Multiple people working out to represent exercise and fertility.

Exercise and fertility

If you feel overwhelmed about exercising when trying to conceive (TTC), you’re not alone. Each person’s exercise routine will be different depending on their preferences, health goals, personal history, and doctor’s recommendations.

What does it mean to “get healthy”?

When you decide to start trying to conceive (TTC), one of the first things on your mind may be to “get healthy.”  But what does that mean? And do you have to be “healthier” when you’re TTC than you are already? Basically, the same things that improve your health day to day are going to improve your fertility as well. So it’s a good idea to continue to focus on health behaviors like stress management, getting enough sleep, eating foods that nourish your body, and exercising!

Not only does exercise improve your fitness and mental health, it can have a significant effect on your fertility, both positive and negative. Exercise can directly influence aspects of your menstrual cycle or can be indirectly related to health conditions that may be impeding your fertility, such as insulin resistance. To understand how exercise and fertility are related, you need to know a bit about your reproductive and endocrine systems.

Hormones explained 

Hormones are chemicals that communicate what is happening amongst your body’s endocrine systems. They make sure that your blood sugar levels, blood pressure, heart rate, mood, and many other processes are working together appropriately. One of these functions is your menstrual cycle. Sex hormones, estrogen, progesterone, testosterone, among several others, fluctuate according to one another to help your body prepare for pregnancy. They cause the growth and release of an egg (ovulation) and the growth of the lining of your uterus, where a pregnancy would implant and develop. 

When these hormones get out of balance, you might ovulate irregularly, or not at all. This can result in skipping periods, or stopping periods altogether. Hormone imbalances can also cause issues like shortened luteal phase and thin endometrial lining (which can make TTC more difficult).

The effect of too much exercise 

While much more research needs to be done on the specific relationship between exercise and fertility, one recurrent finding is that people who exercise strenuously for long periods of time on a regular basis have an increased chance of not ovulating (anovulation) amongst other menstrual cycle disruptions. This can happen gradually over a long period of time or suddenly if you begin a new exercise routine. Anovulation can be an early sign that your exercise routine is too intense, and can happen even before other noticeable changes in your body.

If you are following an intense exercise program and you start getting your period less often or not at all, you should talk to your healthcare provider. Together you can determine what changes in your physical activity routine would best support your body as you TTC.

Research has also shown a correlation between moderate regular exercise and improved fertility across all body sizes. Again, more research is needed to help us understand how much and what type of exercise is ideal for TTC. So for now, you’ll need to work with your provider to determine how much is enough but not too much for your body.

As we mentioned above, there are more indirect ways exercise can help improve your fertility. One example is through the system of blood sugar regulation. 

Blood sugar regulation 

Insulin is a hormone produced in the pancreas to help maintain healthy blood sugar levels. Insulin acts as the “key” that allows our body cells to use the sugar in our blood for fuel. Insulin resistance is when the body has low sensitivity to insulin so the muscles, liver and fat cells have a harder time accessing sugar. 

This can lead to high levels of both sugar and insulin in the blood which can impact your body in many ways, including your fertility. Elevated insulin can cause irregular or absent ovulation. High blood sugar can negatively impact egg quality. 

This is where exercise comes in. Exercise can impact both insulin and sugar levels in the blood. In the short term, while actively exercising, muscles access and use sugar in the blood without needing insulin to “unlock” it. This means exercising or going for a walk after meals can help reduce blood sugar levels. 

Long term, routine exercise helps increase your body’s sensitivity to insulin making it easier for your cells to use the sugar in your blood. This helps reverse the cascade of changes in your sex hormones that happens with insulin resistance and can help your body ovulate more regularly again.

Some signs and symptoms of insulin resistance include: fatigue, feeling shaky after carb intake, frequent cravings, excessive thirst, frequent urination, darkened skin around neck, armpits and body creases, and skin tags. If you are experiencing these, talk to your primary health care provider to discuss labs (fasting glucose & insulin, glucose tolerance test with insulin, lipid panel, inflammatory markers) that could help identify insulin resistance and to make a plan to help reverse its effects.

Getting started

If you have not engaged in much exercise recently, getting started can be intimidating. Your body may not move/respond in ways you want or think that it “should.” Also, for many of us, exercise is a difficult thing to separate from diet culture and body image challenges. If this is you, start with trying to mentally separate physical movement from the intended goal of changing the shape of your body. Try shifting that focus to something that motivates you in your day to day life like participating in a recreational soccer league or going on a long hike you’ve been hesitant to try. Consider that there is no rush to get to peak fitness, you are simply building strength and endurance and even your first workout counts. Don’t hesitate to use modifications to support your abilities and needs. 

When starting any new routine, it’s helpful to set a SMART goal for yourself. To read more about how to do this, check out this article. 

How much exercise is recommended

Each person’s exercise routine will be different depending on their preferences, health goals, personal history, and doctor’s recommendations. To give you a sense of how much to work into your routine, the American Heart Association recommends 150 minutes of moderate intensity exercise per week or 75 minutes of vigorous aerobic activity per week.

An exercise routine should have positive mental and physical benefits. When thinking about getting started, you do not need to choose something that feels like torture. Find exercise you actually enjoy! This doesn’t mean it will always be comfortable. Sometimes you will have to challenge yourself to do more or go longer. And sometimes simply having completed a workout no matter how intense will be enough. Remember you are not a machine, you are a dynamic being whose best from day to day looks different. Don’t let the rough days stop you from continuing to work towards your exercise goals.

What about during the two week wait (TWW)?

You may be wondering if exercise is safe if you’re actively TTC. Here’s what the evidence says:

The safest first step you should always take is to check with your healthcare provider to make sure the exercise you plan to do is safe for you. The American College of Obstetricians and Gynecologists recommends aerobic and strength training exercise for those for whom it is safe before, during, and after pregnancy. Given that exercise has been found to be overall beneficial to most everyone, and has not been found to be directly responsible for early pregnancy loss, it is likely that the benefits of continuing to exercise during the TWW outweigh the risks.

Reviewed by the Ovia Health Clinical Team


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