Fertility Preservation and Assisted Reproduction Among Athletes: An Online Survey.

Introduction: As female athletes' careers lengthen, their periods of peak performance and optimal fertility overlap. Consequently, there is a rising trend of recreational and elite athletes utilizing egg freezing and in-vitro fertilization for reproductive planning. However, there is no empirical evidence supporting exercise recommendations during these periods and the assumed risk of adverse events leads to conservative approaches like reducing or stopping exercise. Therefore, we aimed to examine athletes' exercise participation while undergoing egg freezing and in-vitro fertilization.

Objective: We aimed to examine the impact of continued exercise participation during egg freezing and in-vitro fertilization on health and procedure outcomes.

Methods: We conducted an online survey study of recreational and elite athletes (≥ 18 years of age) who underwent egg freezing and/or in-vitro fertilization in the last 5 years. The survey collected self-reported information on athlete demographics, exercise participation prior to and during egg freezing and/or in-vitro fertilization, health and procedure outcomes and medical advice received during this period. Odds ratios (ORs) or relative risk ratios with 95% confidence intervals (CIs) were calculated for all categorical outcomes using regression adjusted for relevant covariates to compare outcomes in athletes who continued participating in exercise and those who stopped exercise.

Results: Between March and December 2025, 216 athletes (age 36.5 ± 3.8; primarily from the USA, Canada and the UK) were recruited to participate in the study. A total of 38 adverse events were reported by the athletes; however, the proportion of individuals who experienced an adverse event was not different between those who continued to exercise and those who did not (OR 0.74, 95% CI 0.30-1.84). Seventy-nine per cent of athletes continued to exercise while undergoing egg freezing/in-vitro fertilization, with 79% of those who continued to exercise reporting a reduction in usual exercise by reducing intensity, frequency and/or duration of exercise or participating in light activity and walking only. Three quarters of the athletes received advice from their medical provider regarding exercise participation, with the vast majority of athletes (78%) abiding by it, driven by a combination of trust in the care process and the fear of a failed assistive reproductive procedure. Across all the athletes, most reported concerns about continuing to exercise due to the fear of adverse events, with 31% choosing to stop exercising entirely.

Conclusion: Continued participation in exercise did not increase the odds of experiencing an adverse event during ovarian stimulation. Further investigation is required to direct guidance for safe and meaningful exercise participation to support female athlete health and careers.