Date of Graduation

Summer 8-10-2013

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

Abstract

Background: In the United States, 2.3% of women of childbearing age seek treatment for infertility, many of which require the use of in vitro fertilization. Women beginning this therapy are highly motivated to improve their overall health and often engage in diet and exercise modifications. It is well studied that women who engage in strenuous exercise regimens encounter anovulation, hormonal fluctuations, and disturbed energy balance, all of which decrease fertility. Alternately, overweight and obese women who do not exercise also experience infertility and an increased rate of miscarriage, which decrease with weight loss from improved diet and exercise. New research suggests that exercise intensity and duration are important considerations for women preparing for IVF, as strenuous exercise has the potential to reduce the success of IVF outcomes in all women, regardless of BMI.

Method: An exhaustive search was conducted using Medline-OVID, CINAHL (EBSCO Host), and Web of Science using the keywords: “Fertilization in Vitro,” “exercise,” “infertility,” “obesity,” and “lifestyle.” The reference list of each relevant article was scanned for additional pertinent studies. Each selected article was assessed for quality using GRADE.

Results: Two studies met inclusion criteria and were included in this systematic review. A randomized controlled pilot trial with 38 participants demonstrated an increase in live birth and decrease in pregnancy loss among overweight women undergoing IVF who engaged in mild to moderate walking based exercise program. A prospective observational study with 2232 participants demonstrated a statistically significant reduction in live births and increase in pregnancy loss, fertilization failure, implantation failure and cycle cancellation in women who engaged in cardiovascular exercise for greater than four hours per week for one to nine years prior to their first IVF intervention.

Conclusion: Mild to moderate exercise in overweight individuals is shown to improve the outcome of an IVF cycle. Conversely, strenuous cardiovascular exercise may show a decrease in live births and increase in pregnancy loss in all BMI categories. Women preparing for IVF should not initiate a new cardiovascular exercise program close in time to initiation of an IVF cycle, but mild to moderate walking based programs are not observed to cause harm. A weak recommendation that providers should caution against strenuous exercise for women who are preparing for IVF cycles is offered.

Keywords: Fertilization in Vitro, exercise, infertility, obesity, and lifestyle

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