To work out or not to work out, that is the question
One of the most common questions I am asked by women undergoing fertility treatments and women in early pregnancy is, “Can I go to the gym?” After all the efforts, money and time spent, and procedures, patients are often worried that they will do something to decrease their chances of pregnancy after their embryo transfer or that they will cause a miscarriage.
The truth is that there is very little that can interfere with a pregnancy outcome after infertility treatments. In fact, recent data has shown that bedrest after embryo transfer actually decreases pregnancy rates! So grab your gym bag and running shoes, and head to the gym — all will be OK.
But seriously, what are the do’s and don’ts for exercise during fertility treatment and early pregnancy? Here are some tips.
1. When trying to conceive
If you are used to a certain exercise regimen, you are fine to continue it. The exceptions include any exercise that increases core body temperature significantly, such as hot tubs, saunas, hot yoga and cycling. Running, swimming, even those crazy bootcamp classes are OK if you are used to them. The one thing to watch for is very low body weight. Some women — due to a combination of reasons, including stress, excessive exercise, and poor nutritional intake, occasionally caused by an eating disorder such as anorexia or bulimia — can have a very low body weight and BMI, which leads to menstrual irregularity or even a loss of menses completely. Becoming pregnant in this situation can be dangerous. Make sure your body weight is in the ideal range for your age and height.
2. During ovarian stimulation
Fertility drugs make the ovaries enlarge by causing multiple eggs to develop. This can cause symptoms of bloating and abdominal cramping. With exercise, especially heavy exercise, the ovaries are at risk for cysts rupturing and causing pain or, in some cases, ovarian torsion, which occurs when the ovaries twist on themselves and cause loss of their blood supply. While rare, ovarian torsion is a condition that can require emergency surgery to untwist the ovary and restore blood flow. It is important to take notice of any unusual pain with activity while you are undergoing ovarian stimulation, and alert your doctor if the pain is severe or does not resolve in a short period of time. Hormone treatment can also increase fatigue during exercise. If you feel tired, make sure to take it easy and perhaps reduce your exercise regimen or take a break. Drink lots of water to avoid dehydration, which could result in excessive blood clotting when combined with fertility treatment.
3. After IVF and egg retrieval
After an egg retrieval, where a needle is used under ultrasound guidance to recover eggs from the ovary, there is a small amount of blood in the pelvis. The ovaries are sensitive and still enlarged, despite the eggs having been removed. We encourage patients to avoid any strenuous activity for at least two to three days to avoid risk of bleeding or ovarian torsion after egg retrieval.
4. After an intrauterine insemination or embryo transfer
Consider yourself pregnant! That little embryo is floating in the uterus, and the sperm is finding its way to your egg. While implantation has not occurred yet and, contrary to popular belief, the embryo will not fall out, we encourage patients to take it easy in the few days following IUI or embryo transfer. Often, the ovaries are still stimulated and sensitive. However, you can resume your usual workout routine even before your pregnancy test; a workout routine that you are used to will not have any effect on implantation. As mentioned above, do not increase body temperature in excess, so avoid any hot studios.
5. Early pregnancy
The first trimester until 12 weeks is often a time when patients are very worried about the effects of exercise. The truth is that miscarriage is 99% due to genetic issues. You don’t have to worry that going to a spin class will increase your risk. We do tell patients to avoid excess temperature increases, and we say that they will feel more tired than usual, so monitor your breathing and heart rate, and if you feel out of breath, take a break. Some patients will experience first-trimester bleeding. While it’s nerve-wracking, most patients go on to have a totally healthy pregnancy. However, your doctor might tell you to take it easy and be on “modified bedrest” and avoid working out for some period of time (usually until the bleeding resolves). If there is any risk of ectopic pregnancy (a pregnancy outside the uterus, usually in the tube), then you should not exercise because these pregnancies are at the highest risk for complications, including rupturing from the tube and bleeding. Your doctor will let you know if this situation arises. As the pregnancy progresses towards 12 weeks and beyond, we recommend avoiding heavy abdominal exercises to avoid putting pressure on the uterus. Any patient with chronic medical issues should also speak to their doctor about what exercise regimen is best for them.
For the most part, most patients can continue working out, just likely at a reduced level, during their treatment and early pregnancy. Ask your doctor if you have questions about a specific workout regimen. As fertility doctors, we believe a healthy lifestyle contributes to optimal success, so we encourage a good exercise regimen!
So, go ahead and book that spin class, get your yoga mat, and enjoy your workout!