Physical Activity and In Vitro Fertilization Outcomes: A Stage-by-Stage Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.76.76103Keywords
physical activity, in vitro fertilization, assisted reproductive technology, dose-response relationship, embryo transfer, couple-based interventionAbstract
Background. Infertility affects approximately 17.5% of the adult population worldwide. Physical activity is promoted as an element of a healthy lifestyle, yet clinical practice still limits it at selected stages of IVF treatment.
Aim. The aim of this review is to systematize the current literature on the influence of physical activity of the woman, the man, and the couple on treatment outcomes at the individual stages of IVF.
Material and methods. PubMed was searched using two search queries, supplemented with targeted searches.
Results. For women, evidence on the pre-treatment phase is heterogeneous, resembling a "reverse J-curve": benefit at moderate activity, no benefit or risk at extremely high levels. Data on stimulation and embryo transfer are more consistent, not supporting routine restriction and suggesting a psychological benefit of continued activity. In men, evidence is consistent, with no adverse effects. Oocyte retrieval, sperm collection, and joint couple activity remain almost unexamined.
Conclusions. Available evidence does not justify the routine restriction of physical activity during IVF treatment. A recurring theme is the nonlinear dose–response relationship, indicating a benefit of moderate activity. Further studies with objective measurement of exposure, including those focused on the couple, are needed.
References
1. Cox, C.M.; Thoma, M.E.; Tchangalova, N.; Mburu, G.; Bornstein, M.J.; Johnson, C.L.; Kiarie, J. Infertility Prevalence and the Methods of Estimation from 1990 to 2021: A Systematic Review and Meta-Analysis. Human Reproduction Open 2022, 2022, hoac051, https://doi.org/10.1093/hropen/hoac051.
2. Rozen, G.; Stern, K. An Update on Fertility Assistance and Assisted Reproductive Technologies. Australian Journal of General Practice 2023, 52, 11–17, https://doi.org/10.31128/AJGP-08-22-6512.
3. Wang, C.; Lv, H.; Ling, X. Association of Assisted Reproductive Technology, Germline de Novo Mutations and Congenital Heart Defects in a Prospective Birth Cohort Study. Cell Research 2021, 31, 919–928, https://doi.org/10.1038/s41422-021-00521-w.
4. Mosleh, R.; Assi, H.; Kassir, J.; Ajami, H.; Azoury, J.; Ajrouche, R.; Al-Hajje, A. Analysis of Status and Influencing Factors of Knowledge, Attitudes, and Expectations towards Assisted Reproductive Technology among Infertile Women in Lebanon: A Cross-Sectional Study. PLoS One 2026, 21, e0331989, https://doi.org/10.1371/journal.pone.0331989.
5. Cimadomo, D.; de los Santos, M.J.; Griesinger, G.; Lainas, G.; Le Clef, N.; McLernon, D.J.; Montjean, D.; Toth, B.; Vermeulen, N.; Macklon, N. ESHRE Good Practice Recommendations on Recurrent Implantation Failure. Human Reproduction Open 2023, 2023, hoad023, https://doi.org/10.1093/hropen/hoad023.
6. Alexander M. Kotlyar; David B. Seifer Women with PCOS Who Undergo IVF: A Comprehensive Review of Therapeutic Strategies for Successful Outcomes. Reprod Biol Endocrinol 2023, 21, 70–70, https://doi.org/10.1186/s12958-023-01120-7.
7. Mena, G.P.; Mielke, G.I.; Brown, W.J. The Effect of Physical Activity on Reproductive Health Outcomes in Young Women: A Systematic Review and Meta-Analysis. Human Reproduction Update 2019, 25, 541–563, https://doi.org/10.1093/humupd/dmz013.
8. Panas, Z.; Ślinko, I.; Kuliś, G.; Dryl Jarmoc, E.; Krawczuk, K.; Dziemiańczuk, J.; Zimowski, M.; Kadysz, P.; Kolanek, A.; Czajkowski, M. Biological Clock and Reproductive Longevity: Molecular Insights into Ovarian Aging and the Role of Physical Activity. Quality in Sport 2026, 54, 70260, https://doi.org/10.12775/QS.2026.54.70260.
9. Geiger, J.; Quaas, A.; Quaas, P.; Schötzau, A.; Heinzelmann-Schwarz, V.; Gobrecht-Keller, U.; Fischer, M. Impact of Maternal Physical Activity on Outcome of Assisted Reproduction. Frontiers in Endocrinology 2026, 17, 1893897, https://doi.org/10.3389/fendo.2026.1893897.
10. Cieślik, A.; Kosieradzka, K.; Kosecka, K.; Adamowicz, D.; Rudziński, P.; Jargieło, A.; Łopuszyńska, I.; Stańczyk, J.; Meliksetian, A.; Wosińska, A. Do Lifestyle Habits Have an Impact on Infertility in Couples? A Systematic Review of the Topic. Journal of Education, Health and Sport 2023, 26, 81–98, https://doi.org/10.12775/JEHS.2023.26.01.009.
11. Prémusz, V.; Lendvai-Emmert, D.; Makai, A.; Amrein, K.; Chauhan, S.; Bódis, J.; Kovács, K.A.; Várnagy, Á. Pre-Treatment Physical Activity Could Positively Influence Pregnancy Rates in IVF despite the Induced Oxidative Stress: A Cohort Study on Salivary 8-Hydroxy-2′-Deoxyguanosine. Antioxidants 2022, 11, 1586, https://doi.org/10.3390/antiox11081586.
12. Mountjoy, M.; Ackerman, K.E.; Bailey, D.M.; Burke, L.M.; Constantini, N.; Hackney, A.C.; Heikura, I.A.; Melin, A.; Pensgaard, A.M.; Stellingwerff, T.; et al. 2023 International Olympic Committee’s (IOC) Consensus Statement on Relative Energy Deficiency in Sport (REDs). British Journal of Sports Medicine 2023, 57, 1073–1097, https://doi.org/10.1136/bjsports-2023-106994.
13. Rao, M.; Zeng, Z.; Tang, L. Maternal Physical Activity before IVF/ICSI Cycles Improves Clinical Pregnancy Rate and Live Birth Rate: A Systematic Review and Meta-Analysis. Reproductive Biology and Endocrinology 2018, 16, 11, https://doi.org/10.1186/s12958-018-0328-z.
14. Morris, S.N.; Missmer, S.A.; Cramer, D.W.; Powers, R.D.; McShane, P.M.; Hornstein, M.D. Effects of Lifetime Exercise on the Outcome of in Vitro Fertilization. Obstetrics and Gynecology 2006, 108, 938–945, https://doi.org/10.1097/01.AOG.0000235704.45652.0b.
15. Evenson, K.R.; Calhoun, K.C.; Herring, A.H.; Pritchard, D.; Wen, F.; Steiner, A.Z. Association of Physical Activity in the Past Year and Immediately after in Vitro Fertilization on Pregnancy. Fertility and Sterility 2014, 101, 1047-1054.e5, https://doi.org/10.1016/j.fertnstert.2013.12.041.
16. Gaskins, A.J.; Williams, P.L.; Keller, M.G.; Souter, I.; Hauser, R.; Chavarro, J.E. Maternal Physical and Sedentary Activities in Relation to Reproductive Outcomes Following IVF. Reproductive BioMedicine Online 2016, 33, 513–521, https://doi.org/10.1016/j.rbmo.2016.07.002.
17. Deniss Sõritsa; Evelin Mäestu; Margit Nuut; Jarek Mäestu; Jairo H. Migueles; Siret Läänelaid; Aivar Ehrenberg; Aire Sekavin; Andrei Sõritsa; Andres Salumets; et al. 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 2020, 37, 1869–1881, https://doi.org/10.1007/s10815-020-01864-w.
18. Ricci, E.; Noli, S.; Ferrari, S.; La Vecchia, I.; De Cosmi, V.; Castiglioni, M.; Somigliana, E.; Agostoni, C.; Cipriani, S.; Mauri, P.A.; et al. Pretreatment Maternal Lifestyle and Outcomes of Assisted Reproduction: An Italian Cohort Study. BMJ Open 2020, 10, e038837, https://doi.org/10.1136/bmjopen-2020-038837.
19. Läänelaid, S.; Ortega, F.B.; Kunovac Kallak, T.; Joelsson, L.; Ruiz, J.R.; Hreinsson, J.; Wånggren, K.; Stavreus-Evers, A.; Kalda, R.; Salumets, A.; et al. Physical and Sedentary Activities in Association with Reproductive Outcomes among Couples Seeking Infertility Treatment: A Prospective Cohort Study. International Journal of Environmental Research and Public Health 2021, 18, 2718, https://doi.org/10.3390/ijerph18052718.
20. Legro, R.S.; Hansen, K.R.; Diamond, M.P.; Steiner, A.Z.; Coutifaris, C.; Cedars, M.I.; Hoeger, K.M.; Usadi, R.; Johnstone, E.B. Effects of Preconception Lifestyle Intervention in Infertile Women with Obesity: The FIT-PLESE Randomized Controlled Trial. PLoS Medicine 2022, 19, e1003883, https://doi.org/10.1371/journal.pmed.1003883.
21. Wang, C.; Lv, H.; Ling, X. Association of Assisted Reproductive Technology, Germline de Novo Mutations and Congenital Heart Defects in a Prospective Birth Cohort Study. Cell Research 2021, 31, 919–928, https://doi.org/10.1038/s41422-021-00521-w.
22. Espinós, J.J.; Polo, A.; Sánchez-Hernández, J.; Bordas, R.; Pares, P.; Martínez, O.; Calaf, J. Weight Decrease Improves Live Birth Rates in Obese Women Undergoing IVF: A Pilot Study. Reproductive BioMedicine Online 2017, 35, 417–424, https://doi.org/10.1016/j.rbmo.2017.06.019.
23. Palomba, S.; Falbo, A.; Valli, B.; Morini, D.; Villani, M.T.; Nicoli, A.; La Sala, G.B. Physical Activity before IVF and ICSI Cycles in Infertile Obese Women: An Observational Cohort Study. Reproductive BioMedicine Online 2014, 29, 72–79, https://doi.org/10.1016/j.rbmo.2014.03.006.
24. Lo Giudice, A.; Asmundo, M.G.; Cimino, S.; Morgia, G.; Cocci, A.; Falcone, M.; Sokolakis, I.; Capogrosso, P.; Morgado, A.; Russo, G.I. Effects of Physical Activity on Fertility Parameters: A Meta-Analysis of Randomized Controlled Trials. World Journal of Men’s Health 2024, 42, 555–562, https://doi.org/10.5534/wjmh.230106.
25. Matorras, R.; Navarro, A.; Ramos, D.; Malaina, I.; Irazusta, J.; Vendrell, A.; Fernández, A.; Ferrando, M.; Quintana, F. Physical Activity and Sperm Quality: Influence in Sperm Donors. Reproductive Biology and Endocrinology 2022, 20, 83, https://doi.org/10.1186/s12958-022-00946-x.
26. Donato, F.; Rota, M.; Ceretti, E.; Viola, G.C.V.; Marullo, M.; Zani, D.; Lorenzetti, S.; Montano, L. Intensity and Type of Physical Activity and Semen Quality in Healthy Young Men. Fertility and Sterility 2025, 123, 88–96, https://doi.org/10.1016/j.fertnstert.2024.09.005.
27. Sharqawi, M.; Hantisteanu, S.; Bilgory, A.; Aslih, N.; Shibli Abu Raya, Y.; Atzmon, Y.; Estrada, D.; Limonad, O.; Meisel-Sharon, S.; Shalom-Paz, E. The Impact of Lifestyle on Sperm Function, Telomere Length, and IVF Outcomes. American Journal of Men’s Health 2022, 16, https://doi.org/10.1177/15579883221119931.
28. Humaidan, P.; Haahr, T.; Povlsen, B.B.; Kofod, L.; Laursen, R.J.; Alsbjerg, B.; Elbaek, H.O.; Esteves, S.C. The Combined Effect of Lifestyle Intervention and Antioxidant Therapy on Sperm DNA Fragmentation and Seminal Oxidative Stress in IVF Patients: A Pilot Study. International Braz J Urol 2022, 48, 131–156, https://doi.org/10.1590/S1677-5538.IBJU.2021.0604.
29. Hamoda, H. The Management of Ovarian Hyperstimulation Syndrome. Green-Top Guideline No. 5. BJOG: An International Journal of Obstetrics & Gynaecology 2026, https://doi.org/10.1111/1471-0528.70195.
30. Olaso, F.; Mendoza, R.; Echeverria, I.; Malaina, I.; Ibañez, J.; Irazusta, J.; Matorras, R. Impact of Physical Activity on Ovarian Response: A Prospective Study Among In Vitro Fertilization Patients. Cureus 2025, 17, e98640, https://doi.org/10.7759/cureus.98640.
31. Shapiro, M.; Kaing, A.; Christ, J.P.; Huddleston, H.G. Physical Activity During Fertility Care (PACE): A Randomized Controlled Trial of Exercise During Ovarian Stimulation. Fertility and Sterility 2024, 122, e119–e120, https://doi.org/10.1016/j.fertnstert.2024.07.391.
32. Jorge Rodriguez-Purata; Maitane Alonso-de Mendieta; Maria Jose Gomez-Cuesta; Enrique Cervantes-Bravo Live Birth Rate Following Bed Rest Versus Early Mobilization After Embryo Transfer: A Systematic Review And Meta-Analysis. JBRA 2022, 26, 547–553, https://doi.org/10.5935/1518-0557.20220003.
33. Remy, C.; Vinsonneau, L.; Stout, S.; Dupont, C.; Selleret, L.; Monnet, M.; Hours, A.; Sermondade, N.; Bardet, L.; Touboul, C.; et al. Impact of Physical Activity on Frozen Embryo Transfer Outcomes. Journal of Gynecology Obstetrics and Human Reproduction 2026.
34. Jacobs, E.; Summers, K.; Van Voorhis, B. The Impact of Physical Activity and Stress on Frozen Embryo Transfer Cycles: The Step and Stress Tracking to Estimate Pregnancy (SSTEP) Trial. Fertility and Sterility 2026, 125, 401–410, https://doi.org/10.1016/j.fertnstert.2025.08.039.
35. Wang, W.; Yang, F.; Bai, Y.; Lu, Y.; Mao, X. Association between Domain-Specific Physical Activity and Mental Health Status after Embryo Transfer in IVF-ET-Assisted Pregnancy Patients. Scientific Reports 2024, 14, 4928, https://doi.org/10.1038/s41598-024-55097-3.
36. Urata, Y.; Harada, M.; Komiya, S.; Akiyama, I.; Tuchida, C.; Nakaoka, Y.; Fukuda, A.; Morimoto, Y.; Kawahara, T.; Ishikawa, Y.; et al. Lifestyle and Fertility-Specific Quality of Life Affect Reproductive Outcomes in Couples Undergoing in Vitro Fertilization. Frontiers in Endocrinology 2024, 15, 1346084, https://doi.org/10.3389/fendo.2024.1346084.
37. Steegers-Theunissen, R.; Hoek, A.; Groen, H.; Bos, A.; van den Dool, G.; Schoonenberg, M.; Smeenk, J.; Creutzberg, E.; Vecht, L.; Starmans, L.; et al. Pre-Conception Interventions for Subfertile Couples Undergoing Assisted Reproductive Technology Treatment: Modeling Analysis. JMIR mHealth and uHealth 2020, 8, e19570, https://doi.org/10.2196/19570.
38. Malekpour, P.; Hasanzadeh, R.; Javedani Masroor, M.; Chaman, R.; Motaghi, Z. Effectiveness of a Mixed Lifestyle Program in Couples Undergoing Assisted Reproductive Technology: A Study Protocol. Reproductive Health 2023, 20, 112, https://doi.org/10.1186/s12978-023-01652-6.
39. Sunyach, C.; Courbiere, B.; Simon, N.; Delva, F.; Garlantezec, R.; Bretelle, F.; Leandri, R.; Gehanno, J.F.; Esquirol, Y.; Loubiere, S.; et al. PREVENIR-IVF: Study Protocol for a Prospective Multicentre Randomized Open Comparative Trial. Trials 2025, 26, 575, https://doi.org/10.1186/s13063-025-09208-8.
40. Dupont, C.; Aegerter, P.; Foucaut, A.M.; Reyre, A.; Lhuissier, F.J.; Bourgain, M.; Chabbert-Buffet, N.; Cédrin-Durnerin, I.; Selleret, L.; Cosson, E.; et al. Effectiveness of a Therapeutic Multiple-Lifestyle Intervention Taking into Account the Periconceptional Environment in the Management of Infertile Couples: Study Design of a Randomized Controlled Trial - the PEPCI Study. BMC Pregnancy and Childbirth 2020, 20, 322, https://doi.org/10.1186/s12884-020-2855-9.
41. Boedt, T.; Dancet, E.; Lie Fong, S.; Peeraer, K.; De Neubourg, D.; Pelckmans, S.; van de Vijver, A.; Seghers, J.; Van der Gucht, K.; Van Calster, B.; et al. Effectiveness of a Mobile Preconception Lifestyle Programme in Couples Undergoing in Vitro Fertilisation (IVF): The Protocol for the PreLiFe Randomised Controlled Trial (PreLiFe-RCT). BMJ Open 2019, 9, e029665, https://doi.org/10.1136/bmjopen-2019-029665.
42. Boedt, T.; Matthys, C.; Lie Fong, S.; De Neubourg, D.; Vereeck, S.; Seghers, J.; Van der Gucht, K.; Weyn, B.; Geerts, D.; Spiessens, C.; et al. Systematic Development of a Mobile Preconception Lifestyle Programme for Couples Undergoing IVF: The PreLiFe-Programme. Human Reproduction 2021, 36, 2493–2505, https://doi.org/10.1093/humrep/deab166.
43. Ying, L.; Chen, X.; Wu, L.H.; Shu, J.; Wu, X.; Loke, A.Y. The Partnership and Coping Enhancement Programme for Couples Undergoing in Vitro Fertilization Treatment: The Development of a Complex Intervention in China. Journal of Assisted Reproduction and Genetics 2017, 34, 99–108, https://doi.org/10.1007/s10815-016-0817-y.
44. You, R.; Huang, W.; Luo, J. The Dose-Response Effect of Aerobic Exercise on Neuroplasticity: An Analysis of The Mechanism of Drug Relapse Intervention Based on RCTs. Pedagogy and Psychology of Sport 2025, 26, 66394, https://doi.org/10.12775/PPS.2025.26.66394.
45. 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. Archives of Gynecology and Obstetrics 2023, 307, 1667–1676, https://doi.org/10.1007/s00404-022-06606-0.
46. Dai, H.; He, Q.; Liu, Y.; Wu, L.; Wang, H. Effect of Weight Loss Intervention on Assisted Reproductive Outcomes in Women with Obesity and Infertility: A Retrospective Cohort Study. Frontiers in Endocrinology 2026, 17, 1829965, https://doi.org/10.3389/fendo.2026.1829965.
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