when it comes time to have a baby, you may need to put some effort into living your life in a way that supports your fertility, through changes in diet, exercise and lifestyle.

To calculate BMI click here.  Bear in mind that BMI calculations are approximate because they don’t take into consideration your natural body type.  But the BMI calculator is a good reference. There are three basic body morphologies but this calculator works as if you were middle of the road.  If you are naturally skinny, or your healthy body has more curves, these values will be approximate only.  Although it’s not possible to change your basic body morphology, Traditional Chinese Medicine can help you to lose weight if your BMI is above 30, or increase your appetite if your BMI is below 19.

If you’re not sleeping well, that’s going to leave you in a state of physiological stress.  Women with insomnia have been shown to struggle with infertility at rates four times those of women who sleep normally.  Acupuncture and Traditional Chinese Medicine do a great job at improving healthy sleeping.  A consistent good night’s rest will do wonders if you’re sleep deprived.  Here is a link to the website for that describes the importance of sleep as part of a healthy lifestyle and how it impacts your fertility challenges along with effective steps that you can take home to manage your sleep better.

The goal is not to become “stress free”.  That would be impossible.  The goal is to reduce your stress by any amount no matter how small or for how short a time, on a regular basis every day.  By doing this you’re sending your body signals that it is a good and safe time to become pregnant and care for a new baby. Without your body’s unspoken permission and cooperation, becoming pregnant becomes more of an uphill experience.


Stress Reduction is effectively managed by Traditional Chinese Medical Treatment.

I practice stress reduction through Acupuncture, Moxibustion and through Tui Na Chinese Medical Massage.  Specific powerful Acupuncture points are indicated for alleviating stress, anxiety, and poor sleeping.  Application of the heat generated by the burning of Chinese Moxabustion herbs sends healing warmth into your body’s yang center, directly connected to the reproductive organs and the process of reproduction.  The warmth of Moxibustion is universally experienced as relaxing.  Tui Na massage moves the Qi and blood in your body, and improves hormonal balance and blood flow to the reproductive organs, in addition to freeing the blocked Qi in the meridians due to the experience of stress.

You have considerable control over what goes on with your body. When you decide that it is time to have a baby, there are plenty of simple things that you can do to reduce your stress and take care of yourself.  Think of it as homework, unless that stresses you out.  ( :

Extra Credit:  13 Things You Can Do

If you’ve made it this far on this page, I’m impressed!  But it’s not over yet because I want to present to you a Western portrait of stress, how stress affects your fertility, and some things you can do outside of Traditional Chinese Medical Treatment to help yourself be more fertile in the face of stress.

When you experience stress your body assumes the physiological state of  “fight or flight”, and your adrenal glands release cortisol, adrenalin and prolactin, all of which have the effect of shutting down healthy reproductive processes in your body.  Cortisol is known as the “Stress Hormone”.  During long term unrelieved physiological stress the release of these three substances confuses the balance of your fertility hormones, thereby putting up roadblocks to your ability to conceive.

When stress is removed, cortisol, adrenalin and prolactin restore to restive levels and your fertility hormones can do their job unhindered.  Anything that you do that consistently and regularly reduces your stress, for minutes, hours or any time between will bring your stress hormone levels down, thereby sending signals to your body that it is a good time to become pregnant.

Here are a list of 13 things outside of Traditional Chinese Medical treatment that you can choose from, to reduce stress in order to lower Cortisol and improve your Fertility.

  1.  Get your “best” sleep.  To do so, spend some time being physically active during the day, try to adhere to a set bedtime, avoid bright lights and staring at computer screens for extended periods.  Stop drinking fluids for at least a half hour before bed if doing so wakes you during the night for the bathroom, turn off your phone’s ringer, and use white noise or earplugs to block out noises.  And if you feel sleep deprived, take naps during the day.  What is important is that your mind and body feel rested.  Here is a link to one of the soundtracks I use in my office for relaxation.  It may help you get sleepy.  It is three hours long.
  2. Spend some time being physically active.  It is natural for humans to work their muscles every day.  Sedentary living is a modern phenomenon, and not one of our healthier inventions.  Yoga, Chinese Qi Gong Energy practice, and Tai Chi are also great ways to get your body moving.  For reducing stress and Cortisol, Tai Chi has a slight advantage over the other two forms.  And as a secondary benefit, since your reproductive organs lie between your heart and your legs, using your legs increases blood flow to your uterus, ovaries and fallopian tubes.  The quality of your eggs is considerably effected by the amount of nutrients and oxygen they receive while maturing.
  3. Recognize when you’re having stressful thoughts. We can’t avoid having stressful thoughts, but by simply recognizing and identifying when that’s going on, the experience of stress decreases a notch.  And when you can recognize stressful thinking caused by something that is within your control, you can reduce it.  A great example of this is Google surfing about infertility.  Giving yourself a bunch more stuff to worry about is not going to help!
  4. Breathe!  There are simple things you can do to make Stress and Cortisol decrease.  Invest in a relaxation or meditation app.  A 50% decrease in Cortisol has been demonstrated in individuals who habitually practice deep breathing exercises.  Massage reduces Cortisol by 30%.  Yoga, and Tai Chi in particular, lower Cortisol levels plus you get to meet interesting people!
  5. My Favorite Things.  Have fun!  Do cool stuff!  Make your own reasons to be happy!  Studies have demonstrated that laughing, gardening, outdoor activities and engaging in hobbies decreases stress.
  6. Be Patient.  Healthy Relationships are associated with lower stress levels.  And so it should come as no surprise that the opposite is true when there’s a less than perfect balance in the important relationships in your life.  Some guiding principles could include non-judgmental communication, intimacy, patience and affection.  Or if you feel like your partner relationship needs work there’s the couples therapy route!
  7. Puppy Kisses. Believe it or not, having a dog lowers stress hormones in your body.  The bad news is that if you already have a dog, to further decrease Cortisol levels you have to get another one.  (I’m serious). It’s also been demonstrated that being a loving and patient dog owner lowers your pup’s stress hormones, so everyone’s a winner!
  8. Only The Best!   Too often we stress out about our internal selves, and how we feel about ourselves.  Although we can minimize the importance of our own feelings, our internal selves play perhaps the biggest part of our experience of life. If you can remember two things when you’re having negative or stressful thoughts about yourself, you’re headed in the right direction.  The two things are pretty simple and are 1. recognition that you’re having negative or stressful thoughts about yourself, and 2. if only for a couple of seconds, fully allow yourself to feel without judging yourself.  Then let your mind go where it will again.  These tiny positive contributions will begin to impact the negative and stressful messaging that you give yourself.  A nice goal to aspire to is to treat yourself as you would treat others – you’re worthy of that kindness as much as others are.  Another thing you can do is to fix it if you can.  If you’ve created a situation that you could possibly remedy if you were brave enough, be brave enough! And as my mother says, if you meant no harm and it was out of your control, let the universe take care of it.
  9. Faith.   Prayer is good.  It’s not called meditation by accident.  People of Faith have been shown to have lower stress levels when they are actively practicing.  Hallelujah!
  10. Bon Appetite!  Good eating guidelines can be found everywhere.  The hard part is following them.  A healthy body produces less Cortisol.  Sugar increases Cortisol.  A healthy body produces a healthier pregnancy.  Obesity and over consumption can lead to gestational diabetes, which can cause your baby to grow too much for the space you have available.  So try to eat well, for your own health, your fertility, and for your developing baby.  Here’s a few pointers and bright spots specifically related to helping to keep your cortisol levels low:  Bananas and pears reduce cortisol.  So does dark chocolate, and occasional reasonable sweet treats.  Reward is a cortisol reducer – but not too much reward please.  If you rely on caffeine, Black and Green Tea produce less cortisol than coffee.  Yogurt and kimchi contain probiotics that help lower cortisol, but are optimally taken with prebiotics, which include soluble firer that feeds the probiotics.  The more hydrated you are, the better.  It’s important to stay optimally hydrated for a number of reasons ranging from the production of fertile cervical mucous before pregnancy, to maintaining healthy blood chemistry once you’re pregnant, to making sure your follicles/baby is getting the best blood supply it can.
  11. And that’s not all…  If you are trying to get pregnant, or are pregnant, there are certain agreed upon Supplements that you should be taking, and others that are sometimes recommended, and others that you should use in moderation or stay away from entirely.  There are two supplements that specifically lower cortisol levels.  The first is fish oil which is the best source of omega-3 fatty acids, which lower cortisol levels.  The other is Ashwagandha which is an Asian herb used to treat anxiety and stress, thereby reducing cortisol.  Here is a link to my own list of acceptable supplements, and another for supplements that should be avoided when pregnant or considering pregnancy.
  12. Join a Fertility Blog.  I have a 12,000 member favorite from the United Kingdom, so the language and drugs and the National Health System are a little different (and fun!), but it is very low stress and very very supportive.  In addition there are plenty of domestic blogs to choose from.  There are a ton of abbreviations used by women on fertility blogs.  It’s like being part of a secret club.  Here’s a link to abbreviations.  But always remember that although everyone is trying to be supportive, blog members are typically not technical people such as doctors, and you have to presume that information shared is incomplete and not expertly informed although members will speak with authority that they really don’t possess.  So never let a blog scare you!  Also, anecdotal experiences do not mean you are going to have the same experience.  Read with a grain of salt and soak up the support!
  13. Ditch Google! A huge stress comes from searching for answers on Google.  You want to know what’s going on, and the internet is the source for information.  Right?  And we find endless links and none of it leaves us feeling any better.  We tell ourselves that we will be more in control if we are better informed, but usually the information is vague enough to cause unwarranted confusion and further concern.  And almost always the information is disseminated by non-experts based on anecdotal events, that is perpetuated from person to person until it’s accepted as fact.  Rarely does the information that we find assure us.  There’s a real word for this. Cyberchondria.  You will not be increasing your chances of having a baby by spending hours mining the internet for information as your body floods with Cortisol and your blood pressure climbs.  Your progression on this journey will take it’s course whether or not you are glued to Google.  If you stay off the computer you will start noticing your stress levels decreasing.


Best Reproductive Practices

For males:

Ejaculations every two to three days, for two to three weeks (or as much time as is available), prior to having sex for pregnancy.  This practice reduces sperm DNA fragmentation and increases the percentage of high quality sperm cells in the ejaculate.

Abstain from ejaculation for three to five days prior to your sex for pregnancy attempt.  This will increase the number of sperm in the ejaculate, and will maximize the volume of semen, the vehicle that carries the sperm into the female reproductive tract.

When you have sex for pregnancy, assure at least 15 minutes of stimulation before ejaculation. This promotes the highest numbers of sperm and seminal volume for ejaculation. 

Avoid prolonged situations where the testicles become overly warm.  This includes tight underwear, warm baths and hot tubs, and any other situation that causes heat to accumulate.  

Try to engage in moderate exercise daily, and stay well hydrated.  This will increase blood flow to the testicles. An example of moderate exercise would be a 20 to 30 minute walk.

The following supplements have demonstrated improvement in one or more of: sperm motility, sperm morphology and sperm numbers. They have all been studied by the United States National Institute of Health. 

Chinese Ginseng, Maca root, L-Carnitine, Ubiquinol (CoQ10 derivative) and Grape Seed extract. Although all of these are available as included in specialty vitamins such as Fertilaid, you are better off taking the individual substances separately.

For Females:

Know when your LH spike occurs.  This is the best day for a sex for pregnancy attempt.  But due to the vagaries of the way your LH rises, you can get positive results of varying veracities over a period of as many as five days. This is because LH levels rise, spike and decline over a variable period of days. The strongest response is your best day to have sex for pregnancy.  Don’t use your first morning urine to test. Wait until your second urination so you don’t get a confusing false positive results. 

Ovulation occurs about 24-36 hours after your LH spike, but because it can take between 8 and 24 hours for the sperm to reach the egg, and because sperm can survive well in the female reproductive tract for up to five days, ejaculation into the female reproductive tract needs to take place about a day before ovulation.  If you wait until you ovulate, you may well have missed your window of opportunity for fertilization to take place. The ovulated egg cell will only survive for about 12 hours unfertilized, and so it is important for sperm to reach the destination where fertilization will take place in the fallopian tube before ovulation occurs.

Most women can reliably use Ovulation Predictor Kits (OPK) to let them know when they are spiking on LH (luteinizing hormone).  The LH spike predicts that ovulation will take place about 24-36 hours later, therefore when you get your strongest positive test result this is when you should have intercourse because of the time it takes sperm to travel to the site of fertilization, and because sperm will survive for up to 5 days in the female reproductive tract.  Optimally your partner has abstained from ejaculation for three to five days prior to this attempt. Try only once on this day. Multiple ejaculations will decrease the number of sperm and semen per ejaculation. On the day following your LH spike (strongest positive OPK test), have sex only once on that day, as a back-up to your best effort the previous day.  Thereafter it won’t matter insofar as fertilization taking place, so sex need not be regulated.  Having sex thereafter will not negatively impact your ability of achieving fertilization or implantation.

For those who monitor their basal body temperature (BBT), the temperature increases about 12 to 24 hours after ovulation. Although this temperature increase is convenient to confirm that ovulation has taken place, it is useless as an indicator for when you should attempt sex for pregnancy. By the time BBT temperature has increased, you have missed your window of opportunity to provide sperm for fertilization to take place. Sex for pregnancy needs to take place prior to ovulation, and as indicated by a positive OPK test results roughly 24-36 hours prior to ovulation. 

An alternative to the OPK test for determining your LH spike is done by monitoring cervical mucus, uterine position and cervical texture. When the LH spike occurs, the uterus pulls up and back into a higher position and is less easy to reach by fingers. Also, the texture of the cervix softens and the cervical opening is more open. A common comparison states that your cervix will change from feeling like the tip of your nose with the os (opening) feeling closed, to feeling like your lips, with the os now somewhat open. Lastly, your cervical mucous will change from watery to more like egg whites, and with the quality of “spin”, as when a bead of mucous forms a string between two fingers as they slowly separate. Any of these changes indicate ovulation is imminent and sex for pregnancy should take place as soon as is convenient.  It takes a little practice to become familiar with these changes.

Ovulation predictor apps have become popular because they are a high tech and easy to use option. Unfortunately, unless you have a cycle of unvarying consistency and are able to accurately determine when your LH peak happens, these apps are potentially unreliable. Some of these apps assume a luteal phase of 14 days, take an average of the reported length of your recent cycles, and subtract 14 days to arrive at your ovulation day, often inaccurately.  Since your window of opportunity for fertilization is approximately 12 hours, a mistake of a day or more by one of these apps can be disastrous. Please do not rely on these apps by themselves to predict ovulation. 

The Ava Fertility Tracker is a high tech device that measures your body temperature and other variables to predict when you will ovulate. Although it is easy and relieves you of the task of taking your temperature when you first wake, my belief is that it is not as accurate or reliable as orally determining your BBT. And as discussed above, BBT is only useful to tell you that you have already ovulated.  The other variables that Ava monitors have only been claimed as useful by Ava itself, and there is no good research to support Ava’s claims. I encourage women who enjoy the convenience of Ava to use a secondary and more reliable means of predicting “fertile days” and ovulation, such as OPK tests and monitoring of cervical morphology, position and mucous. 

By design, the uterine muscle contracts during female orgasm, and in response to chemicals present in male semen (prostaglandins) to a lesser degree. The contractions have the effect of pulling semen into the uterus and propelling it into the Fallopian tubes where it will ultimately fertilize the egg as it travels down. If possible, the female should experience orgasm following ejaculation as the contractions produced by orgasm are typically more forceful than those produced by the chemicals in the semen. 

Assure that you maintain proper hydration by drinking about two liters of water, or about 8 eight-ounce glasses of water per day. Avoid decongestants and allergy medications that vasoconstrict. They affect blood flow to the arteries supplying follicles and the uterus, and can cause fertile mucous to become hostile to sperm.  Exercise moderately every day to assure good blood circulation to your reproductive organs. For example 20-30 minute walks are a good option. 

Supplements that have been studied by the NIH (except Ubiquinol, but there’s suggestive anecdotal evidence) and shown to better several fertility factors include Black Cohosh (endometrial lining enrichment), DHEA (increase in egg quality), Vitex* (“Chasteberry”, regulate reproductive hormones and support progesterone production), Ubiquinol (CoQ10 derivative), and Emerita brand bio-identical Progesterone cream (Progesterone support to be used after ovulation).  L-arginine* used in conjunction with Vitamin E demonstrated an increase in the thickness of endometrial linings of women struggling with thin endometrial linings.

*L-arginine combined with Vitex is available in a well-regarded supplement called Fertility Blend for women.