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As a pelvic health physical therapist at Shirley Ryan 嫩B研究院, I specialize in helping women stay physically strong, active and free from pain before, during and after pregnancy. This includes working with some women during fertility treatments, such as in vitro fertilization (IVF).
嫩B研究院 has shown that exercise and physical activity during IVF are associated with positive outcomes. However, though there are more than 500,000 babies born worldwide following IVF each year, there is a lack of exercise guidance available for women undergoing fertility treatments.
As a result, some women may stop exercising completely because they are confused about the appropriate level of physical activity during IVF. Also, when I talk to patients, they often express frustration about how they feel — mentally and physically — during fertility treatment.
Yet, exercise is key for mental and physical health as women embark upon their journey to motherhood. We have created the following guidelines, based on current research, to help women build a strong foundation of safe and effective exercise during IVF.
Exercise & IVF: Getting Started
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Exercise provides many health benefits, such as increasing circulation, helping with stress and aiding in weight management. If you are just starting an exercise program during IVF, there are a few things to keep in mind as you get going:
- Build toward the recommended 150 minutes of moderate aerobic exercise per week, with activities such as walking, swimming and cycling. A strengthening program also is recommended to better support your body, with exercises such as standard or standing planks; supine bridges and marches while lying on your back; and shoulder rows with resistance.
- Consider an initial physical therapy consultation for support related to lifting mechanics, exercise initiation, postural control (balance and stability) and/or strength assessment.
- Consider a pelvic floor evaluation for any of the following symptoms: pain with sexual activity; leakage of urine; pelvic pain; urinary frequency or urgency; or constipation.
Exercise Recommendations for Different Phases of IVF
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Following are recommendations for prior to starting IVF, during treatment and transfer, and during pregnancy.
Before starting IVF
Continue to exercise as usual, or — as noted above — start an exercise regime to promote overall health.
During treatment
Continue 150 minutes per week of aerobic exercise but pause strenuous activity. Cardio exercises can include walking, using the stationary bike and swimming. During cardio activity, use the Rate of Perceived Exertion (RPE) Scale to monitor exertion, staying below a 7/10 on this scale (e.g., engage in vigorous activity that causes you to be short of breath, but still allows you to speak in full sentences).
Strengthening is recommended during this time — including upper-extremity strengthening — but avoid any twisting core exercises.
Post transfer
In the first 14 days post transfer, avoid strenuous exercise; high-impact activities; and core workouts including any exercises where you twist your torso. It is OK to continue upper-extremity strengthening and walking, maintaining approximately 150 minutes of activity per week. Keep exertion below a 5/10 during this time period (e.g., moderate activity in which you can still simultaneously speak in sentences).
More than 14 days post transfer
This is the time to build back to previous levels of activity. Continue 150 minutes of moderate intensity aerobic exercise per week and resume a comprehensive strengthening program. At this point, exertion should stay at or below 7/10. (If you are not pregnant, you may resume regular exercise as per your doctor’s recommendations. If you become pregnant, proceed with the following pregnancy guidelines.)
Pregnancy
Regular exercise during pregnancy provides many benefits. It has been shown to reduce back pain, ease constipation, decrease risk of pregnancy complications, promote healthy weight gain and improve overall fitness.
During pregnancy, we monitor a patient’s exertion based on their age-predicted maximum heart rate (which is calculated by subtracting their age from 220). The recommendation is to remain below 60-80% of the age-predicted maximum heart rate and to not exceed 140 beats per minute (bpm).
Also, during pregnancy, continue to build back to previous levels of exercise. Some suggested exercises during pregnancy include walking, swimming or water workouts; riding a stationary bike; modified yoga; or modified Pilates.
Exercise recommendations may change as a patient proceeds further into their pregnancy. This is a great time to work with a physical therapist to modify exercise, if necessary, and prepare for labor and delivery.
Overall, our goal is to support women as their bodies go through the natural changes associated with fertility treatments and pregnancy, while at the same time reducing or preventing any postnatal issues — such as urinary incontinence; pelvic floor dysfunction; and hip and low back pain — so they can focus on enjoying this special time in life.
Resource: Rate of Perceived Exertion (RPE) Scale
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The RPE Scale is a self-assessment tool used to measure the intensity of physical activity.
Meet the Expert
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Kathleen Darley, PT, DPT, is a senior physical therapist at Shirley Ryan 嫩B研究院. Kathleen currently treats women with musculoskeletal and pelvic floor disorders. She has extensive experience treating pre- and postnatal women; athletes; and dancers and performing artists in her role as the lead physical therapist for Shirley Ryan 嫩B研究院's Performing Arts Medicine Program. She earned her bachelor’s degree in kinesiology, graduating magna cum laude from the University of Illinois Chicago. She then went on to earn her doctor of physical therapy degree at Northwestern University Feinberg School of Medicine.
To create these exercise guidelines and to review current research about exercise and IVF, Kathleen collaborated with Sarah Hwang, MD, attending physician and director of women’s health rehabilitation at Shirley Ryan 嫩B研究院; Ariana Alexander, DPT, WCS, senior pelvic health physical therapist; and Amanda Adeleye, MD, a reproductive endocrinology and infertility specialist and the founder and medical director of CCRM Fertility in Chicago.
