Assisted Reproductive Treatments (ART) refers to IntraUterine Insemination (IUI), Ovulation Induction (OI), In Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI).
The journey of Assisted Reproductive Treatments is a complex emotional journey both physically and mentally not only for the women but for men as well. With a lot of complexities occurring within the journey- this is a small snap short of how important it is to have the right support and understanding in regards to the effects of exercise during each phase of IVF.
Different treatment phases need to take into consideration the effects of the complex hormone interactions that are occurring within the body due to the medication being consumed and the procedures undertaken.
Foundation treatment Phase
Usually has a duration of 6 months prior to starting ART treatment. The 16wks prior to start of ART is important as what happens in that 16wks prior to predicts the quality of the egg (and sperm). Extremely important aspect of the journey as it’s the optimal time to ensure that one’s body competition is more favorable for the egg retrieval and transfer. Aim in this stage is to build the healthiest environment / the best home for the transferred egg by reducing any metabolic dysfunction, inflammation within the body and insulin resistance occurring. Ensuring we are neutering the egg and ovaries.
During this phase the focus should be placed on strength training, Aerobic exercise and ensuring optimal rest/ sleep. Ensuring that there is rest between bouts of exercise is important as it limits any inflammation occurring due to delayed onset of muscle soreness (DOMS). Increased inflammation components within the body significantly impacts on a healthy pregnancy. An increase in inflammation components cause damage to the eggs and sperm structure. Inflammation is not all bad, we do need it to occur for tissue repair, what is important is having a good balance. Things such as smoking, diet, stress levels and sleep can contribute to elevating inflammation. If you’re sleeping less than 6 hrs p/night or a shift worker, pregnancy rate can reduce by up to 38%.
Exercise aids with increasing blood flow to the uterus.
Exercise volume- less than 5 hrs is not correct anymore- Studies have now shown that females exercising over 5 hrs p/wk – 47 % were still ovulating normally, therefore exercise is not just about the amount / load, it’s about taking into consideration the individual.
Strenuous aerobic exercise- acute response to exercise is increasing stress and inflammation that can be a little damaging on our eggs (and sperm). Can change how receptive the uterus is to the egg, damage the health of our eggs and the health of embryos.
Moderate aerobic exercise- less stressful than the strenuous bout of exercise but still produces an increase in stress and inflammation, just not to the same level. This level is considered a good level as it refrains from causing damage to the egg and its environment.
Modifying body composition is very important in influencing the hormonal environment, inflammation, and other components. Studies have identified that female obesity can have a negative effect on pregnancy success by up to 15%, it should also be noted that male obesity can reduce the success of pregnancy by up to 35%.
In Cycle Phases include:
Stimulation Phase (Day 1- day 12)– since the ovaries begin to become enlarged and can stay enlarged for some time, it’s important to take into consideration abdominal comfort as well as the risk of ovarian torsion in this phase and the following phases. Ovarian torsion refers when the enlarged ovary which sits like a hammock, flips over and subsequently the twisting that occurs leads to reduced blood flow to the ovary and reducing likelihood of a positive pregnancy. This is very rare; literature suggests about 1% chance of this occurring. However, its good to be mindful of this potential situation. In this stage we want to aim to reduce physiological and mental load, increase comfort levels, keep moving but at a low intensity/ low volume.
Retrieval Phase (48-72 hrs) – IVF is invasive- spend time recovering. In this phase its important to focus on reducing the risk of potential infection. This stage focus is still on non-structured exercise, keeping blood flow to the pelvis, and doing movement that is comfortable for you. Avoid bed rest, movements that are jarring, high impact due to the risk of Ovarian hyper stimulation- which can lead to increased abdominal bloating and pain.
Post-retrieval phase (2 wks)
The first couple of days post, it’s best not to complete any structured exercise due to risk of Ovarian hyper stimulation. Movement is strongly recommended to keep the blood flow to the pelvis.
In-cycle focus should be placed on other aspects such as mobility/ flexibility, stability of pelvis/ posture control, low to moderate strength exercises and familiar exercises (reduce risk of DOMS).
Progression back into exercise levels in the foundation phase.
Can I work out during an IVF cycle?
Studies suggest exercising before IVF cycle improves clinical pregnancy rates.
Research indicates it might be best to reduce intense exercise sessions but don’t stop exercising completely. Maintaining a healthy body weight has been significantly linked to successful fertilization. Opting for more low impact exercise options is best practice since IVF medications are designed to enlarge and stimulate your ovaries to help produce more mature and healthy eggs. It’s suggested that high impact activity such as high-intensity interval training (HIIT), intense cardio exercise stresses your body, have potential to injure your abdomen or inhibit the production of healthy eggs.
When to start exercising after embryo (fresh or frozen) transfer?
Exercising before IVF treatment increases the likelihood of conception. Once the embryo transfer occurs modify your exercise to low intensity to begin with and progress back to previous exercise levels to help create the best environment for a successful pregnancy to occur.
In foundation phase 16 wks + out from the starting treatment process, can be doing some higher intensity exercise to help reduce obesity level.
Complete moderate intensity aerobic and strength exercise to aid in improving body composition.
Do ensure you obtain 6hrs + of sleep.
Keep moving during the In cycle phase to keep blood flow to the pelvis high.
Avoid exercise- studies identify 40% drop-in clinical pregnancy rates for women who stay in bed immediately after embryo transfer. This is because it reduces the blood flow to your pelvis.
Avoid HIIT, high intensity workouts, prolonged aerobic exercise, unfamiliar exercise which can cause an increase in inflammation within the body.
De Souza, M. J., Toombs, R. J., Scheid, J. L., O’Donnell, E., West, S. L., & Williams, N. I. (2010). High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures. Human reproduction (Oxford, England), 25(2), 491–503. https://doi.org/10.1093/humrep/dep411
Campbell, J. M., Lane, M., Owens, J. A., & Bakos, H. W. (2015). Paternal obesity negatively affects male fertility and assisted reproduction outcomes: a systematic review and meta-analysis. Reproductive biomedicine online, 31(5), 593–604. https://doi.org/10.1016/j.rbmo.2015.07.012
Nanni, M., Merola, M.G., Ianniello, S., Orazi, C., Schingo, P.M., Trinci, M. (2016). Ovarian Torsion. In: Miele, V., Trinci, M. (eds) Imaging Non-traumatic Abdominal Emergencies in Pediatric Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-41866-7_14