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Fitness and Fertility

We all know that staying fit is good for our health, right? Well, it turns out fitness can also play a positive role when you're trying to conceive. But not all workouts are created equal, especially when it comes to reproductive health.


This blog dives into how high-intensity exercise can affect fertility and suggests some fitness alternatives to consider on your fertility journey.


The Benefits of Fitness:

Regular exercise comes with a host of health perks. Think longer life, better heart health, improved mental well-being, and a reduced risk of conditions like Type 2 Diabetes, Hypertension, and Congestive Heart Failure (1). Cardio workouts are key for overall health, but here's the catch: too much intense exercise can be tough on women of reproductive age.


How Exercise Affects Female Reproduction:

Let's get a bit technical. The female reproductive system relies on something called the Hypothalamic-Pituitary-Ovarian Axis (HPO Axis). In simple terms, your brain talks to your ovaries and uterus throughout your menstrual cycle. Each month, follicles go through a growth process, preparing to release a mature egg thanks to the intricate communication of reproductive hormones (2)



Diagram of HPO Axis
HPO Axis. Source Source: S.E. Nielsen, A.Y. Herrera, in Hormones, Brain and Behavior (Third Edition), 2017, https://www.sciencedirect.com/topics/neuroscience/hypothalamic-pituitary-gonadal-axis 

Hormones are chemical messengers that coordinate different functions in the body. Too much exercise can mess with these hormonal levels, leading to irregular periods and exercise-induced amenorrhea (absence of menstruation). 


Which Hormones Take a Hit?

Intense workouts can disrupt how Gonadotropin Releasing Hormone (Gn-RH) is released from the brain. Gn-RH is essential for follicular development, without it the HPO Axis is thrown off.  As a result, estrogen and progesterone levels alter as well, two hormones essential for ovulation and embryo implantation. And let's not forget cortisol, the stress hormone, which can spike with excessive exercise. When we exercise too hard, we get that “adrenaline rush” and our body goes into a “fight or flight” response. Think as if you are getting chased by a bear. Constant stress will lead to a hormonal imbalance, including fertility. Elevated cortisol levels reduce the release of Gn-RH ultimately impacting the release of FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone) (3). FSH is essential for follicular growth, while LH is essential for ovulation. As these hormones get off balance, the menstrual cycle is unable to operate properly and therefore fertility is impaired. 


Consider Your Exercise Routine:

While the American Society for Reproductive Medicine provides guidelines on smoking, alcohol consumption, and diet for those trying to conceive, exercise guidance remains somewhat of a gray area. The type of exercise suitable for you depends on your overall health. 


PCOS or Overweight/Obese:

Women with Polycystic Ovarian Syndrome (PCOS) or who are Overweight/Obese, may benefit from maintaining a healthy weight through regular, moderate & high intensity workouts. Studies show that moderate exercise can regulate hormones, improve ovulation, reduce insulin resistance, and restore fertility in women with PCOS and overweight women (4).


Assisted Reproductive Technology (ART) & Fitness: 

For women undergoing ART, exercise has minimal impact on fertility outcomes. However, your provider will advise limited high intensity exercise while undergoing these treatments to avoid ovarian torsion. Ovarian torsion is a complication in which one or both of the ovaries twist, including the fallopian tube(s) (5). Twisting of these ligaments may lead to loss of blood supply to the ovary and ultimately loss of the ovary itself. Ovarian torsion is a medical emergency, therefore, it is advised to minimize high impact workouts to mitigate the risk of ovarian loss and potential infertility. 


Healthy Women & Fitness:

For healthy women trying to conceive, studies indicate that vigorous high-intensity workouts may negatively impact fertility, and therefore, caution is advised. Although high-impact workouts may be satisfying, they can induce stress on the body, which is not ideal for reproductive health.


A specific study highlights the correlation between vigorous aerobic activity and time to pregnancy for women with a healthy Body Mass Index (BMI). "Women engaging in 2 weekly hours of vigorous exercise were 16% less likely to conceive than sedentary women over the same time frame. Among women exercising 3–4 hours per week, this number increased to 27% less likely, whereas ≥ 5 hours were associated with a 32% reduction in the chances of conception" (6). Furthermore, the high caloric burn during HIIT workouts can disrupt your menstrual cycle . While maintaining a low calorie intake may seem appealing, malnourishment can disrupt the hormonal balance, hindering the ability to conceive.


However, active women need not halt their workouts altogether; rather, they should be mindful to increase their caloric intake on days of strenuous exercise.


Fitness Options to Consider:

Low Impact Choices:

  • Brisk walking

  • Light jogging

  • Yoga, Pilates, Barre

  • Swimming


If minimizing your stress levels is your goal, yoga is the way to go. Relaxation techniques that are often a by-product in yoga and meditation practice have been shown to reduce anxiety levels in women undergoing fertility treatments (7).


Workouts to Limit: 
  • Running 

  • High-Intensity Interval Training (HIIT)

  • Intense cycling or spinning

  • Abdominal twists and turns (can lead to ovarian torsion)


That is not to say to stay away from high intensity fitness all together. Rather than engaging in 4 days a week of HIIT, try to alternate one day of high intensity followed by one day of low impact fitness. Try to be mindful of your nutrition on days you engage in vigorous activity to avoid a state of caloric deficit. 

The right level of high-intensity exercise is different for everyone. If you are a gym-rat, do not feel that you have to give up fitness completely. It's always a good idea to chat with your OB-GYN or Reproductive Endocrinologist about a fitness routine that's best for you.


Uncertain about whether your exercise regimen is fertility-friendly or suitable during fertility treatments? Our Patient Empowerment Coaches are available to assist you. Book a 30-minute consultation with a Fertility Registered Nurse to explore how to optimize your fertility safely and effectively, with customized modifications as necessary.


At Grain Fertility, Premium Users have the opportunity to work 1:1 with our dedicated Patient Empowerment Coaches. They will help you prepare for your upcoming consultations with your provider and they will provide resources tailored to your individual needs. Our PEC's are committed to supporting you throughout your fertility journey. You can become a Premium member and take advantage of a risk free two-week trial by signing up today at https://app.grainfertility.com/signup.



Sources:


  1. Ruegsegger GN, Booth FW. Health Benefits of Exercise. Cold Spring Harb Perspect Med. 2018 Jul 2;8(7):a029694. doi: 10.1101/cshperspect.a029694. PMID: 28507196; PMCID: PMC6027933.

  2. Warren MP, Perlroth NE. The effects of intense exercise on the female reproductive system. J Endocrinol. 2001 Jul;170(1):3-11. doi: 10.1677/joe.0.1700003. PMID: 11431132

  3. Oakley AE, Breen KM, Clarke IJ, Karsch FJ, Wagenmaker ER, Tilbrook AJ. Cortisol reduces gonadotropin-releasing hormone pulse frequency in follicular phase ewes: influence of ovarian steroids. Endocrinology. 2009 Jan;150(1):341-9. doi: 10.1210/en.2008-0587. Epub 2008 Sep 18. PMID: 18801903; PMCID: PMC2630911.

  4. Lundgren KM, Romundstad LB, von Düring V, Mørkved S, Kjøtrød S, Moholdt T. Exercise prior to assisted fertilization in overweight and obese women (FertilEX): study protocol for a randomized controlled trial. Trials. 2016 Jun 1;17(1):268. doi: 10.1186/s13063-016-1398-x. PMID: 27250851; PMCID: PMC4888643.

  5. Guile SL, Mathai JK. Ovarian Torsion. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32809510.

  6. Mussawar M, Balsom AA, Totosy de Zepetnek JO, Gordon JL. The effect of physical activity on fertility: a mini-review. F S Rep. 2023 Apr 14;4(2):150-158. doi: 10.1016/j.xfre.2023.04.005. PMID: 37398617; PMCID: PMC10310950.

  7. Domar AD, Clapp D, Slawsby E, Kessel B, Orav J, Freizinger M. The impact of group psychological interventions on distress in infertile women. Health Psychol. 2000 Nov;19(6):568-75. doi: 10.1037//0278-6133.19.6.568. PMID: 11129360.

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