Frequently Asked Questions

This is a tricky question as I do not recommend using BMI as a gauge of how over or underweight you are as it is calculated by dividing the body mass (kg) by height (m)² (World Health Organization, 2018) , rather than looking at the composition of that weight. Taking a body composition analysis gives body fat percentage and muscle mass values. It is common to find that an incredibly healthy person with higher than average amounts of muscle mass and optimal body fat levels are deemed overweight on the BMI scale which is very misleading.

However, a recent study of 55,888 patients found that ‘a BMI outside the range of 23-24.99 kg/m2 is likely associated with a malfunction in the implantation process’ Peterson et al (2023) and that ‘the highest success of clinical pregnancy and live births increased with a BMI of between 23-24.99 kg/M2’.

Fat loss can be a very important part of a couples preconception health plan and exercise should aim to maintain or even increase lean muscles mass while decrease body fat. A well structed resistance training program with an appropriate cardiovascular component too should be undertaken. Seeking advice from a nutritional therapist is also highly recommended.

This is very dose dependant and timing specific. The further away you are from your IVF treatment, the harder you can work – providing you’re able to recover from it! During IVF treatment, high intensity work is not recommended due to the super physiological responses that are happening to the body in those weeks.

During physical preparation for fertility treatment, the following has been found.

‘Female physical activity before IVF/ICSI cycles was associated with increased rates of clinical pregnancy and live births, whereas only a small but not statistically significant increase was found in implantation rate, and no effect was shown on miscarriage rate.’

Rao et all (2018)

However, the intensity of the exercise was not clearly defined.

Both high intensity and prolonged (>60min) workouts are associate with elevations in the stress hormone cortisol and muscle damage. Recovering from this requires a surplus of energy (notably amino acids) which may distract from the energy needs of IVF.

Furthermore, during an IVF treatment cycle I recommend completely avoiding high intensity exercise due to the risk of ovarian torsion.

High intensity work with adequate rest between efforts can be used as a training method in the preparation phase and lead up to IVF.

During the two week wait the priority is to provide and shuttle as much nutrient rich blood flow to the target area as possibly. Therefore, anything that takes away from this process is not advised. Keep your exercise sessions to 30min blocks and at a low to medium intensity.

You should be able to breathe through your nose or hold a conversation at all times. If you are unable to do this then it’s likely you’re working too hard and should dial it in.

By this stage you will have already done a fantastic job of creating the perfect environment for transfer to occur so you must keep that up by send nutrition and blood flow to the area.

Calm 15-20min walk in the morning and evening, mobility work, full body exercises using your own body weight / resistance bands / 50% of your max dumbbells, as well as pelvic floor breathing is perfect during the two week wait.

You can return to light movement 24hrs after your transfer taking the advice given in the questions above. Returning to more energy demanding exercise I advise only after your two week wait. Depending on the outcome, the direction in which you take your training may change. For all, I recommend a committed time slot of 15-20min per day to move your body with the intension of opening up tight spaces with stretches and mobility and creating blood flow with full body movements.

If you feel rested well and have eaten enough to fuel yourself for a workout then in the weeks after your TWW you can return to your regular exercise.

‘Physical activity has been associated with significantly improved clinical pregnancy rates after ART (assisted reproductive therapies’ Kakargia et al (2022) Therefore I encourage keeping a flux of blood and lymphatic fluid to the target area through movement and gentle exercise as this can have a positive impact on implantation success.

While exercise shouldn’t directly negatively impact implantation, it is important not to defer your energy, nutrients and blood flow away from the target area. Moreover, it is important not to create any additional stress in the form of strenuous exercise for the body to handle during the time leading up to and after your transfer.

Let’s split this up into the different phases of a regular IVF cycle

Ovarian stimulation – Yes.

During this phase you should reduce the intensity and type of your workouts. If you are a runner then swop this to walking, swim or a gentle x-trainer (mark gentle as your ability to stay at a nasal breathing only capacity, if you need to use your mouth then you are working too hard so drop it back a bit). If you resistance train then lighten or even remove the load of those exercises that require deep abdominal engagement. During this phase omit impact exercises i.e jumping and and any twists and rotation often found in yoga and traditional core work.

Egg retrieval

24hrs prior to and post your retrieval take a rest day. As you will be at peak stimulation at this point you will have dialled down your exercise to come to complete rest a day or two before collection. On the day of collection I advise a morning walk with your partner outside to really set your circadian rhythm and mood up well for the day.

Time between transfer.

Depending on your timeframe between collection and transfer (immediately or a planned future FET) your goal may be slightly different. If you have an imminent transfer, then the goal is to recover from any tenderness and swelling you may experience post the stimulation and then your collection. Low to medium intensity (Zone 2) cardio is great for increasing lymphatic flow as well as washing the body with fresh originated blood. The aim is to build a good strong lining to enable the best possible transfer conditions and so bodyweight lower body exercises may help here. As always, the pelvic floor lengthens and shortens with good diaphragmatic breathing therefore do plenty of this.

If your transfer time is longer, you can make a gradual return to regular exercise that invigorates and doesn’t deplete the body. Its nice during this time to concentrate of detoxification as the body has been exposed to high amounts of hormones. Gentle sweating and full body exercises will help to stimulate the removal of waste product from the body.

Embryo transfer

24hrs pre and post your transfer I recommend taking complete rest days. However, this does not mean do nothing at all. By this stage you will have already done a fantastic job of creating the perfect environment for transfer to occur so you must keep that up by send nutrition and blood flow to the area. Calm 15-20min walk in the morning and evening, gentle floor-based mobility work as well as pelvic floor breathing is perfect during the two week wait.

There are many exercises that can have a positive impact on the success of IVF! Mobility work that creates space to the lumbopelvic hip complex is essential for allowing fresh oxygenated blood into the area. Combined with exercises that engage the big muscles of the hips and pelvis to create a healthy circulation of blood and lymphatic flow. Harnessing the connection of the pelvic floor and breath will also help to relax not just your muscles but your whole nervous system, lowering stress and raising vitality.

My top 5 exercises to support IVF

• Multidirectional lunges
• Glute bridges
• Pelvic floor with diaphragmatic breathing
• Walking outside
• Calf raises

While daily movement is very much encouraged during an IVF cycle, there are a couple of phases do need a little extra precaution. During the stimulation phase of a cycle, the ovaries swell to extra ordinary size predisposing the individual to possible ovarian torsion. This is when the ovary twists on its ligaments compromising its blood flow. For this reason we take out any impact exercise i.e jumping and running and any twists and rotation often found in yoga and traditional core work. Due to the extra swelling occurring at this time, it is much more difficult to properly engage and brace the core musculature therefore we limit anything that it too demanding here ie heavily weighted movement and anything that relies on deep core stability.

Is it safe to continue with lighter versions of your regular exercise program (omitting the above jumps and twists) and remaining sympathetic to the task at hand which is driving nutrients, blood flow and available energy towards your phase of treatment.