Navigating Fertility Treatments and Exercise
6 minutes
This was updated November 2024 with new research. See the bottom.
Navigating Fertility Treatments and Exercise: A Delicate Balance
Embarking on the journey of fertility treatments can be both physically and emotionally demanding. Amidst the myriad of considerations, one question that often arises is how to navigate exercise while undergoing fertility treatments. Unfortunately, the current recommendations typically take a one-size-fits-all approach, leaving many people who are avid gym-goers wondering how to maintain their exercise routines safely and effectively. Below, we'll explore the complexities of exercising during fertility treatments, examine some research, and discuss the challenges that exercise recommendations throughout fertility treatments create for some individuals.
Fertility Doctors Recommendations:
When it comes to exercise during fertility treatments, most fertility doctors err on the side of caution, advising only gentle activities such as easy walks, yoga, swimming, and light weight training. This excludes running, high-intensity workouts, and any exercises that involve twisting or inversions (such as dance workouts and certain yoga positions). The rationale behind this cautious approach is twofold.
Firstly, there are physical considerations. The medications used during fertility treatments cause ovaries to enlarge, increasing the risk of ovarian torsion - an extremely painful and potentially serious condition. Essentially, it occurs when an ovary becomes twisted, cutting off its blood supply, typically requiring emergency surgery. Therefore, participating in activities involving bouncing or sudden movements, which are common in high-intensity or high-impact exercises, as well as twisting during this period, could worsen this risk. It’s actually ironic that yoga and Pilates are often recommended, as they are more likely to cause torsion than going for a run.
Secondly, there are emotional factors to consider. Fertility treatments typically come with high levels of stress and emotional vulnerability - normally a time when heading to the gym for a good sweat or a comprehensive yoga class that feels soothing to the soul seems ideal. However, suppose a treatment cycle doesn't yield the desired outcome, such as an IUI cycle resulting in no pregnancy or an egg retrieval yielding fewer viable eggs than anticipated. In that case, individuals may experience feelings of self-blame or guilt. Although medical professionals assert that the results are not a result of how someone exercised (more on that below), there is often a lack of a specific cause to pinpoint, thereby increasing the risk that someone would find reasons to blame themselves.
Honorable mentions: There's also a notion that activities such as heavy weight lifting, running, interval training, or other high-impact exercises divert blood flow to the muscles rather than to the uterus, ovaries, and eggs. However, there's limited research supporting this claim.
Finally, there's a 2006 study sometimes cited as evidence that engaging in cardio for over four hours a week increases the risk of cycle cancellation, failed fertilization, and implantation failure. However, the study looked at individuals with a history of one to nine years of four or more hours of cardio per week, which isn’t directly applicable if you're currently undergoing fertility treatment after having previously engaged in such cardio activities. Furthermore, more recent research hasn’t corroborated those findings - thus it remains an unknown.
Exercise and Fertility Outcomes
The American Society for Reproductive Medicine (ASRM) helps people struggling with fertility issues by offering guidance, education, and advocacy. They bring together experts to develop best practices and advance reproductive medicine. Their stance on exercise is that it’s important for maintaining a healthy lifestyle. Based on a literature review, they have published information regarding its effects on pregnancy outcomes during treatment.
They conclude that:
For the most part, the existing literature suggests that PA [physical activity] before and during IVF has either no effect or a positive effect on pregnancy outcomes. Combined with results from the research described in the previous sections, these findings suggest that although vigorous exercise can negatively impact fertility by interfering with ovulation in the context of a natural menstrual cycle, the negative effects of vigorous exercise are no longer apparent when ovulation is carefully controlled through pharmacologic manipulation. Thus, these results suggest that active women can be advised to continue their normal activities during assisted reproduction treatment cycles.
It's important to note that their perspective focuses on the outcome rather than the risks mentioned earlier. In contrast, fertility doctors often adopt a cautious approach because they prioritize an individual’s physical health and consider the potential for ovarian torsion, rather than solely focusing on the outcome.
The Mental Toll for Fitness Enthusiasts:
For fitness enthusiasts, being told to stop exercising can be incredibly challenging for various reasons and it’s relatively common considering the correlation between female athletes and difficulty in conceiving. These women may have been informed by their doctors that their challenges in conceiving naturally stem from excessive exercise or low body fat. Consequently, they may feel that their love and dedication to fitness have betrayed them and contributed to their current struggle to conceive. Being told that their body isn’t behaving as expected, and that what they've always believed would occur naturally is now in jeopardy, is incredibly tough for an individual to process, especially if they feel judged and believe their athleticism is the cause. It leaves them grappling with the fear that their identity as a future mother is being threatened, that their strong and capable body is failing them, and that their fitness routine is to blame.
Additionally, for many fitness enthusiasts who have incorporated exercise into their lives for years, it's not just a hobby but a part of their identity and a coping mechanism for life's inherent stressors. Removing this one constant, which not only brings immediate post-workout satisfaction but also positively influences their overall self-perception, can be extremely distressful. Furthermore, there is a social aspect of fitness they may heavily rely on for connection that is also now being taken away. To add insult to injury, treatment is rarely a one-time event, but can carry on for months and years.
Observations and Personal Insights of Fitness and Fertility Treatment:
From my personal observations and experiences working as a therapist specializing in infertility counseling, as well as being a certified pre and postnatal personal trainer, I’ve learned that some individuals choose to continue activities beyond what that standard take-it-easy approach would suggest, believing the benefits outweigh the risks. For them, incorporating activities such as weightlifting, running, and cycling into their routines, but doing so mindfully and in a more moderate way, is helpful for maintaining their mental health.
It's essential to recognize that these observations do not constitute recommendations. Each individual's circumstances and physical condition vary, and what works for one person may not be suitable for another.
Silver Lining
Despite the general standard recommendations for gentle exercise, it’s important to know that for someone who has a regular fitness routine – even a rigorous one – it’s actually only a brief period of time that it typically needs to be restrained. Typically, that brief period is during stimulation (more so for IVF than for an IUI where the medication regimen is much more tame) and for a brief period after the retrieval. Perhaps during that period, you could try a new form of exercise such as swimming, brisk walking or using a stationary bike. It may not give you the same type of sweat and exhaustion feel, but you may find it comforting in another way. It might also be worth investing in a certified pre and postnatal personal trainer who also understands how fertility treatments affect the body and can help you navigate getting your ‘fix’ without compromising anything.
Most importantly, listnen to you body. If a particular exercise feels uncomfortable or causes discomfort, it's important to honor that feeling. Moreover, if exercising triggers feelings of self-doubt or guilt, it’s essential to listen to that inner voice that might be signaling it’s not worth the risk. Individuals should contemplate whether they would blame themselves if a treatment cycle is unsuccessful due to exercise.
Of course, you should not solely rely on my advice, but definitely ask your doctor. Most fertility doctors are very busy, and it’s easier to give the same one-size-fits-all approach, but if you specifically open the conversation to why it’s important to you and ask for specific guidelines for your situation, you may find you have more freedom to continue than you initially thought.
Final thoughts on Exercise and Fertility treatments:
It's important to acknowledge that navigating exercise during fertility treatments is not black and white, despite what you may have been told. Each person's situation is unique, and what works for one individual may not work for another.
Regardless of whether you are a fitness enthusiast or a more passive participant unless the doctor suggests bed rest, I encourage everyone to do something. Try to maintain your routine as much as possible. For example, if you usually go to the gym after work, consider going for a walk or trying a new type of workout that is deemed more appropriate for where you are in your cycle. Consistency will help you continue to reap benefits by maintaining some normalcy in your life, which is often uprooted by anxiety, doctor appointments, moodiness, isolation, and all the other challenges that fertility treatments entail.
New research led by Maren Shapiro, M.D. at UCSF: PHYSICAL ACTIVITY DURING FERTILITY CARE (PACE): A RANDOMIZED CONTROLLED TRIAL OF EXERCISE DURING OVARIAN STIMULATION
Infertility diagnosis and treatment, particularly IVF, are highly stressful. Exercise is known to reduce stress, but IVF patients are often advised to limit vigorous activity due to unproven concerns, such as ovarian torsion.
This study aimed to assess the impact of exercise on well-being during ovarian stimulation, with secondary goals of evaluating IVF outcomes and mental health measures.
Study Design:
Participants: 213 individuals (ages 18-43) undergoing their first ovarian stimulation cycle for IVF or oocyte cryopreservation.
Groups: Randomized into exercise (following DHHS guidelines) and no-exercise groups.
Tools: Nightly surveys, wearable activity trackers, and stress measured via the Perceived Stress Score (PSS).
Exclusions: Medical contraindications to exercise.
Key Findings:
Exercise participants showed a trend towards lower stress levels (PSS scores) compared to non-exercise participants.
Those active at baseline who continued exercising had significantly lower stress levels.
No significant stress reduction was observed in previously inactive participants.
IVF outcomes were similar across groups, and no cases of ovarian torsion were reported.
Conclusion: Continuing physical activity during ovarian stimulation reduces stress in active individuals without increasing risks like ovarian torsion, challenging the need for strict exercise restrictions.
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