Can physical activity impact my fertility?
Jen and Mark are a happily married couple in their late 30s. They have been very invested in their careers and enjoyed traveling at every opportunity. About a year ago, they decided it was the right time to slow down their adventures and start a family. Unfortunately, they have not had a successful conception and have begun to explore other options to help with their fertility journey. Aside from getting a full medical work up, Jen and Mark were encouraged to explore other non-invasive options to improve their chances of a successful pregnancy. Jen was also referred to pelvic floor physical therapy to address some discomfort she was experiencing with intimacy. At her appointment, she mentioned her struggle with fertility and was surprised when her physical therapist (PT) told her that a structured physical activity program has been shown to help with fertility.
As with most conditions, there are many contributing factors to male and female infertility, including age, stress, nutrition, caffeine, weight, environmental exposures, alcohol consumption, and medical conditions. There are some factors which we have control over, often called modifiable, and others that we do not have control over, such as our age. One aspect that we do have control over is our amount and intensity of physical activity.
Physical activity appears to support fertility when performed in an appropriate dosage as it helps to increase antioxidant defense, reduce inflammation in the body, increase immune function, increase insulin resistance, and increase circulating sex hormones.1
A systematic review and meta-analysis gathered available research involving 708,965 male and female subjects to determine physical activity and its effect on infertility. In this review, high physical activity was described as over 150 minutes per week and less than 30 minutes per week was described as low physical activity. Anything in between 30 and 150 minutes was considered moderate physical activity. The findings indicated that high physical activity reduced the risk of infertility by 39% while moderate physical activity reduced the risk of infertility by 30%.1 Keep in mind that while physical activity can help to regulate our hormones, excessive exercise can cause hormone dysfunction. That is why it is especially important to balance physical activity with appropriate rest and nutrition. Energy deficits from eating less calories than one is using can have a negative effect on hormones and menstrual cycles.3
Another study found that regular physical activity in obese women undergoing IVF found a 39% success rate versus 16% in sedentary women and improved live birth of 24.4% versus 7.4%. Exercise has also been found to be beneficial for those with PCOS including the fact that it can improve menstrual and/or ovulation frequency in 60% of women following moderate intensity exercise three times per week for 45 minutes over 12 weeks.2
Physical activity can also play an important role in emotional and mental well-being. Women have been found to have higher levels of anxiety, depression, and anxious depression than men between the ages of 20-35. Women reported lower anxiety, depression and anxious depression when participating in at least 60 minutes per week of moderate intensity activity as compared to sedentary women. In those who are experiencing infertility, regular physical activity improves depression, body image distress and health related quality of life.2
Physical activity can often be an overlooked treatment to assist with fertility especially since about 55% of women aged 18-45 years old do not meet current physical activity recommendations.2
Physical activity has also been found to benefit male fertility. A research review found that a “healthy amount” of exercise in men can be helpful in terms of fertility. Men who exercised at least 3 times per week for 1 hour scored higher in “almost all” sperm parameters in comparison to men who participated in more frequent and rigorous exercise. Men who were moderately physically active had significantly better sperm morphology (shape) and demonstrated improved sperm number, concentration, and velocity as compared to sedentary males.3-4 Sperm have been found to improve after reduced time spent watching the TV, which is reduced when replaced with physical activity.4 Keep in mind that moderate-intensity continuous training is found to be more beneficial as compared to high-tensity continuous and high-intensity interval training for males.4
Interestingly, biking for more than 5 hours per week has demonstrated reduced total motile sperm counts and sperm concentration. This shows that, not only is physical activity important for fertility, but also the type of physical activity.3 The testicles are meant to be kept at a cooler temperature than the rest of our body for ideal sperm production; therefore, exercise or other activities that increases testicle compression or temperature, such as biking, tight underwear, and hot environments like hot tubs can be counterproductive.
If you are experiencing infertility, whether you are a male or female, please consider the important role of physical activity. It is possible that you are not getting enough physical activity to promote good sperm production and movement, optimal body weight, improved hormone balance, and improved immune function. On the other hand, you may be over exercising causing an excessive stressor on your system or doing movements that may be impacting appropriate sperm development. If you are unsure, reach out to a specialized professional, like a physical therapist, to determine if adjusting your level and type of exercise may be beneficial. It would be extra beneficial to seek out the guidance of a pelvic floor physical therapist as they can also perform a more in-depth assessment of your pelvic floor function in relation to physical activity.
Written by Jordan Schmidt, PT, DPT
References
- Xie, F., You, Y., Guan, C., Gu, Y., Yao, F., & Xu, J. (2022). Association between physical activity and infertility: a comprehensive systematic review and meta-analysis. Journal of translational medicine, 20(1), 1-13.
- Harrison, C. L., Brown, W. J., Hayman, M., Moran, L. J., & Redman, L. M. (2016). The Role of Physical Activity in Preconception, Pregnancy and Postpartum Health. Seminars in reproductive medicine, 34(2), e28–e37. https://doi.org/10.1055/s-0036-1583530
- Sharma, R., Biedenharn, K. R., Fedor, J. M., & Agarwal, A. (2013). Lifestyle factors and reproductive health: taking control of your fertility. Reproductive biology and endocrinology : RB&E, 11, 66. https://doi.org/10.1186/1477-7827-11-66
- Ilacqua, A., Izzo, G., Emerenziani, G. P., Baldari, C., & Aversa, A. (2018). Lifestyle and fertility: the influence of stress and quality of life on male fertility. Reproductive biology and endocrinology : RB&E, 16(1), 115. https://doi.org/10.1186/s12958-018-0436-9
