Rethinking about Movement: What is too much?

The fertility journey can prompt introspection on the extent to which one prioritizes her own health, and in particular her reproductive system. However, becoming pregnant is no longer just a health-related issue for people who have been diagnosed with infertility and have found the journey to be much more challenging. It then comprises of social elements that involves self-esteem and body image. We are socialized to immediately sign up for a gym membership and dive headfirst into an extensive exercise routine at the first hint of a heavier weight and/or a feeling of having a larger body. Physical exercise combined with weight loss are important elements in increasing chances of fertility,¹ however, we need to reconsider our definition of beneficial movement. 

Not all movement is beneficial 

Exercise promotes fertility by improving blood flow, immunity, and coping with stress.² But not all exercise is beneficial. When we think of exercise and reproductive health, it becomes a question of what is too much or too little exercise? Studies have shown that women with the highest levels of frequency or intensity of exercise had increased risk of infertility.³ These intense activities include powerlifting, marathon training, high intensity interval training (HIIT), and cross-fit. Progesterone levels are maintained during the luteal phase (the time between ovulation and the start of a woman's period) so that a fertilized egg can attach to the uterine lining. When a woman exercises excessively, her progesterone levels decline,⁴ which prevents uterine lining thickening necessary for implantation of a fertilized egg. Insufficient levels of progesterone and an inadequate uterine lining lead to a failure of implantation. Ovulatory dysfunction can also occur when ovulation hormones including gonadotropin-releasing hormone (GnRH), follicle stimulating hormone (FSH), luteinizing hormone (LH), and estradiol are suppressed due to excessive activity.⁵ Simply put, excessive exercise can cause hormonal imbalances which may inhibit or shut down the reproductive system and make it more difficult to conceive. 

How much is safe?  

How much physical activity is safe while trying to conceive? Literature have been mixed on the specific amount of exercise that can reduce the likelihood of pregnancy. However, studies have consistently found that moderate exercise is beneficial to women who are trying to conceive.^2,6 This means that low impact exercises should be prioritized over high impact ones. It is best to take it easy when trying to conceive, even if vigorous exercise is your usual routine.  Tone your exercise routine down and aim for 150 minutes per week of moderate-intensity physical activity. 

Consistency is key 

Cultivating awareness of one's physical exertion levels is important. Exercising at a moderate intensity requires some effort, raises your heart rate and breathing rate, but doesn't leave you completely winded. These are the types of movement that feel sustainable, allowing you to keep up a conversation without stopping to catch your breath. Moderate intensity exercises could mean leisure walking, bike riding around your neighborhood, dancing, yoga, swimming at an easy pace. Low-impact exercises like yoga and stretching help the body relax, which is important when trying to conceive. There is no evidence in the current literature that one exercise is better than another. The best regimen is the one you enjoy doing consistently.  

Well-rounded strategy  

Exercise alone is not enough to increase chances of fertility, just as weight loss cannot be reduced to a single metric. Consistent physical activity is an integral component of a healthy lifestyle that also includes having proper and adequate nutrition, getting enough sleep, and managing stress. The Roadmap includes movement recommendations so that you can take on the simplest approaches to exercising without becoming overwhelmed. Consistency is a skill that develops through time. The Roadmap can serve as a guide for your initial action and subsequent efforts toward achieving your fertility goals.