Exercise While Trying to Conceive:
Does Exercise Help or Harm Fertility?

Written by: Dr. Will Haas, MD, MBA

Edited by: Dr. Ashley Eskew MD, MSCI

Last updated: July 1st, 2021

Woman exercising at home when trying to conceive

If you love exercising, you might be wondering if you can continue your routine when trying to conceive… And if exercise is not your thing, you might be wondering if you should give it a go to increase your chances of success. 

Of course, someone has probably told you to STOP exercising when trying to get pregnant. Perhaps your doctor even told you to slow down for a bit… 

Luckily, there’s a lot of good research to help guide us on this important fertility topic because it’s not an all or nothing decision.

Here’s a quick overview of what you’ll discover:

Why Exercise To Begin With?

You know exercise is good for you… 

But do you know just how good it can be? 

Being active has been shown to have many health benefits, both physically and mentally. In fact, regular exercise has been shown to: 

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    Help your body manage blood sugar and insulin levels.

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    Reduce your risk of heart disease.

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    Improve your mental health and mood.

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    Reduce your risk of some cancers.

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    Improve your sleep.

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    Improve your sexual health.

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    Increase your chances of living longer.

All good stuff, right? 

Of course, we know most of you don’t lace up your shoes thinking about how the next 30-60 minutes are going to reduce your risk for chronic illness. It’s about feeling good, community, clearing your head, and ENDORPHINS! 

Let’s explore why and how you can continue exercising when trying to get pregnant…

Benefits of Exercise When Trying to Get Pregnant

Before we jump into whether or not exercise is actually advisable, let’s look at the potential mechanisms through which physical activity and exercise can positively affect fertility.

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    Exercise may influence ovarian function by altering the production of estrogens and other steroid hormones via the hypothalamic-pituitary-ovarian axis (1).

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    Exercise can impact reproductive health through its ability to regulate energy balance and optimize body mass index (BMI), which, in turn, are correlated with fertility (2).

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    Exercise can improve lipid profiles and inflammation (3).

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    Moderate-intensity exercise has been shown to increase the expression of antioxidant enzymes throughout the body (4).

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    Exercise may improve assisted reproductive technology (ART) outcomes through improved insulin sensitization, which has been shown to have an effect on ovarian response to clomiphene citrate during ovulation induction (5).

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    Exercise can help to relieve stress and anxiety, which have been shown to negatively affect fertility treatment outcomes (6-7).

We could list out several other potential connections between exercise and fertility, but we think that you can see there are some pretty compelling mechanisms supporting exercise when you are trying to grow your family.

Important Exercise Considerations When You’re Trying to Conceive

As you probably know already, the question of whether you can or should exercise before you get pregnant is a bit more complicated, especially if you’ve been struggling to conceive. 

And it probably doesn’t help that there’s so much conflicting advice floating around out there: 

Exercise is great, just don’t do intervals…” 

Stay active, but don’t get your heart rate up too high…” 

Absolutely NO exercise while trying to conceive!

Luckily, a meta-analysis published by researchers in Australia has been able to shine some light on whether exercise is okay to do when trying to conceive (8). In fact, they found that physical activity has a positive impact on reproductive outcomes with higher pregnancy and live birth rates among women who exercise regularly. These benefits seemed to be even stronger among patients with a greater BMI, polycystic ovary syndrome (PCOS), and insulin resistance. 

Should I stop all exercise if I’m undergoing fertility treatments?

Many patients going through fertility treatment, especially in-vitro fertilization (IVF), are told “minimal to no exercise.” 

Fortunately, more and more research is starting to emerge on whether or not this advice is prudent when it comes to maximizing your chances of conceiving. 

More on that in just a moment… 

For now, let’s take a look at why you might be told to stop exercising while undergoing IVF. As part of the IVF process, women are given hormonal injections to grow multiple follicles in preparation for egg retrieval. During this period, the ovaries tend to enlarge significantly, in some women becoming the size of softballs! When the ovaries enlarge they have an increased risk of twisting on themselves, potentially cutting off their blood supply which can become a surgical emergency (ovarian torsion). Hence, the no exercise recommendation 🙁 

While the risk of exercise-induced ovarian torsion from IVF is relatively small – only one case study has been reported in PubMed at this time (9) – many fertility specialists will counsel their patients to avoid high-impact exercises or movements after ovarian stimulation since this is a preventable surgical emergency.

Now despite the small risk for ovarian torsion, there does appear to be significant benefits of low- to moderate-level activity while undergoing fertility treatment. 

In fact, based on results from one of the best-designed studies we’ve seen to date, higher levels of light physical activity with less sedentary behavior have been associated with a higher number of oocytes and embryos obtained in IVF (10).

Pretty exciting, right? 

Now if we dig a little deeper, research by Dr. Audrey Gaskins and colleagues found that certain aerobic exercises such as rowing and the elliptical ski machine were associated with a higher probability of live birth among women undergoing IVF (11). This is great news as it certainly fits with the recommendation to avoid high-impact exercises as we discussed above. 

But what if you don’t like boring, low-impact cardio? 

Well, simply decreasing your amount of screen time (especially on the weekends) AND reducing the number of continuous sedentary blocks of time you have throughout the day may also positively increase the number of oocytes and embryos obtained in IVF (10).

We hope you’re starting to see that the “NO exercise” recommendation might not be the best strategy to follow when undergoing IVF. 

Can I exercise during the two-week wait? 

Our fertility warriors out there know just how long and anxiety-provoking the two-week wait can be when trying to get pregnant. 

For those of you just getting started, the “two-week wait” refers to the luteal phase of your menstrual cycle that begins after ovulation (and possible fertilization of an egg) OR the wait time between embryo transfer and taking a pregnancy test. So, it should come as no surprise if the voice in the back of your head starts asking if exercise is safe to do over those two weeks.

When looking at the scientific literature, most women tend to engage in little to no activity after embryo implantation with IVF (12). Therefore, the impact of exercise on implantation is tough to determine from clinical studies. With that said, there is some evidence to suggest that light exercise is unlikely to cause harm and might even be beneficial during the two-week wait. 

In fact, when looking back at the study conducted by Dr. Deniss Sõritsa and colleagues, they ultimately concluded that light physical activity during the most critical period of establishing a pregnancy (e.g., after embryo transfer and until confirmation of a clinical pregnancy), was not harmful for the IVF procedure to succeed (10).

How much exercise is too much? 

The answer to this question really comes down to whether or not your exercise routine creates an ongoing energy deficit. 

Over an extended period of time, a caloric deficit brought about by exercise can disrupt the normal signaling of your reproductive hormones and result in menstrual cycle disturbances.

In fact, exercise-related menstrual disturbances are common in women who exercise regularly. Some studies estimate that up to 60 percent of exercising women experience some form of menstrual disturbance (13). The most extreme form of exercise-related menstrual disturbance is hypothalamic amenorrhea, where the cycle stops completely. 

We don’t bring this up to scare anyone out of exercising, but it’s important to ensure that you are nourishing your body with a pro-fertility diet that includes enough calories to match your energy expenditure. 

If you’re worried about throwing off your menstrual cycle because you love to exercise, it might be a good idea to have your resting metabolic rate (RMR) calculated and track your body composition from time to time. 

And if you’re looking for a more definitive answer on how much you can exercise, one systematic review of 10 studies found an increased risk of anovulation in extremely heavy exercisers (> 60 minutes/day), while vigorous exercise of 30-60 minutes/day was associated with reduced risk of ovulatory infertility (14). This probably shouldn’t be taken as a hard and fast rule, but hopefully, it gives you some guides on just how many hours you can put in at the gym.

Unfortunately, this study left many common questions unanswered, which is partially due to the lack of available research out there. With that being said, let’s try and address some of the common TTC exercise questions that we get asked…

What About Exercising During Pregnancy?

Being active with regular, moderate exercise once you get pregnant will help you have a healthy pregnancy and birth.  

Research has shown that being active before and during early pregnancy can reduce your risk of having problems in pregnancy, such as gestational diabetes or pre-eclampsia. It has also been shown to reduce the risk of cesarean delivery when you’re pregnant. 

It’s important to point out that there are some conditions during pregnancy that may preclude you from continuing your exercise routine such as preeclampsia, severe anemia, and placenta previa to name a few. But that’s a conversation for a different day… 

Bottom line: If you are healthy and your pregnancy is uncomplicated, in general it is safe to continue or start exercising. Remember, according to the American College of Obstetricians and Gynecologists (ACOG), physical activity does not increase your risk of miscarriage, low birth weight, or early delivery when you’re pregnant. 

Does Exercise Matter for Male Fertility?

It goes without saying, but it takes two to get pregnant… So let’s not forget to talk about the impact exercise can have on male fertility!

More often than not, we hear concerns about how strenuous exercise can harm male fertility. And most of the time this is brought up because of a study that found cycling more than 5 hours per week decreased sperm counts in men undergoing fertility testing (15). 

On the other hand, another study found that both sperm counts and motility improved among sedentary men when participating in a cardiovascular exercise program. Interestingly enough, their sperm parameters worsened when they stopped exercising (16). 

One word of caution… It’s critically important that your male partner NOT use testosterone therapy while you’re trying to start a family. Taking supplemental testosterone shuts your body’s natural production down, which indirectly shuts down the production of sperm. In some cases, this can be irreversible – yikes! 

The Best Exercises for Fertility

When you consider all of the research together, the majority of the evidence suggests that light-intensity exercise is beneficial to almost all women throughout their fertility journey. 

On the other hand, high levels of intense exercise might impair fertility in some women and the decision to continue with a more vigorous exercise routine should be discussed with your healthcare provider. 

In the meantime, here are a few exercises that are generally considered safe if you’re trying to conceive or you are already pregnant: 

Walking and Jogging

Both walking and jogging are excellent forms of cardiovascular exercise, especially since you don’t need any special equipment. And once you are pregnant, walking is safe and recommended right up to your delivery day. For our seasoned runners out there, it’s likely okay to stay on track, as long as you get your doctor’s approval and stick to level terrain. 

Swimming 

Swimming is a low-impact exercise that builds muscle tone and offers fantastic cardiovascular benefits. It’s ideal for expecting moms since it makes them feel weightless and can help relieve common pregnancy symptoms like back pain. If you’re undergoing fertility treatments, it’s probably best to avoid the flip turns (remember the whole ovarian torsion thing). 

Indoor Cycling

Spinning is another great low-impact exercise to incorporate into your fertility journey. Monitor your intensity, especially if you partake in group classes or Peloton rides – it can be easy to get carried away when the music starts pumping. 

Strength Training

Weight lifting builds muscle tone and strength which helps keep you in shape and burn calories even when you’re not working out. If you are new to weight training, opt for lighter weights with more repetitions (12 – 15), or focus on resistance exercises that use your own body weight, like lunges, squats, crunches, and push-ups.

And because we know some of you want to know… CrossFit can be okay when you’re expecting if you’ve been at it for years and you get approval from your doctor. Regardless, make sure to avoid jumping or jarring movements, and be sure to take breaks when you need them.

Yoga

Yoga is an ideal exercise if you’re trying to get pregnant, especially since it helps build strength, balance, endurance, and muscle tone in less than 60 minutes. The breathwork in yoga also helps you relax and has been shown to improve anxiety and depression levels in women undergoing fertility treatments (17). If you’re a fan of super-hot yoga, you’ll want to get your doctor to sign off as there is some concern that the extra heat might not be safe for a developing fetus.

Final Thoughts on Exercise When Trying to Conceive

When done in the right amount, exercise can certainly benefit your reproductive (and mental!) health. 

Remember, there’s no need to stop exercising altogether. Low- to moderate-intensity exercise not only improves your overall health and well-being, but it can contribute to success with fertility treatments (and improve sperm parameters too)!

Depending on where you are along your fertility journey, your chosen method of exercise may need to change temporarily, so don’t forget to review your routine with your healthcare provider. 

And whatever your favorite form of exercise, don’t forget to enjoy the endorphins!

With Love & Empowerment,
Dr. Ashley Eskew and Dr. Will Haas

References

  1. Tworoger SS, Missmer SA, Eliassen AH, Barbieri RL, Dowsett M, Hankinson SE. Physical activity and inactivity in relation to sex hormone, prolactin, and insulin-like growth factor concentrations in premenopausal women – exercise and premenopausal hormones. Cancer Causes Control. 2007;18:743–52.

  2. Redman LM. Physical activity and its effects on reproduction. Reprod BioMed Online. 2006;12:579–86.

  3. Sorensen TK, Williams MA, Lee I-M, Dashow EE, Thompson ML, Luthy DA. Recreational physical activity during Pregnancy and risk of preeclampsia. Hypertension. 2003;41:1273–80.

  4. Gomez-Cabrera M-C, Domenech E, Viña J. Moderate exercise is an antioxidant: upregulation of antioxidant genes by training. Free Radic Biol Med. 2008;44:126–31.

  5. Palomba S, Falbo A, Russo T, Orio F, Tolino A, Zullo F. Systemic and local effects of metformin administration in patients with polycystic ovary syndrome (PCOS): relationship to the ovulatory response. Hum Reprod. 2010;25:1005–13.

  6. Hämmerli K, Znoj H, Barth J. The efficacy of psychological interventions for infertile patients: a meta-analysis examining mental health and pregnancy rate. Hum Reprod Update. 2009;15:279–95.

  7. Frederiksen Y, Farver-Vestergaard I, Skovgård NG, Ingerslev HJ, Zachariae R. Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis. BMJ Open. 2015;5:e006592.

  8. Mena GP, et al. The effect of physical activity on reproductive health outcomes in young women: a systematic review and meta-analysis. Hum Reprod 2019;25:542-564.

  9. Littman ED, Rydfors J, Milki AA. Exercise-induced ovarian torsion in the cycle following gonadotrophin therapy: case report. Hum Reprod. 2003 Aug;18(8):1641-2.

  10. Sõritsa, D., Mäestu, E., Nuut, M. et al. Maternal physical activity and sedentary behaviour before and during in vitro fertilization treatment: a longitudinal study exploring the associations with controlled ovarian stimulation and pregnancy outcomes. J Assist Reprod Genet. 2020; 37, 1869–1881.

  11. Gaskins AJ, Williams PL, Keller MG, et al. Maternal physical and sedentary activities in relation to reproductive outcomes following IVF. Reprod Biomed Online. 2016 Oct;33(4):513-521.

  12. Everson KR, Calhoun KC, Herring AH, et al. Association of physical activity in the past year and immediately after in vitro fertilization on pregnancy. Fertil Steril. 2014 Apr; 101(4): 1047-1054.e5.

  13. De Souza MJ, Toombs RJ, Scheid JL, et al. High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures. Hum Reprod. 2010 Feb;25(2):491-503.

  14. Hakimi O, Cameron L. Effect of Exercise on Ovulation: A Systematic Review. Sports Med. 2017 Aug;47(8):1555-1567.

  15. Wise L, et al. Physical activity and semen quality among men attending an infertility clinic. Fert Stert 2011;95:1025-1030.

  16. Maleki B, et al. The effects of three different exercise modalities on markers of male reproduction in healthy subjects: a randomized controlled trial. Reproduction and Fertility 2017;153:157-174.

  17. Oron G et al. A prospective study using Hatha Yoga for stress reduction among women waiting for IVF treatment. Reprod Biomed Online. 2015;30:542-8.

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