Non-pharmacologic approaches to stress-induced infertility

The neuroendocrine system is a complex network of biological mediators that integrate incoming information to elaborate an action plan designed to promote survival. The hypothalamus is the neuroendocrine integration station, and it transmits information to effector systems, particularly via the pituitary gland. Stress impacts all aspects of the complex neuroendocrine network, particularly the reproductive system via the hypothalamic-pituitary-gonadal (HPG) axis. Functional hypothalamic amenorrhea results from synergistic interactions among psychogenic and metabolic stressors and results in altered hypothalamic function, including suppression of the GnRH drive to the pituitary. Other neuroendocrine concomitants invariably involve activation of the HPA axis and suppression of the hypothalamic-pituitary-thyroidal (HPT) axis. The key to treatment is to reset the hypothalamus in order to recover from the constellation of neuroendocrine aberrations. Interventions that reduce the activation of HPA and/or increase HPT will increase GnRH drive and permit recovery of HPG activity. Cognitive behavioral therapy, hypnosis, and protocols that reduce stress are therapeutically effective in treating stress-induced infertility while avoiding the pitfalls of pharmacological interventions. The impact of these non-pharmacological interventions, unlike medications, has the potential to accrue with time.