Life Course Events and Reproductive Function: Examining the Long-Term Influence of Stress on Women's Fertility and Reproductive Health Over the Life Course
Gleason, Jessica L
Thoma, Marie E
Moser Jones, Marian
MetadataShow full item record
Over the last decade, infertility, or the inability to achieve pregnancy after 12 months of trying, has risen to a place of public health prominence, with links being made to cardiovascular disease, diabetes, cancer, and other chronic disease. The mechanisms linking infertility to later-life morbidity are unclear, but are most likely due to shared physiologic pathways, such as chronic perturbation of the stress response axes. This investigation had three primary aims: understanding the current state of the research on psychosocial factors as precipitants of infertility by conducting a systematic scoping literature review; exploring associations between infertility-related conditions, endometriosis and uterine fibroids, and chronic inflammation and telomere attrition; and, examining the temporal influence of early life stress on infertility. For the first aim, few studies were identified that directly explored a temporal association between psychosocial factors and infertility, though these studies support the plausibility of this association. For the second aim, women with endometriosis had higher odds of having elevated levels of the inflammatory biomarker, C-reactive protein, and their telomeres shortened at a rate of 1% for every year of diagnosis of their condition. Black women with endometriosis had 13.6% shorter telomeres than those without endometriosis. For the third aim, the experience of stressful life events (SLEs) was associated with elevated odds of infertility, which increased with each increasing event, such that women reporting three and four or more events had 1.68 (CI: 1.16, 2.42) and 1.88 (CI: 1.38, 2.57) higher odds, respectively. Maternal responsiveness moderated this association, such that those with lower responsiveness had higher increasing odds of infertility with the experience of two, three, or four or more events (OR=1.98, CI: 1.01, 3.93; OR=2.63, CI: 1.18, 5.89; OR=3.07, CI: 1.53, 616). The results of this investigation indicate that there may be a temporal association between stress and infertility. Additionally, given their associations with reproductive function, inflammation and stress may be part of the shared mechanisms linking infertility to poor overall health, as well as future health outcomes.