How does stress impact fertility?

Stress significantly impacts fertility through its effects on several physiological systems, most notably ovulation (due to suppression of the adrenal’s release of progesterone), thyroid function, and adrenal health. In this article, we’ll cover:


  1. How stress delays ovulation by suppressing progesterone secretion by the adrenals
  2. How stress affects thyroid function (which indirectly influences FSH levels)
  3. How stress causes estrogen dominance

Stress and ovulation

Little known fact… the adrenals produce progesterone and (indirectly) estrogen.

While it’s widely thought that a surge in luteinizing hormone (LH) prompts ovulation, a corresponding release of progesterone by the adrenals precedes ovulation (and may be the trigger for that LH surge).

In fact, in the absence of the progesterone spike, high levels of luteinizing hormone cause follicles to vanish entirely (vanishing follicle syndrome).

Studies around this are new but compelling and invite a revision to thought around the role of stress in ovulation.

We’ll take a look at adrenals and estrogen dominance a little later in this article.

For now, let’s dig a little deeper into progesterone’s role in ovulation.

Progesterone and Ovulation

In the adrenal glands, cholesterol is the precursor for many of the hormones made within the adrenals.

Cholesterol is converted to pregnenolone which then goes down either the progesterone pathway or the androgen pathway (DHEA).

Progesterone is the precursor to several stress hormones (notably cortisol) in the adrenals.

In times of stress, demand for cortisol is high and so more progesterone is consumed to create cortisol for the body to deal with the stressor.

So, when you get stressed and ovulation is eminent, it’s possible to have an anovulatory cycle (no egg released) or a delayed ovulation because there’s simply not enough progesterone left to allow for that progesterone spike needed to prompt ovulation.

 The role of thyroid hormone and ovulation

Stress can affect thyroid function by altering the regulation of thyroid-stimulating hormone (TSH) and the thyroid hormones (T3 and T4). High levels of cortisol are also known to suppress the hypothalamic-pituitary-thyroid (HPT) axis, which reduces thyroid hormone production.

And, dysregulated cortisol (either too high or too low) prevents cellular uptake of thyroid hormone from the bloodstream which causes a hypothyroid state in the body’s tissues and impacts ovulation (while increasing levels of follicular stimulating hormone (FSH) secreted by the pituitary.

Hypothyroidism (either due to low secretion of thyroid hormones by the thyroid gland or due to the thyroid hormones, T3 and T4, not being able to make their way out of the bloodstream and into the body’s tissues, is a leading cause of infertility.

Estrogen Dominance and Healthy Ovulation

Surprisingly, androgens made by your adrenal glands are able to convert to estrogens in the body’s tissues. I have a theory (based on what I’ve seen with at-home urine monitoring) that imbalances in salt regulation (i.e. too much salt in the diet) increase adrenal production of androgens resulting in estrogen dominance. Estrogen regulates blood volume (fluid retention) and protects against the excess salt.

One other aspect of this (not my own theory, instead this one’s solidly backed by research) is adrenal fatigue also increases adrenal production of androgens resulting in estrogen dominance. The reason for this is that the hormone ACTH (released by the pituitary) is made in excess when the body needs more cortisol (either due to stress or due to the adrenals not responding well/not making cortisol very well as happens in adrenal fatigue).

ACTH stimulates secretion of both cortisol and DHEA which serves as a precursor to other androgens (like testosterone) and ultimately estrogen. When too much DHEA is secreted, it’s possible to shunt more of it down the estrogen conversion pathway leading to estrogen dominance.

And, this leads me to another question… does supplementing with DHEA (which can be purchased over the counter) lead to estrogen dominance?

We’ll explore that in a future post 🙂.


1. Progesterone and Ovulation: Whirledge, S., & Cidlowski, J. A. (2010). Glucocorticoids, stress, and fertility. *Minerva Endocrinologica*, 35(2), 109–125. This article discusses how glucocorticoids (like cortisol) affect reproductive function, including impacts on progesterone levels and ovulation.

2. Thyroid Function: Poppe, K., Glinoer, D., & Tournaye, H. (2007). Thyroid dysfunction and autoimmunity in infertile women. *Thyroid*, 17(11), 1075–1083. This study explores the relationship between thyroid dysfunction, autoimmunity, and infertility, highlighting the importance of thyroid hormones in reproductive health.

3. Adrenal Health: Mastorakos, G., & Ilias, I. (2003). Maternal and fetal hypothalamic-pituitary-adrenal axes during pregnancy and postpartum. *Annals of the New York Academy of Sciences*, 997(1), 136–149. This review provides insights into the role of the hypothalamic-pituitary-adrenal axis in pregnancy and postpartum, with implications for stress and fertility.

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