Leptin is a hormone released from body fat that helps regulate our food intake and energy balance. We know that energy balance is linked to reproductive function, and it appears that leptin may play a key role in linking these.
Higher levels of leptin are found in infertile men and women when compared to fertile couples and there is a clear association between increasing leptin concentration and higher body fat. There are also complications that come with very low levels of body fat and being in a negative energy balance and in this instance, leptin may help restore fertility. Read more about energy balance here.
High levels of leptin in overweight males and females have been shown to impair fertility and attenuate embryo development. Leptin concentration has also been found to predict unexplained infertility in a North Indian population and can be a sensitive marker for anovulatory fertility disorders.
So if levels of leptin are associated with impaired fertility, how can they be modified?
It is true that Exercise is Medicine and incredibly within two weeks of initiating regular exercise in those with normal to high levels of body fat, leptin levels start to reduce, regardless of gender or age. Part of this is attributable to reducing body fat levels and one of the best ways to influence body composition (how much fat mass and muscle mass you have) is to engage in regular resistance training. Indeed, leptin levels are reduced to a greater extent with a combination of strength and aerobic training when compared to just aerobic training.
The reduction in leptin that accompanies regular exercise is believed to be one of the mechanisms by which exercise improves the regulation of blood sugar levels. With a lowering of leptin comes enhanced insulin sensitivity which has many benefits for improving fertility and is one of the key reasons why engaging in regular exercise and adopting a healthy diet can be such effective strategy to improve the chance of conception.
Body composition (the balance between muscle mass and body fat) influences the chance of spontaneous conception and the outcome of assisted reproductive treatments so maintaining optimal body composition is a great way to improve your reproductive health. Did you know that exercise guidelines recommend strength training 2-3 times per week for optimal health?
Strength training is the best way to maintain or build muscle mass, boost your metabolism and reduce body fat. And you can do this all without having to set foot into a gym! All you need is a small space and a towel and you can follow your program on The IVF Project app and realise all the fabulous benefits of strength training which include:
The Australian guidelines for health state that we need to move more and sit less. Specifically, they recommend including 150-300 minutes of moderate intensity aerobic activity a week (and of course strength training twice a week!). But what is ‘moderate intensity’? Do you know if you are working hard enough or too hard?
Monitoring your heart rate will enable you to determine your exercise intensity. If you have a heart rate monitor then this can be easy to track the intensity of your aerobic sessions but you can also take your heart rate manually. The range classed as moderate intensity is between 55% and <70% of your maximum heart rate.
You can estimate your maximum heart rate by the simple formula: 220 – age = maximum heart rate. Once you have your maximum heart rate you can work out the intensity range as a percentage of this. For example, someone aged 35 would have a predicted maximum HR of 185 beats per minute. Working at the top end of moderate intensity (ie. 69%) would mean that they had a HR of 128 beats per minute.
Be cautious with any heart rate monitor that records heart rate at the wrist rather than using a chest strap as these are not very accurate, particularly when moving at pace.
To measure your heart rate manually find your pulse at your wrist (the radial artery) or at your carotid artery in your neck. Using your index and middle finger, count the number of beats you feel in 20 seconds. Multiply the number of beats you count in 20 seconds by three to find the number of beats per minute. This is not so easy when you are on the move but you can always stop mid walk or jog to take a measure and know you are on track.
No Heart Rate Monitor? No Worries!
The intensity of aerobic sessions can also be determined using the Borg Rating of Perceived Exertion scale, or RPE. Perceived exertion refers to how hard you feel you are working. RPE is based on the physical sensations you experience during exercise, including increased heart rate, increased respiration or breathing rate, increased sweating, and muscle fatigue.
The scale is from 6 to 20 (Table below). As your exercise intensity increases, your RPE number will increase as you feel you are working harder. On the scale below 6 means "no exertion at all" and 20 means "maximal exertion." If you were sitting at your computer reading this your RPE of the physical activity you are doing is likely to be 6 (particularly if you are sitting!). 19-20 on the scale would be extremely strenuous exercise level. For most people this is the most strenuous exercise they have ever experienced.
Moderate exercise on the RPE scale is in the range of 11 to 12. If you have a noticeable increase in breathing rate during your exercise session but can maintain a conversation, then you are most likely in the moderate range.
What Exercise is Safe During IVF or for Maximising Fertility?
If you are looking to boost your fertility, either naturally or with fertility treatment, then exercise should be an important component of the positive lifestyle changes you make to benefit conception and the health of your baby. Knowing how much to do though can be tricky as each individual has different health considerations and different levels of fitness. There is no one size fits all approach when the end goal is so precious!
Different stages of an IVF treatment cycle require different exercise prescriptions. For men, the exercise you do in preparation for providing a sperm sample may be different to the exercise you do in the post-collection period. For women, your exercise prescription will differ between pre-treatment, stimulation, the period between egg collection and transfer day, and the seemingly forever two week wait. There will also be differences in your exercise prescription for frozen treatment cycles.
Just as you want a specialist extracting your eggs or handling your sperm sample, make sure you see an expert for exercise guidance. An Exercise Physiologist can help to create the right program to improve your chance of success needs to be based on your current health and activity levels, the cause of infertility and in particular your stage of fertility treatment. The scientific evidence is clear that the correct exercise prescription can improve your chance of success.
Male factor infertility accounts for ~20% of IVF/ICSI cycles undertaken. While there are many reasons for male infertility, there is a 50% greater chance of reductions in fertility in overweight males. Male factor infertility is associated with increased levels of inflammation and oxidative stress that can damage sperm, causing DNA fragmentation. Male factors, such as increased oxidative stress, are also implicated in recurrent pregnancy loss. So how can you improve the health of your swimmers?
Does Exercise Work?
Exercise has been shown to improve sperm quality and DNA damage by reducing markers of inflammation and oxidative stress. Research also shows that exercise can combat the negative effects of a bad diet for sperm, improving sperm quality by 68%. Importantly, moderate intensity exercise is superior to high-intensity interval training for improving sperm health so you need to get the exercise prescription right. For highly trained athletes, regular, high-intensity exercise with minimal recovery between sessions may actually reduce sperm quality. An Exercise Physiologist can provide you with the optimal exercise program to enhance your fertility.
If you are male and your preferred mode of exercise is cycling there is also evidence to suggest that you may need to back off time spent on the bike and swap this for another aerobic activity. Cycling for more than five hours a week is associated with a 92% chance of low sperm concentration. If you are trying for a baby then you can still cycle but may need to modify the frequency and intensity of your sessions.
If you are a gym junkie then keep training at moderate levels and avoid the use of supplements which may be contaminated with steroid-like substances. It goes without saying, avoid the use of anabolic steroids too. After two years of anabolic steroid use, 80% of bodybuilders (average age 27 years) had testicular atrophy, 24% reduction in sperm volume, 32% reduction in sperm motility, and a 62% reduction in sperm fertility index – not great for baby making.
Best Chance of Success
Even if male factor fertility issues are not the primary reason you are undergoing IVF, ensuring your sperm are in tip-top shape will help you to maximize your chance of success. If you have not exercised regularly before and are planning to undergo IVF, exercise will benefit your sperm health. The bonus is that improved sperm health will improve the health of your offspring too!
We love making a real difference to people's lives. Carmel had been trying to conceive for many years before joining The IVF Project. She shares her story here...
What prompted you to join?
I joined the IVF Project as I was lost, I was scared that if I exercised too much I would reduce my chances of success, my routine of exercise was destroyed as a result of being told not to get hot and sweaty in the two week wait and not knowing exactly what this meant. As a result my weight had ballooned over the course of 4 years of trying to conceive. One nurse would say don't swim, another would say its fine and I would always forget to ask my doctor (really I felt a little silly not knowing what type of exercise was ok). So when I was talking to a friend she suggested The IVF Project.
Why did you choose The IVF Project over other options?
I had tried a personal trainer, and he was great but really didn't understand the complexities of working out, endometriosis and IVF. I was starting to read some info about IVF and exercise and had come across an article by Dr Kitic about a week before The IVF Project was recommended. It was really the first time I felt someone would understand and was trained to support women in my situation.
Has being a member met your expectations?
I don't think I utilised all aspects of the Project. My partner did not get on board and I really only focused on the exercise side of things. But in terms of the exercise programs created for me, I found that they were well suited - hard enough that I was gaining muscle and loosing some weight, without leaving me feeling like I could not succeed. Any time I contacted Dr Kitic I had prompt, supportive responses. The reminders to exercise and the videos of the workouts were great - I needed both at the beginning, until exercise became a part of my routine again. Also the recipe for protein balls was a hit - so simple!
Where are you currently at in your fertility journey?
After 5 years of trying to conceive, 8 cycles of IVF we are expecting our first baby on 16th August this year.
Do you feel that you have been given a greater advantage to conceive by being a member ?
The IVF Project gave me the confidence to exercise again after my second endometriosis operation (and throughout the lead up and recovery of my third op also). Through the support of The IVF project I stopped second guessing if what I was doing (or not doing) was counter productive to the IVF process.
If someone asked you "Do you think it's worth becoming a member of The IVF Project" what would you say?
YES!!! I could not recommend it more strongly. It gave me confidence, made me feel informed about what I should be doing and when in a cycle - info that is not easy to find. The app is easy to use and the tailor made exercise plans don't require any equipment and can be done in your own home.
Thank you for your support- your work is invaluable for someone like me who was lost and beginning to question whether it would ever happen for us.
We hope to help you on your journey too!
There is a lot of scientific evidence to support the relationship between increasing weight and reductions in fertility, but as we also know improvements in fertility can been realised just a few months after adopting a more active lifestyle, even without weight loss.
Your weight is made up of body fat and fat free mass, which includes your muscle and bone. It is the proportion of each of these that is important in influencing your health and fertility. Muscle is metabolically active tissue which means that if a higher proportion of your body weight is made up of muscle, your metabolic rate is higher, burning more calories. You also have the benefit of improved glucose regulation, improved mitochondrial biogenesis (making new components of the energy storehouses in our cells), strength for everyday activities, and improved bone and tendon health.
The findings from a recent study published in Clinical Nutrition are a great illustration of why resistance training should be a component of your regular exercise routine rather than focusing on a number on the scales (1). In the study, overweight men and women were allocated to a very low energy diet for three months with some walking exercise, or the same very low energy diet and walking with resistance training 3 x week.
Weight loss in the group that did not resistance train was 19.4kg while the resistance training group lost 15.8kg. Now, if you were just looking a number of the scales you would assume that the resistance training was not as beneficial. But wait- there is more to the story!
Using techniques that can differentiate between fat mass and lean mass, the researchers showed that the group that did no resistance training lost 4.6kg of lean mass (muscle). That is almost 5kg of metabolically active tissue! This translated to a reduction in resting metabolism, meaning that their metabolic rate was reduced. This is important to note as when a significant amount of weight is lost, metabolic rate is often reduced which reflects a slower metabolism, which can make it difficult to lose more weight.
So what happened in the resistance training group? The group that resistance trained three times a week lost no muscle mass and their metabolic rate stayed the same, unlike the other group who experienced a reduction in resting energy expenditure. The scales alone as you can see did not tell the whole story! Resistance training was superior for weight-loss composition by preserving lean mass, and still enabling the loss of body fat.
Ideal body composition is important for fertility, regardless of your body weight. Have you got the optimal resistance training prescription to enhance your fertility?
Fitting physical activity into your day takes planning – it is unlikely to just happen unless you are lucky enough to wear your sandshoes and workout clothes all day!
Give some conscious thought into how you may build some more activity into your day and be at the ready. At the end of a long day it is tempting to just head home and sit on the couch so to combat this temptation I take my exercise gear to work and get changed before I leave the office. As soon as I am in the front door I grab the dog and head out before I have had time to think too much about it. A furry fried is definitely a motivator to head out to hit and the pavement.
Having your workout gear right beside the bed for when you wake up can also be a great strategy to build an exercise routine, so you are dressed and ready to go first thing.
If you spend most of your day sitting look at ways you can break up that sedentary time. Could you have a walking meeting? Head out for a short brisk walk in your lunch break? Head to the water cooler every hour for a short reprieve from sitting? This will keep you hydrated too and provide more walking breaks to go to the bathroom!
If you find that you have been at your desk without moving for two hours take a short break and perform some of the exercises below to revive you. Sitting for prolonged periods increases blood sugar and cholesterol levels, slows your metabolism and increases your chance of chronic disease, having a negative impact on fertility. Take control of your health and fertility and make sure you move every two hours.
Standing with feet shoulder-width apart, press up onto the tippy toes, pause at the top, and then lower back down. Perform 8 to 10 calf raises.
While sitting in your chair, extend your right leg until it is level with your hip, contracting the muscle at the front of your right leg. Hold for 3 seconds and then relax it. Perform 8 to 10 of these on each leg.
Standing Push Up
Face a wall, standing a little farther than arm’s length away, feet shoulder-width apart. Lean your body forward and put your palms flat against the wall at shoulder height and shoulder-width apart. Slowly breathe in as you bend your elbows and lower your upper body toward the wall in a slow, controlled motion. Keep your feet flat on the floor. Perform this exercise 8 to 12 times.
Sitting in your chair, slowly lift both feet off ~3-5cm off the floor while maintaining an upright posture and your knees bent at 90 degrees. Brace your abdominal muscles and hold your feet up for 5 seconds. Perform five of these and as you get stronger you can extend your holds up to 15 seconds.
Lifestyle change is an effective strategy to improve your chance of conception success. If you are planning to conceive in 2018 the New Year should bring with it a focus on positive choices you can make for your health and fertility rather than a list of unachievable resolutions! Remember that no matter how good your fertility clinic and treating specialist is, YOU are the one that can influence the quality of your eggs and sperm.
Think of some positive changes you could make to your current routine.
Would you like to do more walking or cycling to boost your aerobic fitness and improve your mitochondria for improved egg and sperm quality?
Would you like a home strength program that’s achievable to improve your metabolism and body composition?
Would you like to eat more omega-3 fatty acids to improve your chance of IVF success?
If you would like some guidance we are here to help!
In a very simplistic view, changes in body weight are the result of our energy balance. This can be summarised in the equation: Energy In – Energy Out = Energy Balance. If we eat (and drink) more energy than we expend through exercise, activities of daily living and our basal metabolic rate (the energy we need to keep our basic bodily functions going) we end up in a positive energy balance and our body weight increases.
Not all Energy is Created Equal
While the simple energy balance equation is a good starting point, not all energy (kilojoules or calories) is created equal. Eating 1000kJ of energy can influence our body composition differently depending on the composition of macronutrients of the 1000kJ. Macronutrients are carbohydrate, protein and fat and how much of each of these we include in our diet can influence our body composition. Eating 1000kJ of carbohydrate will have different effects on our physiology compared to eating 1000kJ of protein. There will also be different influences on body composition depending on the type of macronutrient as carbohydrates are not all created equal, just as the type of fat and protein included in our diet can have an effect.
Combining fat with fibre (carbohydrate) prolongs the time it takes for food to travel through our digestive tract  and leads to a greater sense of fullness after eating, compared to eating fat alone. Adding fat or protein to a carbohydrate-rich meal lowers the blood glucose response compared to eating carbohydrate alone . Getting the right balance of protein can also help maintain metabolically activity tissue (muscle) while losing body fat.
Are you getting the right mix of macronutrients and optimising your micronutrient intake to improve your fertility? Join us for the answer!
1. Samra RA (2010) Fats and Satiety. In: J. P. Montmayeur and J. le Coutre, editors. Fat Detection: Taste, Texture, and Post Ingestive Effects. Boca Raton (FL).
2. Akhavan T, Luhovyy BL, Brown PH, Cho CE and Anderson GH. Effect of premeal consumption of whey protein and its hydrolysate on food intake and postmeal glycemia and insulin responses in young adults. The American journal of clinical nutrition. 2010;91: 966-975.
Being overweight (or more correctly over fat) impacts upon health and importantly fertility. Data shows that overweight women with infertility take longer to conceive, have lower spontaneous conception rates, and have higher rates of infertility treatment cycle cancellation and failure . Males who are overweight or obese have a 50% greater chance of reductions in fertility .
If you are male and slightly overweight (average body mass index >25), aerobic exercise (jogging) improves markers of inflammation and oxidative stress that are known to negatively affect sperm [3, 4]. Importantly, for males moderate intensity exercise is superior to high intensity interval training for improving sperm health so you need to get the exercise prescription right.
In females with infertility, losing 10% of their maximum weight (eg. losing 7kg if you are 70 kg) through exercise and diet improves rates of conception, live birth rates and spontaneous conception (shown in the table below) .
There are so many benefits of eating well and exercising right for fertility besides weight loss though, and there is evidence that engaging in regular physical activity improves the outcome of assisted reproductive treatments, even without substantial weight loss. Being active regularly and eating well improves the outcome of assisted reproductive treatments even in you do not need to loose weight. Get moving and eat to optimise your fertility! Join us for expert advice at The IVF Project.
1. Luke, B., et al., The effect of increasing obesity on the response to and outcome of assisted reproductive technology: a national study. Fertil Steril, 2011. 96(4): p. 820-5.
2. Sunderam, S., et al., Assisted reproductive technology surveillance--United States, 2006. MMWR Surveill Summ, 2009. 58(5): p. 1-25.
3. Hajizadeh Maleki, B. and B. Tartibian, Moderate aerobic exercise training for improving reproductive function in infertile patients: A randomized controlled trial. Cytokine, 2017. 92: p. 55-67.
4. Hajizadeh Maleki, B., B. Tartibian, and M. Chehrazi, The effects of three different exercise modalities on markers of male reproduction in healthy subjects: a randomized controlled trial. Reproduction, 2017. 153(2): p. 157-174.
5. Kort, J.D., et al., A retrospective cohort study to evaluate the impact of meaningful weight loss on fertility outcomes in an overweight population with infertility. Fertil Steril, 2014. 101(5): p. 1400-3.
In response to stress, which may take the form of injury, illness, eating an unhealthy diet, sleep deprivation, other physiological stress or emotional stress, the body’s immune system responds by releasing various chemical regulators in an attempt to restore the normal environment, or ‘homeostasis’. These chemical regulators may be released from the white blood cells of the body which communicate with other cells and tissues. Some of these chemical messengers are small proteins called cytokines which indicate inflammation or activation of the immune system.
While acute inflammation is a normal, healthy response to short term stress or injury, chronic low grade inflammation is implicated in a number of disease such as cardiovascular disease, diabetes and particularly infertility . Elevated levels of inflammation negatively affect sperm and oocyte quality, reducing fertilisation and conception rate.
Reducing inflammation is an effective strategy to enhance fertility, and exercise and diet are proven to reduce inflammation. Having a sedentary lifestyle which includes sitting for long periods of time is associated with higher levels of inflammatory proteins while engaging in regular exercise reduces inflammation. Just as physical activity can modulate inflammation, what you eat can also have an impact. High fat diets increase inflammation while diets high in fruits, vegetables, whole grains and legumes reduce inflammation.
Exercise can protect against diet induced abnormalities in sperm  but a combination of eating a variety of fresh, unprocessed foods and engaging in regular exercise is the ideal way to optimise your fertility. If you do have an occasional meal that would be considered high fat, exercise (the right prescription of aerobic and resistance exercise) beforehand can reduce levels of fats in the blood stream and associated inflammation [3, 4]. In young health males eating fast food exclusively for two weeks, exercise protected against the negative diet induced reductions in good cholesterol (HDL) and insulin resistance . If you plan on eating a high fat meal, head out for a 60 min walk before you indulge to limit the damage!
Are you getting the right exercise prescription to optimise your fertility? Do you want to get individualised advice on how to improve your diet for conception?
1. Maxia N, Uccella S, Ersettigh G, Fantuzzi M, Manganini M, Scozzesi A, et al. Can unexplained infertility be evaluated by a new immunological four biomarkers panel? A pilot study. Minerva Ginecol. 2017.
2. Alhashem F, Alkhateeb M, Sakr H, Alshahrani M, Alsunaidi M, Elrefaey H, et al. Exercise protects against obesity induced semen abnormalities via downregulating stem cell factor, upregulating Ghrelin and normalizing oxidative stress. EXCLI J. 2014;13: 551-572.
3. Fuller KNZ, Summers CM and Valentine RJ. Effect of a single bout of aerobic exercise on high-fat meal-induced inflammation. Metabolism. 2017;71: 144-152.
4. Wilburn JR, Bourquin J, Wysong A and Melby CL. Resistance Exercise Attenuates High-Fructose, High-Fat-Induced Postprandial Lipemia. Nutr Metab Insights. 2015;8: 29-35.
5. Duval C, Rouillier MA, Rabasa-Lhoret R, Karelis AD. High Intensity Exercise: Can It Protect You from A Fast Food Diet? Nutrients. 2017; 9.