It’s hard to believe that IVF was once little more than an experimental procedure, especially considering 1-2% of live births in Canada are now attributed to IVF. For many, it’s is a miracle. For others, it represents another set of challenges: physical, financial and mental. 

The reality is that one in six couples in Canada experience difficulty with fertility. Which, ultimately, means there is a growing need for reproductive assistance. Procedures like IVF will only become more and more commonplace. 

However, on top of being taxing for couples, in any number of ways, it can also be confusing and scary. So, our goal is to help elucidate, not just the procedure, but also what fitness and exercise might look like for women going through the process.

First, let’s look at IVF and what it is. Then we’ll get into side effects and guidelines for exercise. Remember though, we are not doctors and, therefore, any recommendations are based solely on available research and anecdotal evidence. Always consult your doctor before making any changes to your current activity levels.

Here we go, IVF, from the beginning.

For those who don’t know, IVF stands for In Vitro Fertilization. It is a series of clinical procedures designed to assist with conception. Generally, a simple enough concept.

A simplified overview of the process looks something like this:

The Process

Ovulation Induction

• Hormones are administered via injection to stimulate egg production in the ovaries
  • during a natural cycle, only one egg develops. Ovulation induction’s aim is to produce multiple viable eggs in one cycle

Egg Retrieval

• a minor surgical procedure whereby a thin, hollow tube is inserted into the vagina and the ovaries/follicles holding the eggs
  • the needle is connected to a suction device that gently removes eggs from the follicles

Insemination

• retrieved eggs and sperm are combined in the lab and fertilization takes place

Embryo Transfer

• formed embryos, allowed 3-5 days to mature, are transplanted into the uterus and implanted via needle/tube.
  • fertilized eggs that do not mature into embryos or embryos of poor quality/with abnormalities are discarded

24 Hour Rest Period

Blood Pregnancy Test

• taken 2 weeks after embryo transfer

Now, the basics are fairly complex and time consuming. There are an abundance of tests, drug administration and waiting. On top of which, every woman is different. Every doctor is different. Every cycle is different. Therefore, recommendations are different. Meaning, unfortunately, there is very little consensus amongst doctors on what wellness protocols women should follow while undergoing IVF, especially when it comes to exercise.

Side Effects

The most commonly reported side effects of IVF are:

• • bloating
  • cramping
  • discomfort
  • breast tenderness
  • mood swings
  • headaches
  • bruising
  • allergic reaction
  • bleeding
  • infection

However, there are some rare effects that doctors will/should make their patients aware of; they include:

• • Ovarian Hyperstimulation Syndrome (OHSS)
    • an exaggerated response to excess hormones
      • as a result, ovaries swell significantly and become painful
  • Ovarian Torsion/Adnexal Torsion
    • • an ovary/adnexa rotates in on itself and blood supply is cut off by the ligament
        • early detection is difficult as symptoms are similar to those experienced in pregnancy — ie. abdominal pain, nausea and vomiting — doctors will often dismiss complaints as pregnancy related without looking into the issue further
        • late detection can result in necrosis and loss of the ovary/fertility

These rare side effects result in doctors warning women off of exercise while doing IVF. The additional weight of the ovaries, due to the increased egg supply, puts them at risk of twisting in on themselves. Twisting and rapidly changing positions of the body during strenuous exercise compound this risk. 

That said though, the risk of experiencing ovarian torsion while undergoing IVF is still extremely rare. 

As per the literature:

• incidence of adnexal torsion after assisted reproductive technologies (ART) is given around 0.2 %
• a significant increase of up to 33 % is reported for cases with additional OHSS and in pregnant women

Still, some doctors recommend avoiding exercise while undergoing IVF treatment altogether and others only caution against strenuous exercise, making room for gentle activity.

So what does this mean if you want to remain active while receiving reproductive assistance?

Here’s where we land:

Exercise Impact during IVF

It is generally accepted that exercise has a positive impact on fertility and is cited for its ability to reduce complications during pregnancy (ie. gestational diabetes). However, it is also well documented that strenuous activity should be avoided during IVF, specifically during the stimulation/induction cycle and immediately after embryo transfer. These phases of the process put patients at the highest risk for rarer complications, such as ovarian torsion, due to the additional weight carried in the ovaries themselves.

Ultimately, in an ideal world, a woman would, by way of ultrasound, confirm the regression in ovary size before returning to regular activity levels. However, this is rarely feasible so literature has suggested that if no viable pregnancy has occurred then regular exercise levels can be resumed after the completion of the next menstrual cycle. — If another cycle of IVF is required, proceed with caution as indicated above and refer below for general guidelines.

Aerobic exercise:

• Limited to walking, light jogging, elliptical, swimming
  • NO jumping, HIIT, rapid changes in direction, twisting or flips at the end of a lane swim

Strength Training:

• Limited to light weights
  • NO heavy, strenuous weight lifting, NO crossFit
  • Weight training is particularly discouraged during the final phase of ovarian stimulation and embryo transfer

Flexibility:

• Limited to gentle stretching or yoga
  • NO inversions or twisting

Again, we want to reiterate that every person is different. If you are undergoing any kind of clinical procedure or surgery always talk to your doctor before changing your routine. 

If you are going through IVF and are looking for support when it comes to your health and wellness, please don’t hesitate to reach out to us. Our goal is to ensure that everyone who walks through our doors is assisted with personalized programs founded on thorough research, built around our clients’ goals, lifestyle and medical history. 

We’re here to help you achieve your highest standard of living. Whatever that looks like. 

For more information about who we are and what we do, follow us on Instagram!

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References:

Atlanta Center for Reproductive Medicine. (2022, February 17). IVF and exercise – what you need to know. Atlanta Center for Reproductive Medicine. Retrieved October 20, 2022, from https://www.atlantainfertility.com/about-us/blogs/2022/february/ivf-and-exercise-what-you-need-to-know/#:~:text=Strenuous%20exercises%20%E2%80%94%20like%20running%2C%20high,break%20from%20any%20rigorous%20training

Littman, E. D. (2003). Exercise-induced ovarian torsion in the cycle following gonadotrophin therapy: Case report. Human Reproduction, 18(8), 1641–1642. https://doi.org/10.1093/humrep/deg338

Spitzer, D., Wirleitner, B., Steiner, H., & Zech, N. H. (2012, August). Adnexal torsion in pregnancy after assisted reproduction – case study and review of the literature. Geburtshilfe und Frauenheilkunde. Retrieved October 20, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168525/

Team, P. N. W. F. (2021, February 24). Fitness and fertility: To exercise or not while trying to conceive. PNWF. Retrieved October 20, 2022, from https://pnwfertility.com/2021/02/24/fitness-and-fertility-to-exercise-or-not-to-exercise-while-trying-to-conceive/

Zermiani , M., & Gutierrez, S. A. (2022, April 19). Can physical exercise be performed during ovarian stimulation? inviTRA. Retrieved October 20, 2022, from https://www.invitra.com/en/can-physical-exercise-be-performed-during-ovarian-stimulation/