THE TRUTH ABOUT ‘ADRENAL FATIGUE’ AND INFERTILITY
Why “Adrenal Fatigue” isn’t real — and how it affects fertility.
Let me start with the facts: adrenal fatigue is not a real medical diagnosis.
It's not recognized by the Endocrine Society (doctors MOST specialized in adrenal function), the American Medical Association, or any major medical organization in the world. There are no published studies demonstrating that chronic stress causes your adrenal glands to become "fatigued" or "exhausted."
And yet it's talked about all. the. time. It's also super appealing because it seems to explain SO much!
So this might be really hard to hear, especially if someone has sold you on the idea that this explains why you're exhausted, can't lose weight, or haven't yet conceived. But stay with me, because while adrenal fatigue isn't real, your exhaustion absolutely is. And understanding what's actually happening in your body is the first step toward feeling better.
What real adrenal failure looks like.
Your adrenal glands can fail. It's called adrenal insufficiency, or Addison's disease, and it's a serious, life-threatening medical condition that looks nothing like what gets labeled "adrenal fatigue."
Real adrenal failure means severe weight loss, dangerously low blood pressure, skin darkening, and often landing in the ER in adrenal crisis. This is not "I'm tired and stressed and can't handle my to-do list." This is "I might die without immediate cortisol replacement."
And it shows up clearly on standard medical tests. Your doctor doesn't need to measure your salivary cortisol at four time points throughout the day or order a DUTCH test. If your adrenals have actually failed, basic medical testing will show it. I explain why DUTCH testing is often harmful to fertility here.
What are salivary cortisol and DUTCH tests actually measuring?
When you do salivary cortisol or DUTCH testing that shows a ‘flat cortisol curve’ or ‘low cortisol,’ you're seeing a snapshot of your body's stress response pattern at one moment in time. Remember that cortisol surges 50-60% in the first 30-40 minutes after waking, then it declines throughout the day with 12-18 distinct pulses in 24 hours. So time of day accounts for 72% of the variance in cortisol levels.
A ‘flat curve’ doesn't mean your adrenals are exhausted. It might mean you're in chronic stress adaptation, you didn't sleep well, your circadian rhythm is disrupted, you have depression, you're in a different phase of your cycle, or you're simply having a high-variability day in a hormone system that’s designed to be variable.
But needless to say, your adrenals are still working. In fact, they might be working overtime trying to help you survive the conditions of your life. The test just captured a snapshot of that survival response and labeled it ‘dysfunction.’
The real problem is you're stuck in stress cycles.
Here's what we need to understand about stress. Your stress response is one of the most elegant survival systems ever evolved. When you encounter a threat, your body mobilizes everything you need - energy, focus, strength, and speed.
The way it’s supposed to work is after the stressor resolves, your body is designed to complete the cycle through physical discharge (shaking, crying, laughing, moving), then return to baseline, social connections, and integration where your nervous system registers ‘the threat is over, I survived, I'm safe.’
But the problem is modern life keeps you stuck in the middle without ever letting you complete the cycle.
You wake to your alarm (a threat), immediately check if your period started (a threat), take your temperature and log your data (high alert monitoring), rush through getting ready while thinking about timing intercourse (pressure), sit in traffic calculating cycle days (anxiety), go to work where nobody knows what you're going through (isolation), smile through a pregnancy announcement (cortisol spike), come home to inject yourself or take another round of supplements (stress and medicalization), scroll Instagram seeing everyone else's IVF success and baby announcements (comparison, grief), sleep poorly because you're in your two week wait or worried about your next appointment, you then wake up and start it all again.
Where did you discharge the stress? And where did your body get to complete the cycle?
You didn't ‘run from the lion’ — you sat through another day of limbo and lack of control. You didn't fight the predator — you smiled and said "congratulations" when your heart was breaking. Your stress response kept mobilizing energy with nowhere for it to go.
This isn't adrenal fatigue. This is living in relentless, unresolved activation. Your adrenals are doing their job — responding to the signals your brain keeps sending, which are threat, threat, threat. The problem isn't that they're tired. The problem is they've never been told the threat is over.
This is why I focus on whole-person fertility care rather than chasing isolated hormone markers.
When stress responses don't complete, your body adapts. Initially you feel wired and tired — anxious about every twinge, googling symptoms at 2am, unable to stop thinking about your protocol. Over time, your nervous system may shift toward blunted responses, feeling flat or numb, and profound fatigue. Basically, going through the motions but feeling disconnected from hope.
This isn't your adrenals giving up. It's your nervous system trying to protect you from burning out by dampening the alarm system. And so this creates chronic inflammation, disrupted sleep, impaired immune function, blood sugar dysregulation, digestive problems, reproductive disfunction (because your body doesn't prioritize reproduction when it thinks you're being chased by tigers), mood disorders, brain fog, and chronic pain.
These symptoms are real. But it's not because your adrenals are fatigued. It's because you're living in conditions that keep your stress response chronically activated without completion.
Why the ‘adrenal fatigue’ framework harms you.
When someone diagnoses you with "adrenal fatigue" and prescribes adaptogens and adrenal support supplements, this framework creates two devastating problems:
1. It externalizes the solution and misses real issues. The focus becomes fixing your biochemistry rather than examining the conditions of your life. You're looking for the right supplement combination instead of asking what needs to change. Meanwhile, you're not addressing undiagnosed hypothyroidism (incredibly common in fertility patients), iron deficiency, vitamin D deficiency, depression, sleep disorders, or blood sugar dysregulation. All actual treatable conditions that impact fertility.
2. The diagnosis itself becomes another stressor. Now you're not just struggling to conceive, you have test results showing something is ‘wrong’ with your body. Now you have another supplement protocol to time correctly, another thing to optimize, another body system that's ‘failing’ you. You can't complete stress cycles when the ‘treatment’ for your stress creates more stress and more monitoring and more things to get right.
The adrenal fatigue diagnosis deepens the sense that your body is betraying you. Exactly the opposite of what you need when you're already navigating the grief, uncertainty, and physical demands of trying to conceive.
What does help? Here’s 7 ways to complete the stress cycle.
If your exhaustion isn't about adrenal fatigue, then what helps? The answer is about completing stress cycles and creating conditions for your nervous system to return to safety.
1. The Physical Completion of Stress Cycles
Your body mobilized energy to handle a threat, and that energy needs to go somewhere.
Movement. Walking (especially in nature), dancing, shaking, stretching, any movement that feels good and allows release. Not ‘workouts to optimize egg quality or lose weight’ — but ways of letting your body know the threat is over. A walk around the block after seeing another pregnancy announcement. Dancing in your kitchen after your trigger shot. Simple stretching after sitting through another appointment.
Breathwork. Long exhales signal your nervous system that the threat is over. Box breathing (4 counts in, hold 4, out 4, hold 4), physiological sighs (deep inhale, second short inhale, long exhale), or any practice emphasizing longer exhales than inhales. Do this before trigger shots, before checking pregnancy tests, and after difficult conversations.
Physical release. Crying when you need to cry (after another negative test or in your car after the baby shower you couldn't skip), a genuine belly laugh with a friend who gets it, shaking or trembling (what animals do naturally after threat), and progressive muscle relaxation which my IVF Transfer Meditation guides you through.
2. Tend and Befriend: The Biology of Social Connection
Women have a specific stress response pattern often overlooked — tend and befriend. When under threat, women instinctively care for dependents and seek connection with others. This response is underpinned by oxytocin, which counters cortisol's effects.
When close relationships are threatened or you're socially isolated, plasma oxytocin rises — a biological signal calling for connection. This is why social isolation during fertility challenges is so physiologically damaging. You're not just emotionally alone, your biology is actively calling for connection as a stress-regulation mechanism.
Tending. Tending can look different when you don't have living children yet, or when being around young children feels too painful right now.
Caring for pets — the oxytocin release from petting a dog or cat is real and powerful
Tending plants or a garden — something growing, something alive, something you're nurturing
Caring for nieces, nephews, or friends' children if and only if that feels good — it's completely okay if it doesn't
Volunteering for causes you care about
Mentoring someone in your field
Any act of nurturing that feels authentic
If you're navigating secondary infertility and have living children, caring for them naturally activates your tend response. But if baby showers and children's birthday parties feel like torture right now, you're not broken. Your body is protecting you from additional pain. It’s ok to honor that.
Befriending. Befriending can mean:
Actually talking to friends who get it — not just texting "I'm fine"
Physical affection with people you trust — hugs with your partner that aren't about intimacy timing, or hand-holding with a friend who knows your story
Being in community — fertility support groups, acupuncture waiting rooms where everyone just gets it, or online spaces where you don't have to explain
Sharing your actual struggles instead of maintaining the ‘everything's fine, we're just relaxing and it'll happen’ facade
Connecting with others on this path who understand the very specific grief of announcements, due date math, and pregnancy symptoms that never come
Being helped by others by letting someone bring you dinner after a failed cycle, accepting the offer to skip the baby shower, or receiving care instead of always giving it
This isn’t optional. For women, social connection is a biological necessity for completing stress cycles. Your body literally uses oxytocin to counter cortisol. If you're isolated — maybe because talking about fertility feels too vulnerable, or because you don't want to ‘burden’ others with another update, or because you're protecting yourself from more pregnancy announcements — your nervous system cannot complete stress cycles effectively. It thinks you're all alone facing threats.
3. Boundaries and the Radical Act of Saying No
If you're stuck in chronic stress response, something in your life is relentless. And adaptogenic herbs aren't going to fix that. But do you know what might? Not ‘managing your stress better’ while maintaining an impossible load. Not bubble baths while everything stays the same. But by actually examining what needs to stop, and simply saying “No.” Maybe for you it’s:
The baby shower you don't have to attend
A family member who keeps asking "Any news?" or “Why not adopt?”
The friend who complains about her pregnancy
A work project that conflicts with your monitoring appointments
The social media scrolling that leaves you comparing your cycle day to everyone else's announcement
The expectation that you'll host another holiday while you're mid-IVF
The well-meaning advice from people who conceived easily
Your perfectionism demanding you optimize every single variable while also staying positive
Boundaries are how you tell your nervous system, "The threat can end." When you say ‘no’ to what depletes you, you create space for your body to complete stress cycles.
This is especially hard when trying to conceive because everyone has opinions about what you should try, how you should feel, or whether you're stressed (which they've heard is bad for fertility — thanks everyone!) But your body will not prioritize reproduction when it thinks you're in danger. And chronic, unrelenting stress, including the stress of having no boundaries around your fertility journey, signals danger.
Boundaries aren't selfish. They're essential for the nervous system regulation that allows fertility to flourish.
4. Pause and Reset: Tending to Your Own Needs
Your body needs you to actively signal, "I'm stepping out of the threat response. I'm listening to myself now."
Micro-pauses. Actually taking your lunch break instead of googling studies about your protocol. Five minutes in your car before going into the clinic. One conscious breath before opening the patient portal. Closing your eyes for 60 seconds between logging symptoms and moving on with your day.
Deliberate tending. A shower where you're actually present and not calculating how many days until your beta. Making yourself tea and sitting down to drink it. Putting on clothes that feel good on your body today, regardless of bloating. Going to bed when you're tired instead of staying up to research one more thing. Time in nature even if it's just sitting on your front step.
Befriending your experience. Journaling without an agenda by not just tracking symptoms but letting your actual feelings flow. Meditation as listening (not as stress reduction you're doing for egg quality). A nap when your body asks for rest, even in the middle of stims. Reading something purely for pleasure that has nothing to do with fertility. Watching something that makes you laugh.
Connection that refuels. A date night with your partner where you don't discuss protocols or timing. Coffee with a friend where you can be real about how hard this is. Time with people who don't need anything from you and aren't tracking your cycle. Or choosing solitude if that's what restores you.
Boundaries as self-care. Not answering your phone when your mother-in-law calls to check if you're pregnant yet. Leaving the baby shower early because you're done. Protecting your weekend plans even though your sister wants you to babysit. Saying "I'd rather not talk about it" when someone asks about your fertility.
These aren't ‘self-care treats’ you earn after doing everything else. They're essential interruptions to the stress cycle. When you pause and reset, you're telling your nervous system, "We're safe enough to stop. We're safe enough to have needs."
5. Reassessing Extreme Measures Born of Desperation
When people are desperate to conceive, they often adopt extreme measures, like cutting out entire food groups because someone on Reddit said it worked, taking 20+ supplements, rigid fasting protocols, eliminating all ‘fun’ foods, obsessive tracking of every symptom, severe calorie restriction or extreme macros to ‘optimize body composition.’
These feel productive. They feel like control when everything about fertility feels out of control. They feel like you're doing something when waiting is torture. But your body doesn't experience restriction as ‘optimizing,’ it experiences it as scarcity — which is another form of threat. And scarcity signals don't tell your body that now is a good time to reproduce.
Ask yourself, is this sustainable? Can I do this for years if needed? Does this feel good, or am I white-knuckling? Am I doing this because evidence shows it helps, or because I'm desperate and it feels like ‘doing something’? Has this actually improved my cycles or energy, or just given me a sense of control?
Sometimes the most radical thing you can do is stop the extreme measures. Eat three meals a day with pleasure. Move in ways that feel good, not punishing. Sleep more instead of 7AM acupuncture to ‘support implantation.’ Release the rigid rules that make you feel like a failure every time you can't follow them perfectly. Let your body relax into having enough.
This might feel terrifying if you're convinced only extreme effort will work. But I've seen it repeatedly. Women who broaden and soften and get bigger picture get better. Cycles regulate, energy returns, and conception happens. The all-or-nothing approach often adds more stress than benefit. So learn more about my online courses! I am all about creating evidence-based fertility courses, which focus on nervous system regulation, medical literacy, and sustainable support. My programs are all about root-up, truly evidence-based wellness and fertility — not restrictive protocols that become another source of stress.
6. Addressing What's Actually Wrong
While examining stress cycles and lifestyle, make sure you're not missing real medical issues. Get appropriate testing for thyroid function (TSH, Free T3, Free T4, antibodies — as hypothyroidism is incredibly common in fertility patients and causes fatigue, weight gain, mood changes, and irregular cycles), iron studies (ferritin, iron saturation, TIBC — not just ‘hemoglobin is normal’), vitamin D, B12, fasting glucose and insulin, HbA1c. Consider screening for depression, anxiety, sleep disorders, celiac disease, or autoimmune conditions if indicated.
Be sure to work with appropriate providers too. A therapist who understands fertility grief, a sleep specialist if you haven't slept well in months, an endocrinologist for thyroid issues, your primary care doctor for comprehensive evaluation.
These are the things that actually change outcomes. Not adrenal support supplements. Not DUTCH tests showing cortisol patterns. Real diagnosis and real treatment of real conditions.
7. The Slow Work of Nervous System Regulation
You can't supplement your way to nervous system safety. Your nervous system has learned the world is threatening through the accumulated grief of failed cycles, negative tests, losses, procedures, disappointments, announcements that break your heart, the monthly hope-then-crash of your cycle, and the relentless uncertainty. Unlearning that requires consistent signals of safety like regular sleep and wake times, consistent meals, predictable routines (outside of your protocol chaos), safe relationships where you can be honest, environments that feel secure, experiences of pleasure and ease, moments when you're not striving, or optimizing, or tracking.
Consider working with:
A therapist who understands fertility grief and trauma (especially one trained in somatic therapy, EMDR, or polyvagal approaches)
An acupuncturist or Traditional Chinese Medicine practitioner who sees the whole person (not just your FSH and AMH) and how you're sleeping, what you're craving, how you're digesting life and food, what your emotional landscape looks like, and where you feel held or alone
A bodyworker who understands nervous system regulation and can help you release the tension you're holding from months or years of this
A functional medicine provider who prioritizes lifestyle and nervous system regulation over adding more supplements to your already overwhelming protocol
And maybe most importantly, give it time. Your nervous system didn't become dysregulated overnight. It won't re-regulate overnight. But with consistent signals that the threat is over and that you're safe, the rest is possible — and it will adapt.
This is the work that matters — not optimizing your cortisol curve. Building a life your nervous system can relax into, which paradoxically creates better conditions for conception than any amount of cortisol monitoring.
The bottom line.
If someone has told you that you have adrenal fatigue, here's what I want you to know:
Your adrenals are not tired. Your adrenals are not failing. Your adrenals are not the problem.
Your adrenals are doing exactly what they're designed to do — responding to the signals your brain keeps sending about threat and stress. And trying to conceive, especially after months or years of disappointment, is threatening to your nervous system.
The exhaustion you feel is real. The difficulty coping is real. The sense that your body isn't working right is real.
But the solution isn't about supporting your adrenal glands with supplements. The solution is about examining why your nervous system can't complete stress cycles. What keeps you in chronic activation? What prevents resolution and return to rest? The solution is about building a life that your body can experience as safe. Safe enough to relax, to digest, to sleep deeply, to play, to connect, to reproduce.
This is harder than taking supplements. It requires examining your actual life — your boundaries around fertility discussions, your relationships, your pace, your expectations of yourself, your grief that needs tending, your needs that keep getting postponed ‘until after we conceive.’
It requires recognizing that you can't optimize your way out of living in conditions that create chronic stress. You have to change the conditions.
Your body is not broken. Your body is brilliant. It's trying to protect you. And sometimes, the most fertility-supporting thing you can do is help it feel safe.
Warmly,
Nicole
FAQs
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No. “Adrenal fatigue” is not a recognized medical diagnosis and isn’t supported by evidence from endocrinology research. While exhaustion and burnout are very real, they’re typically caused by chronic stress, sleep disruption, mental health conditions, thyroid or nutrient issues, or nervous system dysregulation — not failing adrenal glands.
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Yes. Chronic, unresolved stress can disrupt ovulation, menstrual regularity, sperm health, sleep, immunity, and hormone signaling by keeping the nervous system in a constant threat erestate. Fertility improves not by eliminating stress entirely, but by helping the body complete stress cycles and return to a state of safety and regulation.
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Usually not. Salivary cortisol and DUTCH tests measure cortisol patterns at a single point in time and are often misinterpreted as “adrenal dysfunction.” These tests rarely change fertility treatment decisions and can increase anxiety; addressing sleep, stress physiology, thyroid health, blood sugar, and overall medical care is far more impactful.
Nicole Lange
LICENSED ACUPUNCTURIST
HOLISTIC FERTILITY EDUCATOR
Adrenal fatigue isn’t a real diagnosis — but your exhaustion while trying to conceive is very real. Learn what’s actually happening in your body, why cortisol tests are often misinterpreted, and 7 evidence-based ways to restore energy, regulate stress, and support fertility without supplements or blame.