Exercise and fertility: an update

Association between childhood obesity and infertility in later life: a systematic review of cohort studies

BACKGROUND

The global prevalence of childhood obesity has exhibited a troubling surge in recent years. Due to the raised questions regarding its potential correlation with infertility in adulthood, this systematic review has been undertaken to explore the relationships between childhood obesity, and infertility later in life.

METHODS

A comprehensive search was performed in three international databases (PubMed, Web of Science, and Scopus). All cohort (retrospective or prospective), case-cohort, and nested case-control studies until April 2022 which assessed the association of obesity in children and adolescents with male and female infertility indicators in later life were included. The quality of the included studies was assessed by Newcastle-Ottawa quality assessment checklists.

RESULT

Out of the initial 32,501 documents, eleven eligible studies with a total sample size of 498,980 participants were included. Five studies focused on the number of offspring and indicated that obesity, especially in adolescence had an association with later life lower number of children, nulliparity, and childlessness in both men and women. Concerning conceiving problems, two studies showed that obesity before age 12 increased the risk of female fertility problems in the future. Two studies reported that obesity in early life raised the risk of impaired female reproductive system such as menstrual or ovulatory problems. As well as females, a study discovered that obesity in men during their 20s was linked to an elevated risk of low sperm motility and poor sperm morphology. Another study has reported men with higher pre-pubertal BMI had lower sex hormone-binding globulin; however, the same association was not seen between childhood BMI and semen quality.

CONCLUSION

The evidence suggests a positive association between childhood obesity with infertility indicators in later life. Childhood weight reduction strategies are suggested to be implemented in societies in order to reduce infertility rates in later life.

Impact of Physical Activity and Sedentary Behavior on Spontaneous Female and Male Fertility: A Systematic Review

BACKGROUND

Before pregnancy is recognized, ovulation, fertilization, and implantation must all occur. Physical activity and sedentary behavior may impact pregnancy success by altering each or all of these processes. The aim of this review was to review the association between physical activity and sedentary behavior with spontaneous female and male fertility.

METHOD

PubMed/MEDLINE, Web of Science, CINAHL, SPORTDiscus, and Embase were searched from inception to August 9, 2021. Eligible studies included randomized controlled trials or observational studies, published in English, describing an association between physical activity or sedentary behavior (exposures) and spontaneous fertility (outcome) among women or men.

RESULTS

Thirty-four studies from 31 unique populations were included in this review (12 cross-sectional studies, 10 cohort studies, 6 case-control studies, 5 randomized controlled trials, and one case-cohort study). Of the 25 studies among women, the majority identified mixed results (n = 11) or no association (n = 9) between physical activity and female fertility. Seven studies reported on female fertility and sedentary behavior, and 2 found sedentary behavior was associated with decreased female fertility. Of the 11 studies among men, most of the studies (n = 6) found that physical activity was associated with increased male fertility. Two of the studies reported on male fertility and sedentary behavior, and neither identified an association.

CONCLUSIONS

The association between spontaneous fertility and physical activity in both men and women remains unclear, and the association with sedentary behavior remains largely unexplored.

Impact of energy availability and physical activity on variation in fertility across human populations

Human reproduction is energetically costly, even more so than other primates. In this review, we consider how the energy cost of physical activity impacts reproductive tasks. Daily energy expenditure appears to be constrained, leading to trade-offs between activity and reproduction expenditures in physically active populations. High workloads can lead to suppression of basal metabolic rate and low gestational weight gain during pregnancy and longer interbirth intervals. These responses lead to variation in fertility, including age at first reproduction and interbirth interval. The influence of energetics is evident even in industrialized populations, where cultural and economic factors predominate. With the decoupling of skills acquisition from food procurement, extrasomatic resources and investment in individual offspring becomes very costly. The result is greater investment in fewer offspring. We present a summary of age at first reproduction and interbirth interval trends across a diverse, global sample representing 44 countries and two natural fertility populations. While economic factors impact fertility, women in energy-rich, industrialized populations are capable of greater reproductive output than women in energy-stressed populations. Thus, energetic factors can be disentangled from cultural and economic impacts on fertility. Future research should focus on objective measurements of energy intake, energy expenditure, and physical activity in a broader sample of populations to elucidate the role of energetics in shaping reproductive outcomes and health.

Moderate-Intensity Exercise Training in Association with Insulin Promotes Heat Shock Proteins 70 and 90 Expressions in Testicular Tissue of Experimental Type 1 Diabetes

Objective

The current research was designed to analyze the effect of moderate-intensity exercise training (MEXT), solely and simultaneous with insulin, on the network between oxidative stress and Hsp70 and Hsp90 chaperones after experimental type I diabetes (DM) induction in rats.

Materials and Methods

In the experimental study, 36 mature Wistar rats were assigned into control and experimental type I DM-induced groups, and then the diabetic animals were categorized to sedentary type I DM-induced (SDM), exercise training-sole without DM (E), exercise training DM-induced (EDM), insulin-treated sedentary DM-induced (ISDM), and exercise training insulin-treated DM-induced (EIDM) groups. After 6 weeks, Johnson’s score was evaluated to analyze the spermatogenesis ratio.

Results

The Hsp70 and Hsp90 expression levels, testicular total antioxidant capacity (TAC), protein peroxidation ratio, testicular DNA fragmentation ratio, and mRNA damage were investigated. The animals in EDM and EIDM groups (solely and simultaneously) represented a significant (P<0.05) improvement in Johnson’s score, spermatogenesis, and TAC ratios versus SDM animals. Moreover, the DM-induced DNA and mRNA damage and protein peroxidation ratio were significantly (P<0.05) recovered in EDM and ISDM groups, which was more remarkable in the EIDM group. The EDM and EIDM groups exhibited significant (P<0.05) increment in Hsp70 and Hsp90 expression levels versus the control and SEDT1 animals. However, the EIDM group exhibited no significant changes compared to the control animals.

Conclusion

The EX could ameliorate the EDT1-induced detrimental impact by up-regulating Hsp70 and Hsp90 expressions. Meanwhile, it exerts potentially more effective impact, when it is considered simultaneously with insulin therapy.

Potential inhibitory effect of swimming exercise on the Kisspeptin-GnRH signaling pathway in male rats

Aerobic exercises are considered as an effective method of improving several undesirable health outcomes; however, their implications in the male reproductive axis have remained controversial. The present study evaluated the impact of physical exercise on the male reproductive system in rats and investigated the potential central and peripheral mechanisms involved in it. Twenty male Sprague-Dawley rats were randomly divided into control and exercise groups, with 10 rats per group. The rats were subjected to a swimming exercise for 60 min/day for five days a week and the protocol was followed for six constitutive weeks. We found that the swimming exercise significantly decreased the testicular weight and the testicular somatic index. Furthermore, there was a marked reduction in several sperm characteristics, including sperm count, motility, morphology, and viability in the exercised rats. The serum levels of reproductive hormones, i.e., testosterone (T), luteinizing hormone (LH), and follicle stimulating hormone (FSH) were significantly decreased. A histological examination of testes and epididymis revealed defective spermatogenesis. Molecular analysis revealed the downregulation of the expression of mRNAs of the hypothalamic kisspeptin (Kiss1), Kiss1 receptor (Kiss1r), gonadotropin-releasing hormone (GnRH1), GnRH1 receptor (GnRHr), and testicular Kiss1r along with an upregulation in the gene expression of GnRHr in the pituitary. We also observed a significant reduction in the activity and the expression of mRNAs of testicular superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) and a marked elevation in the levelsof malondialdehyde (MDA). These findings implied that chronic swimming exercise suppressed the Kisspeptin-GnRH signaling pathway, consequently reducing the production of male reproductive hormones. A simultaneous increase in the oxidative stress could contribute to exercise-induced inhibition of male reproductive functions. To conclude, an appropriate training program is important to maximize the benefits and minimize the side effects of physical exercises on the male reproductive system.

Effect of Exercise on Ovulation: A Systematic Review

BACKGROUND

Infertility has been described as a devastating life crisis for couples, and has a particularly severe effect on women, in terms of anxiety and depression. Anovulation accounts for around 30% of female infertility, and while lifestyle factors such as physical activity are known to be important, the relationship between exercise and ovulation is multi-factorial and complex, and to date there are no clear recommendations concerning exercise regimes.

OBJECTIVES

The objective of this review was to systematically assess the effect of physical activity on ovulation and to discuss the possible mechanisms by which exercise acts to modulate ovulation in reproductive-age women. This was done with a view to improve existing guidelines for women wishing to conceive, as well as women suffering from anovulatory infertility.

SEARCH METHODS

The published literature was searched up to April 2016 using the search terms ovulation, anovulatory, fertility, sport, physical activity and exercise. Both observational and interventional studies were considered, as well as studies that combined exercise with diet. Case studies and articles that did not report anovulation/ovulation or ovarian morphology as outcomes were excluded. Studies involving administered drugs in addition to exercise were excluded.

RESULTS

In total, ten interventions and four observational cohort studies were deemed relevant. Cohort studies showed that there is an increased risk of anovulation in extremely heavy exercisers (>60 min/day), but vigorous exercise of 30-60 min/day was associated with reduced risk of anovulatory infertility. Ten interventions were identified, and of these three have studied the effect of vigorous exercise on ovulation in healthy, ovulating women, but only one showed a significant disruption of ovulation as a result. Seven studies have investigated the effect of exercise on overweight/obese women suffering from polycystic ovary syndrome (PCOS) or anovulatory infertility, showing that exercise, with or without diet, can lead to resumption of ovulation. The mechanism by which exercise affects ovulation is most probably via modulation of the hypothalamic-pituitary-gonadal (HPG) axis due to increased activity of the hypothalamic-pituitary-adrenal (HPA) axis. In heavy exercisers and/or underweight women, an energy drain, low leptin and fluctuating opioids caused by excess exercise have been implicated in HPA dysfunction. In overweight and obese women (with or without PCOS), exercise contributed to lower insulin and free androgen levels, leading to the restoration of HPA regulation of ovulation.

CONCLUSIONS

Several clear gaps have been identified in the existing literature. Short-term studies of over-training have not always produced the disturbance to ovulation identified in the observational studies, bringing up the question of the roles of longer term training and chronic energy deficit. We believe this merits further investigation in specific cohorts, such as professional athletes. Another gap is the complete absence of exercise-based interventions in anovulatory women with a normal body mass index (BMI). The possibly unjustified focus on weight loss rather than the exercise programme means there is also a lack of studies comparing types of physical activity, intensity and settings. We believe that these gaps are delaying an efficient and effective use of exercise as a therapeutic modality to treat anovulatory infertility.

The effects of 16 weeks of intensive cycling training on seminal oxidants and antioxidants in male road cyclists

OBJECTIVE

To examine the effects of 16 weeks of intensive cycling training on seminal reactive oxygen species (ROS), malondialdehyde (MDA), superoxide dismutase (SOD), catalase, and total antioxidant capacity (TAC) in male road cyclists.

DESIGN

Repeated measures design.

SETTING

The Exercise Physiology Laboratory of the Urmia University.

PARTICIPANTS

Twenty-four healthy nonprofessional male road cyclists (aged 17-26 years) participated in this study.

INTERVENTIONS

All subjects participated in 16 weeks of intensive cycling training. The semen samples were collected, respectively, at baseline (T1), immediately (T2), 12 (T3), and 24 (T4) hours after the last training session in week 8; immediately (T5), 12 (T6), and 24 (T7) hours after the last training session in week 16; and 7 (T8) and 30 (T9) days after the last training session in week 16.

MAIN OUTCOME MEASURES

Total antioxidant capacity and SOD were measured by colorimetric assay. The levels of ROS were measured by a chemiluminescence assay. Malondialdehyde levels were measured by thiobarbituric acid reactive substance assay. Catalase was measured by monitoring the initial rate of disappearance of hydrogen peroxide (initial concentration 10 mM) at 240 nm.

RESULTS

The levels of seminal ROS and MDA increased (P < 0.008) and remained high after 30 days of recovery. The levels of seminal SOD, catalase, and TAC decreased (P < 0.008) and remained low after 30 days of recovery (P < 0.008).

CONCLUSIONS

Sixteen weeks of intensive cycling training may have deleterious consequences for spermatozoa and hence may affect sperm healthy parameters in male cyclists.

Prevalence of behaviour-related fertility disorders in a clinical sample: results of a pilot study

INTRODUCTION

There is no doubt that lifestyle factors can be detrimental to fertility. The aim of the present pilot study was to identify initial prevalence rates for behaviour-related fertility disorders in a clinical sample of couples wanting a child.

METHODS

Between February 2010 and August 2010, all patients coming for the first time to Heidelberg University's Women's Hospital for consultation on involuntary childlessness were asked to fill out a questionnaire designed by the authors of this article. The questionnaire was based on a review of the relevant literature, with special reference to the latest research findings on behaviour detrimental to fertility. Of the 156 couples addressed, 110 women and 100 men took part in the study.

RESULTS

For behaviour-related infertility, 9 % of the women and 3 % of the men in our sample were classified on the basis of BMI <18.5, sexual disorders, or abuse of anabolic steroids. If we include smokers, these figures increase: 11 % female smokers and 18 % male smokers. A further 19 % of the women practised sport to an excessive degree; and 26 % of the women and 53 % of the men had a BMI ≥25.

DISCUSSION

The prevalence of behaviour-related fertility disorders should not be underestimated. For the prevention of behaviour-related fertility disorders, it is important to inform the population about lifestyle-mediated fertility risks.

Physical activity and age at menopause: the Nord-Trøndelag population-based health study

BACKGROUND

Age at menopause may affect women's subsequent morbidity and mortality. In contrast to numerous other health outcomes, little is known about the possible effects of physical activity on age at menopause.

OBJECTIVES

To assess the relationship between leisure-time physical activity and age at menopause.

METHODS

Premenopausal women participating in a population-based health survey (HUNT 2) conducted in the county of Nord-Trøndelag, Norway reported their physical activity in the period of 1995-1997. Age at menopause was reported during 2006-2008 (HUNT 3). Cox proportional hazards models were used to estimate hazard ratios for menopause and logistic regression to estimate odds ratios for early menopause, with 95% confidence intervals, adjusting for age at menarche, parity, use of oral contraceptives prior to the 6 months preceding participation in HUNT 2, symptoms of depression, smoking status, and education.

RESULTS

Women aged 40-49 years at baseline had lower hazard ratios for menopause when participating in any light leisure-time physical activity compared with no activity (p < 0.05) and similar results were observed in 19-39-year-olds. In 50-59-year-old women, the results varied greatly and did not reach statistical significance.

CONCLUSIONS

The effects of leisure-time physical activity on age at menopause may be age-dependent. We found indications of earlier menopause for the least active women aged 19-49 years at baseline.