If a patient reports extremely high stress, which reproductive effect is most consistent with the material?

• A. Ovulation becomes more frequent
• B. Anovulation and ovulatory dysfunction may occur
• C. Stress has no impact
• D. Fertility is guaranteed

Answer: (B)

Extreme stress disrupts the brain’s regulation of the menstrual cycle. Stress activates the hypothalamic-pituitary-adrenal axis, raising cortisol and CRH, which blunt GnRH pulse generation from the hypothalamus. With GnRH reduced, the pituitary releases less LH and FSH, so normal follicle development and ovulation are impaired. The result is anovulation or ovulatory dysfunction, which is why that option fits best with a pattern of high stress.

The idea that ovulation would become more frequent contradicts this dampening effect on GnRH and gonadotropins. Saying stress has no impact ignores well-established hormonal interactions, and claiming fertility is guaranteed ignores that stress can reduce fertility and lead to irregular or absent ovulation.