Abstract
Purpose
This systematic review is designed to summarize the evidence concerning the impact of maternal physical activity on the reproductive outcomes following assisted reproduction techniques (ART), namely in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).
Methods
We searched for eligible studies on PubMed, EMBASE databases and the Cochrane Library from their inception until September 2021. Our primary outcomes were live birth rate and miscarriage, while secondary ones included clinical pregnancy and implantation rates. The quality of the evidence was evaluated using a study-specific adaptation of the Robins I tool.
Results
Quantitative data from 10 cohort studies (CS) and 2 randomized control trials (RCT), involving 3431 women undergoing ART treatments, were included in the analyses. The pooled results exhibited uncertainty regarding the effect of physical activity on live birth rate per woman (OR 1.15, 95% CI 0.92–1.43, p = 0.23, I2 = 61%, 9 studies) and miscarriage rates (OR 0.79, 95% CI 0.44–1.43, p = 0.43, I2 = 44%, 6 studies). However, physical activity was associated with significantly improved clinical pregnancy rate after ART (OR 1.39, 95% CI 1.08–1.79, p = 0.0009, I2 = 68%, 10 studies), whereas implantation rate after ART almost reached statistical significance (OR = 1.95, 95% CI 0.99–3.82, p = 0.05, I2 = 77%).
Conclusion
The current evidence is still insufficient to firmly conclude on the effect of maternal physical activity on live birth, miscarriage and implantation rates. Although clinical pregnancy rates favored physical activity in this group of patients, these results must be undertaken with caution due to the low quality and the high heterogeneity of the studies included.
Similar content being viewed by others
References
Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R et al (2017) The international glossary on infertility and fertility care, 2017. Fertil Steril 108(3):393–406
Domar AD, Rooney KL, Milstein M, Conboy L (2015) Lifestyle habits of 12,800 IVF patients: prevalence of negative lifestyle behaviors, and impact of region and insurance coverage. Hum Fertil 18(4):253–257
Rooney KL, Domar AD (2014) The impact of lifestyle behaviors on infertility treatment outcome. Curr Opin Obstet Gynecol 26(3):181–185
Kilpeläinen TO, Qi L, Brage S, Sharp SJ, Sonestedt E, Demerath E et al (2011) Physical activity attenuates the influence of FTO variants on obesity risk: a meta-analysis of 218,166 adults and 19,268 children. Lewis C, editor. PLoS Med 8(11):1001116
Patterson R, McNamara E, Tainio M, de Sá TH, Smith AD, Sharp SJ et al (2018) Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis. Eur J Epidemiol 33(9):811–829
O’Keefe EL, Torres-Acosta N, O’Keefe JH (2020) Training for longevity: the reverse J-curve for exercise. Mo Med 117(4):355–361
Kritikos A, Bekiari A, Nikitaras N, Famissis K, Sakellariou K (2009) Hippocrates’ counselling with regard to physical exercise, gymnastics, dietetics and health. Ir J Med Sci 178(3):377–383
Nandi A, Raja G, White D, Tarek ET (2022) Intrauterine insemination + controlled ovarian hyperstimulation versus in vitro fertilisation in unexplained infertility: a systematic review and meta-analysis. Arch Gynecol Obstet 305(4):805–824
Zeng J, Yao Z, Zhang Y, Tian F, Liao T, Wu L et al (2022) Fertilization and neonatal outcomes after early rescue intracytoplasmic sperm injection: a retrospective analysis of 16,769 patients. Arch Gynecol Obstet. https://doi.org/10.1007/s00404-022-06445-z (Internet)
Furlan AD, Pennick V, Bombardier C, van Tulder M (2009) 2009 updated method guidelines for systematic reviews in the Cochrane back review group. Spine 34(18):1929–41
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, PRISMA-P Group et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4(1):1
Kakargia E, Mamalakis E, Frountzas M, Anagnostou E, Siristatidis C. The role of maternal physical activity on in vitro fertilization outcomes: a systematic review and meta-analysis. PROSPERO 2021.CRD42021245731 [Internet]. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021245731. Accessed 12 May 2021
Dignen B (2008) Undertaking systematic reviews of research on effectiveness. York Associates International, p 8 (Business minimax)
Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339(jul21 1):b2535–b2535
Stroup DF (2000) Meta-analysis of observational studies in epidemiology a proposal for reporting. JAMA 283(15):2008
Evenson KR, Calhoun KC, Herring AH, Pritchard D, Wen F, Steiner AZ (2014) Association of physical activity in the past year and immediately after in vitro fertilization on pregnancy. Fertil Steril 101(4):1047-1054.e5
Ferreira RC, Halpern G, de Cássia Savio Figueira R, de Almeida Ferreira Braga DP, Iaconelli A, Borges E (2010) Physical activity, obesity and eating habits can influence assisted reproduction outcomes. Womens Health 6(4):517–24
Gaskins AJ, Williams PL, Keller MG, Souter I, Hauser R, Chavarro JE (2016) Maternal physical and sedentary activities in relation to reproductive outcomes following IVF. Reprod Biomed Online 33(4):513–521
Kiel IA, Lundgren KM, Mørkved S, Kjøtrød SB, Salvesen Ø, Romundstad LB et al (2018) Women undergoing assisted fertilisation and high-intensity interval training: a pilot randomised controlled trial. BMJ Open Sport Exerc Med 4(1):e000387
Kucuk M, Doymaz F, Urman B (2010) Effect of energy expenditure and physical activity on the outcomes of assisted reproduction treatment. Reprod Biomed Online 20(2):274–279
Läänelaid S, Ortega FB, Kunovac Kallak T, Joelsson L, Ruiz JR, Hreinsson J et al (2021) Physical and sedentary activities in association with reproductive outcomes among couples seeking infertility treatment: a prospective cohort study. Int J Environ Res Public Health 18(5):2718
Moran L, Tragareli V, Norman R, Noakes M (2011) Diet and IVF pilot study: short-term weight loss improves pregnancy rates in overweight⁄obese women undertaking IVF. Aust N Z J Obstet Gynaecol. https://doi.org/10.1111/j.1479-828X.2011.01343.x
Morris SN, Missmer SA, Cramer DW, Powers RD, McShane PM, Hornstein MD (2006) Effects of lifetime exercise on the outcome of in vitro fertilization. Obstet Gynecol. https://doi.org/10.1097/01.AOG.0000235704.45652.0b
Palomba S, Falbo A, Valli B, Morini D, Villani MT, Nicoli A et al (2014) Physical activity before IVF and ICSI cycles in infertile obese women: an observational cohort study. Reprod Biomed Online 29(1):72–79
Ramezanzadeh F, Kazemi A, Yavari P, Nasr-Esfahani MH, Nejat S, Rahimi-Foroshani A et al (2012) Impact of body mass index versus physical activity and calorie intake on assisted reproduction outcomes. Eur J Obstet Gynecol Reprod Biol 163(1):52–56
Ricci E, Noli S, Ferrari S, La Vecchia I, De Cosmi V, Castiglioni M et al (2020) Pretreatment maternal lifestyle and outcomes of assisted reproduction: an Italian cohort study. BMJ Open 10(11):e038837
Sõritsa D, Mäestu E, Nuut M, Mäestu J, Migueles JH, Läänelaid S et al (2020) Maternal physical activity and sedentary behaviour before and during in vitro fertilization treatment: a longitudinal study exploring the associations with controlled ovarian stimulation and pregnancy outcomes. J Assist Reprod Genet 37(8):1869–1881
Hales CM, Carroll MD, Fryar CD, Ogden CL 2020 Prevalence of obesity and severe obesity among adults: United States, 2017–2018. National Center for Health Statistics, no 360
Bessesen DH (2008) Update on obesity. J Clin Endocrinol Metab 93(6):2027–2034
Sermondade N, Huberlant S, Bourhis-Lefebvre V, Arbo E, Gallot V, Colombani M et al (2019) Female obesity is negatively associated with live birth rate following IVF: a systematic review and meta-analysis. Hum Reprod Update 25(4):439–451
Meldrum DR (2017) Introduction. Fertil Steril 107(4):831–832
Einarsson S, Bergh C, Friberg B, Pinborg A, Klajnbard A, Karlström PO et al (2017) Weight reduction intervention for obese infertile women prior to IVF: a randomized controlled trial. Hum Reprod 32(8):1621–1630
Funding
The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.
Author information
Authors and Affiliations
Contributions
All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by EK, EM, MF and EA. The first draft of the manuscript was written by EK and all authors commented on previous versions of the manuscript. CS supervised and guided the whole initiative. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
Ethical approval
The authors declare that the present manuscript is not a result of original research on human subjects but a review of the current literature thus an ethics approval is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kakargia, E., Mamalakis, E., Frountzas, M. et al. The role of maternal physical activity on in vitro fertilization outcomes: a systematic review and meta-analysis. Arch Gynecol Obstet 307, 1667–1676 (2023). https://doi.org/10.1007/s00404-022-06606-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-022-06606-0