Psychotherapy can help restore fertility in women who become so stressed from managing their busy lives that they stop ovulating, a conference heard.

A pregnant woman receives a prenatal screening. Psychotherapy can help restore fertility in women who become so stressed from managing their busy lives that they stop ovulating, a conference heard. [AFP]

Fertility experts have long wondered why women who are active, young and otherwise healthy suddenly become infertile, a condition called anovulation.

The causes are sometimes attributed to hormone changes caused by too much exercise or undernutrition, and often the woman is given hormone treatment, such as oral contraception if immediate fertility is not desired, or ovulation induction if it is.

But Sara Berga, a professor of gynecology and obstetrics at Emory University in Atlanta, presented preliminary research which suggests that, among such women, the cause of anovulation lies with stress and it can be reversed through psychological help.

Berga's team looked at 16 women who were of normal weight who had not menstruated for more than six months.

Some were perfectionist types whose lifestyle, either at home or at work, placed them under a lot of stress, while others felt overwhelmed by the demands their lives made on them.

The 16 had functional hypothalamic amenorrhea (FHA), a type of infertility caused by a prolonged reduction in a hormone that initiates a molecular cascade that leads to ovulation.

The telltale, though, was analysis of the women's spinal fluid, which showed high levels of cortisol, a hormone that is a marker of stress and is often linked to depression, osteoporosis and other health problems.

The women were randomly divided into two groups. Half received cognitive behaviour therapy (CBT) for 20 weeks -- psychological counselling designed to help them put their problems in perspective. The other half were simply observed.

"A staggering 80 percent of the women who received CBT started to ovulate again, as opposed to only 25 percent of those randomized to observation," Berga told the annual conference of the European Society of Human Reproduction and Embryology (ESHRE) in Prague.

In the CBT group, six regained full fertility and one showed some signs of restored ovarian function. Two of the six became pregnant within two months.

In the non-CBT group, only one recovered her fertility, and one showed some signs of ovarian function.

"This study underlines the important contribution that lifestyle factors play in determining overall health and reproductive health in particular. To reverse stress-induced ovulation, it is not enough simply to address metabolic sources of stress," said Berga

Berga pointed out the cost and side effects of conventional hormone treatment as compared to CBT. None of the 16 women gained weight or showed important shifts in levels of leptin, a hormone linked to weight gain or metabolic change.

The next step will be to widen the research with a larger number of he women.

"If the larger scale study confirms our earlier results, we will have very strong evidence for offering stress reduction as an effective therapy for a significant group of fertile women," said Berga.