Melanie Cole, MS (Host): Are you someone that loves to exercise, but you're trying to have a baby? Do you worry that your exercise might be affecting your ability to get pregnant? Welcome to Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole. And joining me today is Kelly Curtis. She's a physician assistant with the Reproductive Science Center of New Jersey.

Kelly, thank you so much for being with us today. I'd like you to start by speaking a little bit about the relationship between exercise and fertility. We've heard over the years about exercise and the ability to have a period and for extreme athletes, amenorrhea, that sort of thing. But exercise and fertility isn't something we hear a lot about. Tell us about it.

Kelly Curtis, PA: Yeah, thanks for having me. So, we do know exercise is good for overall health. And one of those components of the health is fertility. So, I think the question is how much is too much exercise for those who are already very active that may be looking to be trying to conceive, you know, a family soon. But I think that's more of a limited population. I think there's a larger population that actually is not doing enough exercise or is more sedentary in their lifestyles. So, that is to discuss the importance of exercise on your fertility and any benefits it could have not only for fertility purposes, but your overall health.

Melanie Cole, MS: Kelly, you and I both have a background in exercise, and we've been learning more and more about how exercise really affects the body as a whole. But when we're speaking specifically of fertility, are there any specific exercise or intensities that are more helpful or possibly detrimental to trying to get pregnant?

Kelly Curtis, PA: Yeah. So, it's definitely an area that needs more research, and it's so individualized. My perception of intensity may be different than yours and the next person. But it's blanket statements. So for you as an individual, if you are already active, where we would get concerned if it's too much exercise is if you're starting to see irregularities in your menstrual cycle or if you're working out for hours in a week at a high vigorous intensity. So, what we can kind of loosely define vigorous workouts is where you're not able to hold a conversation, where you're breathless, you're sweating. The rate of perceived exertion, it may be like an eight or 10 on a scale of how exhausting the workout is.

What is recommended or they've seen benefits from is something moderate to vigorous, but moderate intensity activities. So, this is brisk walking. It can definitely still be more intense with like strength training, cross training, things like that, but it's not something where you're training for a marathon we want to make sure, again, that, if you are a person that typically has normal ovulatory cycles, you're able to track them, that you maintain that if you're trying to up the intensity of your workouts.

Melanie Cole, MS: Well, as we're talking about intensity, and I mentioned in my intro that high intense and athletes have, we've heard about amenorrhea and not getting their menstrual cycle. So, many women are concerned that exercise might affect their menstrual cycle and thereby affect their fertility. Can you speak just a little bit about that intensity level? And you mentioned that it's kind of subjective for us and the talk test and we need to be able to talk but are there risks to our fertility if we're say a runner or a marathon runner or somebody like that? Because you see marathon runners cranking and even when they're pregnant, sometimes. You know, they're hardcore. Can it affect the fertility?

Kelly Curtis, PA: So again, it kind of comes back to individual basis. So if you are a marathon runner, and you're interested in conceiving, it doesn't mean you're not going to be able to have a baby because of activities that you're doing. But if you're a marathon runner, you haven't had a period in three months, you're not getting adequate nutrition, which also, you know, exercise and nutrition very much go hand in hand. But if we're trying to isolate just how activity and exercise affects your fertility, then maybe backing down or decreasing your training or trying to conceive during an off period if you're, you know... I know runners are very, very dedicated. So if you are training for a marathon, your body can see it as stress, it can relieve mental stress, exercise, which can be very beneficial for multiple reasons. But if your body feels under attack because you have such intense workouts and things like that, then the last thing it wants to do is try to grow a baby. So, it could be potentially detrimental if you are training at a very, very high level, many hours a week for that. And there, historically, the Female Athlete triad is kind of an old name. Relative Energy Deficiency in Sports or REDS is the latest name for this, making sure that if you are training at this very high-intensity level, that you are getting the adequate calories and nutrition and maintaining weight, which can be beneficial without having to potentially sacrifice the intensity of the workouts.

Melanie Cole, MS: So, you mentioned stress and how that can be detrimental in itself, and exercise certainly is a great stress reliever. How do we balance that, Kelly? Because I think that trying to get pregnant is stressful, and going through fertility treatments can be stressful on a couple. So, how do we balance the amount of exercise? I like to tell people that it's take nice walks and lift some light weights, do some things that won't really, as you say, put that too taxing stress on the body. What do you tell people every day when they're trying to balance something that can help them with that stress and not doing too much that could actually affect it?

Kelly Curtis, PA: Yeah. So I mean, you're spot on. It's important to have an outlet and we know the benefits of physical activity. There's not much downfall outside of injury prevention. So, it is important not only for ovulatory purposes, weight management purposes to have a good amount of physical activity. But like I said, it's just knowing your body, understanding your body and just listening. And if the goal of exercise is weight loss, then we want you to do it in a smart manner and making sure that you're getting, again, adequate nutrition, with all of that as well. But if you're somebody that has just always been active, maintain a healthy weight, it's actually then making sure that your levels aren't so vigorous and the hours aren't of exercise aren't so long that your body is in an energy deficiency and not able to take on more than one task, a.k.a., creating a baby while having a vigorous workout routine.

Melanie Cole, MS: Yeah. You make great points. And so, we have to maintain that balance. Now, one thing that's often overlooked is male fertility, Kelly. So, give us a little bit of information about exercise and fertility for males. Does it decrease the sperm count? Does it increase it? Tell us how that affects males.

Kelly Curtis, PA: Sure. So, there is some research that shows a great benefit for active males, whether that be cardiovascular training, strength training, that would be beneficial in improving sperm concentration, motility, overall sperm quality. It's definitely more benefit than risk. Where it becomes risky is oftentimes I like to say the behaviors associated with exercise. So, if you're somebody that goes to the gym and you're working out, but you like to hit the sauna afterwards or the hot tub, those are things that we want to avoid. So, you know, if you're one of those guys that is not concerned with their workout routine, but you know, you also love the sauna, that might be something to cut out.

But if you are more sedentary, we know that if you have excess fat, that fat can actually produce estrogen, which is not favorable for male fertility. So, that population of men may benefit from exercise and weight loss for that reason. But activities to avoid specifically for males is cycling or spinning. So, the testicles are strategically placed to be cooler than the rest of the body. So, that's why we recommend avoiding any excess heat that can be damaging to sperm. And if you're somebody that's overweight as well, just the position and body habitus can warm the testes, which is not ideal, but also avoiding cycling for long periods of time. You know, if you're training or performing exercises, over one and a half, two hours a week, it may be something to potentially cut back if you're currently trying for a family.

Melanie Cole, MS: This is great information, Kelly, and important for couples that are trying to get pregnant to hear, especially if they're active and want to be active. So, I'd like you to wrap it up for us with your best advice. And while you're telling us that, you can give us a little bit of advice if we're lucky enough to get pregnant, when there does the exercise fit into that picture?

Kelly Curtis, PA: Sure. So, this is not the recommendation to stop exercising by any means. There's so many benefits of maintaining exercise regardless of where you're at in your fertility journey. But the recommendation, at least in the population I deal with, it's more of those who are not as active or are interested in becoming active, but are not sure how to get started or where they can go with their exercise.

So, at this point, any activity you can be doing, I know we kind of during our conversation talked about those who are highly active, athletic, vigorous, exercise, marathon runners, things like that. But also if you are a beginner, you just got to start somewhere. There's YouTube videos, Peloton apps, a bunch of gyms that you can join or community sites, those are all great places to start, or just walking. Ideally, brisk walking is a good place where you can feel your heart rate elevate a little bit. You can talk, but maybe not have a normal conversation as you would like you and I are. And then, I would also recommend strength training. So, there are benefits to strength training as well to prevent injury. It's a different movement for your body. It's not just one linear motion. And you may actually benefit, specifically in the PCOS population, with a combination of vigorous exercise and strength training.

And then, once you become pregnant, we're pretty conservative with recommendations during pregnancy, especially with our fertility treatments just starting out during the first trimester, but we still encourage you to continue activity. So, that may be something, again, where you're monitoring your perceived exertion, keeping it at a rate of less than six, the heart rate monitors. All of that is great to have an objective measurement of your intensity. And keeping your activity and heart rate less than 140 is how we counsel our patients on doing exercise. And nothing that's going to be high risk. So, watching your weightlifting, don't go for a personal record of how much you can lift, but more maybe lower weight and more repetitions. And then, anything to avoid contact or jumping and things like that. We want more low-impact exercises once you do become pregnant.

Melanie Cole, MS: Great information, Kelly. You are just a wealth of really good advice. Thank you so much for joining us today. And for more information, please visit fertilitynj.com to get connected with one of our providers. That concludes this episode of Fertility Talk with RSCNJ, the Reproductive Science Center of New Jersey. I'm Melanie Cole. Thanks so much for joining us today.