Pregnancy is a funny thing. Many women spend most of their lives trying to avoid it, only to suddenly decide it's 'game time' and that they would like to conceive in their next cycle, thank you very much.
But of course, life doesn't always go to plan, and given many women are now choosing to start families later in life, coupled with the fact fertility is ageist, a successful pregnancy without some form of assistance may simply not be possible for some Australian women.
And so begins the process of specialist appointments, monitoring ovulation cycles, submitting oneself to various tests and, depending on the situation, potentially IVF treatment.
All of which can amount to a very stressful experience, which in itself may affect fertility. Talk about unfair, right? You're stressed because you can't get pregnant, and then that stress goes ahead and makes it even harder to fall pregnant, which in turn makes you more stressed. GEE THANKS, BODY.
So just how much does stress impact your likelihood of falling pregnant, and how can you effectively manage it?
The science behind stress and fertility
"It's a very involved conversation with respect to fertility," Dr Simone Campbell, specialist with City Fertility Centre, told The Huffington Post Australia. "There are differing pieces of evidence with respect to stress.
"We know, of course, that women can get pregnant even when extremely stressed, for example in war situations, rape situations. It does not stop pregnancy across the board."
However there's also evidence to suggest stress does have an impact. For instance, some research shows stress can interfere with fertility by preventing the actions of a key reproductive hormone known as gonadotropin releasing hormone (GnRH). On top of that, research from the University of California Berkeley shows stress can also result in the increase of another type of hormone, the Gonadotropin-Inhibitory Hormone (GnIH), which further impedes the actions of GnRH.
(So in layman's terms: stress is not only messing with the productivity of the 'good' fertility hormone GnRH, it's also causing the body to release another type of hormone which is messing with it even more).
What we're talking about in many ways is not something which is an absolute. There are variations in how much it can affect an individual, like everything else we see in the world.Dr David Knight
"We also know stress increases cortisol, which we know has negative effects," adds Dr David Knight, IVF specialist from Demeter Fertility.
"There's also evidence acute stresses can certainly be associated with change in a woman's cycle.
"So yes, we do have direct evidence that stress affects reproduction. The problem of course is, at a bigger level, how much? Being raped is pretty stressful. Being raped in a war zone is pretty stressful too. Yet we know that these women who are raped in war zones can still conceive and have babies.
"What we're talking about in many ways is not something which is an absolute. There are variations in how much it can affect an individual, like everything else we see in the world."
Stress and fertility treatment
Now, no one is saying the levels of stress faced while trying to fall pregnant is anywhere near the levels of stress faced while trying to stay alive in a war zone. So let's just get that well and truly out of the way.
But to say the process of seeking fertility treatment is stress-free would not only be unfair, but incorrect. It is stressful. For some, massively so.
"When we look at how people look at fertility treatment, associated with their lack of ability to conceive, and we do psychometric testing in regard to how they are going emotionally, we find the degree of personal stress is not dissimilar to those diagnosed with malignancy," Knight told HuffPost Australia. "So it's pretty stressful.
"The difference is when someone's got cancer, everyone rallies around them and they have unconditional support. If people have problems conceiving, you don't get that so much.
Google is no help at all. [Couples] will look up absolutely every symptom and by the time they see me, they are so over-educated, but not with the right education. Dr Simone Campbell
"So those who are having trouble conceiving often don't tell other people. I guess there is this view, on a societal basis, that people who have trouble conceiving aren't valued as highly as those who do.
"In certain cultures, for instance, you don't have sex before you get married, and as soon as you do, you're supposed to start reproducing. If you don't, you're selfish, irrespective of whether you have control over it or not.
"So there are societal riders that will flow on top of the diagnosis and can add even more stress to the situation."
Furthermore, the very nature of trying to make something happen which, realistically, is outside of your control, can be emotionally draining.
"People can become so focused on everything about their cycle. They're thinking about when they have to have intercourse... they're thinking about it all the time," Campbell said.
"Looking at a group of couples trying actively to get pregnant, I also have to say Google is no help at all. They will look up absolutely every symptom and by the time they see me, they are so over-educated, but not with the right education. In my opinion, this only adds to the stress."
While it is difficult to establish exactly how much stress affects fertility, it can only be assumed that managing that stress is a good thing (even if it has nothing to do with your reproductive chances and everything to do with your sanity).
"How much does stress affect, overall, your chances of conceiving? Well, we don't know," Knight said.
"It's hard to quantitate. For instance, we look at people who have depression and people who don't have depression, and we see similar pregnancy rates. So at least in those circumstances, one psychiatric disorder doesn't appear to decrease the chances of getting what you want.
"How you feel about it, of course, is a different thing.
"It is always possible to manage things. It just depends on a person's desire and ability to do so."
One could further argue it also depends on what options are available to them, which could be why some fertility clinics and practices are expanding their offerings to include more support when it comes to their patient's emotional well-being.
I can't offer couples a 100 percent guarantee of pregnancy or say they will be pregnant in three months' time. Sometimes this means they give up on treatment, just because the stress gets too much.Dr Simone Campbell
City Fertility Centre, for instance, has partnered with Positive Mind Body Australia, a health and well-being organisation which offers a special program tailored to address the unique issues associated with fertility stress.
Developed by Dr Alice Domar, a leading psychologist in the US and Associate Professor at Harvard, the program has been successfully running in Boston for over 25 years.
Campbell, who works at the centre, is a big fan of the program.
"It actually gives [couples] a way to deal with some of that stress," she told HuffPost Australia. "Which is such a great thing. It's not going to go and necessarily result in them getting pregnant, but it makes what I am doing for them so much more manageable. They are able to deal with the process better.
"Because, at the end of the day, I can't offer couples a 100 percent guarantee of pregnancy or say they will be pregnant in three months' time. Sometimes this means they give up on treatment, just because the stress gets too much. But if we're talking about expectations and they are able to manage those expectations, it makes the process a lot easier."
I have always had this saying that 'happy women make happy eggs'. Dr David Knight
Knight, also, only has good things to say about couples seeking to manage the stress associated with fertility treatment, if only for the fact it means they are less likely to give up on the process before they are successful.
"Look, I haven't seen any data saying that decreasing stress improves your chance of having a baby," Knight said. "But in the same breath, I have always had this saying that 'happy women make happy eggs'.
"I think there is this tendency for people to be really negative about fertility treatment. But here's the reality. No one wants it, but if you're never going to have a baby unless you have fertility treatment, isn't it fantastic that it's there? Otherwise you'd never have a baby. So realistically, no one likes doing anything in medicine, but gee whiz, when we need something, we're glad to have it around.
"Any medical procedure is stressful. But it's important to continue to live your life while you are going through it. If you're able to be positive about your cancer diagnosis, for example, it doesn't change your rate of survival, but it makes the remainder of your life better because you are looking at your life in a different way.
"Similarly, you are better off if you can view life in more positive light at the time you are undergoing [fertility] treatment. Yes, that is easier said than done. I know from personal experience. [My wife] Sonja and I did a number of cycles of IVF and I have to say, I found myself a number of times getting pretty pissy with the fact I wasn't getting what I wanted."
There is no point giving up one cup of coffee a day, or one glass of wine every few days. There is no point if you enjoy doing those things. Dr David Knight
In the event you are undergoing fertility treatment and are finding the process to be stressful, it may be worthwhile seeking out counselling, or a service such as the Mind Body Program, or at the very least attempting to get on with life as you normally would.
"It would be great if there was a special fix but there's not. It would be great if the human body made eggs that made babies, and more often, but it doesn't," Knight said.
"My advice to patients is to make the treatment just a part of your life. Don't make your life your treatment.
"Live your life, stick this in there, try and make it as minimally intrusive as it can be. All medicine is intrusive, yes, but get on and have fun. Don't do things that aren't going to help or are going to make your life worse.
"There is no point giving up one cup of coffee a day, or one glass of wine every few days. There is no point if you enjoy doing those things. Do the things that count and if they don't actually work, accept it and get on.
"It's hard, yes. But you don't get to play for Australia without going for training. If you want to be great, you have to do the things that help you be great."