Exercise during ovarian stimulation lowered stress levels, with no impact on IVF outcomes

Key takeaways:

• Women who exercised during ovarian stimulation had lower stress levels vs. inactive women.
• Neither ovarian torsion rates nor IVF outcomes were impacted by exercise during stimulation.

DENVER — Continued physical activity during ovarian stimulation reduced stress levels without increasing rates of ovarian torsion for women undergoing in vitro fertilization, according to new data presented at the ASRM Scientific Congress & Expo.

“Many people use physical activity and exercise for stress relief, but the standard of care in fertility treatment is to recommend reduced or no exercise during ovarian stimulation due to the theoretical concern that exercise might increase rates of ovarian torsion and uncertain outcomes on IVF outcomes,” Maren Shapiro, MD, reproductive endocrinologist and infertility specialist at the University of California San Francisco, said during a presentation.

Shapiro and colleagues conducted the randomized controlled PACE trial, which enrolled 213 women aged 18 to 43 years (mean age, 35 years) who were entering their first ovarian stimulation cycle for IVF or oocyte cryopreservation at a University of California, San Francisco, fertility clinic. Participants were randomly assigned to standard care (n = 106), with instructions to limit exercise during ovarian stimulation, or to continued exercise (n = 107), with a recommendation of 75 minutes of vigorous or 150 minutes of moderate exercise per week. Participants wore an Apple Watch to monitor physical activity and completed nightly surveys on physical activity and stress levels at baseline and during follow-up.

Primary outcome was stress as assessed by the Perceived Stress Score. Secondary outcomes included ovarian torsion rates and IVF outcomes.

Perceived Stress Score before treatment was 22 in the continued exercise group and 21 in the standard care group. After oocyte retrieval, researchers reported a trend toward higher stress levels in the standard care group vs. the continued exercise group (change in score: 2 points vs. –1 point; P = .04). Among the 157 women who were active at baseline, those assigned to he standard of care group had higher stress levels after oocyte retrieval compared with those assigned to the continued exercise group (P = .004). Researchers observed no significant difference in stress scores for women who were inactive at baseline.

IVF outcomes, including oocytes collected, fertilization rate, cleavage rate and blastocyst rate, were similar between the two groups. No cases of ovarian torsion occurred during the study period. However, the study was not powered to find a difference in ovarian torsion, according to the researchers.

“[These results] suggest that current exercise restrictions may be causing harm without holding clear and measurable benefit, and I would argue that an activity restriction during ovarian stimulation should be reconsidered,” Shapiro said.