15 Aug The Role of Exercise in Fertility, IVF and ART

This article was contributed and written by Accredited Exercise Physiologist, Chenaya Cooper.
Please note: this article discusses fertility and miscarriage. If you need support, help is available.

Exercise prior to and during assisted reproductive technology (ART) improves clinical pregnancy and live birth rates.

Did you know? Physical activity is considered a health-promoting behaviour for all aspects of health, including reproductive health.

While we know the importance of both egg and sperm health for fertility, there are many new studies investigating the benefits of physical activity for clinical pregnancy rates, live birth rates and miscarriage prevalence.

Research shows that moderate intensity exercise prior to In-Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ISCI) cycles is associated with an increase in clinical pregnancy rates and live birth rates, with no increased risk for miscarriage.

Researchers also conclude that specific considerations surrounding exercise must be taken for differing clinical populations; these being healthy (presumed fertile) women trying to conceive, women diagnosed with Polycystic Ovarian Syndrome (PCOS) and women undergoing Assisted Reproductive Technology (ART).

HOW DOES EXERCISE HELP FERTILITY?

From compounding clinical research, we now understand the importance of physical activity related to better clinical outcomes for pregnancy and ART. Evidence shows that exercise improves:

• Energy balance in relation to the reproductive system.
• Insulin sensitisation, ovarian function and ovarian sensitisation to clomiphene citrate (a medication used to treat infertility in women who do not ovulate, including those with PCOS). 
• Endometrial insulin resistance, specifically for sedentary or PCOS patients, which contributes to a reduction in the risk of miscarriage.
• Maternal and foetal health outcomes.
• Mental health outcomes, specifically for those experiencing infertility.
• Immune function including elevated platelets, reduced lymphocytes, reduced inflammation and improved sympathetic nervous system activation. 

WHAT DOSAGE OF EXERCISE IS BEST WHEN UNDERGOING ASSISTED REPRODUCTIVE TECHNOLOGY (ART)?

Pre-ART:

A dose-responsive approach to exercise is imperative for improving clinical pregnancy outcomes.

Vigorous-intensity physical activity has been shown to have a negative effect on fertility by increasing the risk of anovulatory cycles (cycles with no ovulation) and increased time to conception (difficulty trying to conceive). 

Additionally, exercising to exhaustion is associated with higher incidence of fertility problems versus low intensity, specifically in the success rate of conception.

Therefore, research recommends that moderate intensity exercise at 150mins/week is best for pre-conceptive health outcomes leading to higher rates of IVF/ISCI success!

Moderate intensity exercise can be anything from hiking and weightlifting to Pilates and jogging, depending on your fitness level. Additionally, for women diagnosed with PCOS, resistance training is imperative for promoting improvements in insulin resistance, anovulatory cycles and metabolic parameters leading to improvements in fertility.

During ART:

Appropriate exercise will change throughout the ART phases. Considerations are required for the following phases of treatment:

• Foundation (6-months to minimum 16-weeks prior to stimulation): address chronic adaptations to exercise (e.g. build cardiovascular capacity, improve musculoskeletal health, and improve metabolic health in preparation).  
• Stimulation (day 1-12 of stimulation): moderate aerobic and strength-based exercise recommended. 
• Retrieval (immediate 48-75 hours following retrieval): recovery exercise (low intensity and low impact), ensuring avoidance of bed rest.
• Post-Retrieval (2 weeks following retrieval): Resumption of modified physical activity.

It is important to seek expertise from an Accredited Exercise Physiologist (AEP) specialising in women’s health to ensure your preconception health is optimised and your exercise routine supports you throughout your ART process!

Your AEP will prescribe personalised, research-based exercise interventions centered around your individual needs and fertility health.

Find your local AEP here.

Written by Chenaya Cooper. Chenaya is an ESSA Accredited Exercise Physiologist specialising in women’s health at Flow Physio Co. You can find Chenaya on LinkedIn here!