Can Physiotherapists Play a Role in Fertility?

We recently finished another round of the increasingly popular Physiopedia Volunteer Orientation Course. As part of the final assignment members were tasked to write an original piece of work to share with the profession, the contributions were of the highest quality. Below is the great piece of work written by Nicole Sandhu.

The Link Between Weight and Fertility

A study conducted by Kiel et al. (2018), examined the effect of high-intensity interval training (HIT) on women undergoing assisted fertilization through a pilot randomized control trial. Eighteen woman with a body mass index of over 25.0 kg/m​2​ were split into two groups: the control group “usual care” (n=10) and the intervention group “HIT” (n=8). The first outcome measure was “ongoing pregnancy” and the second was “insulin sensitivity, reproductive hormones, oxygen uptake, and body composition.” The study concluded that HIT significantly improved insulin sensitivity, VO​2 ​peak, and abdominal fat. Furthermore, fertility outcomes may increase by improving insulin sensitivity and the regulating the hypothalamic-pituitary-adrenal axis, central obesity, as well as, cardiovascular fitness [​2,3].

Implications for Clinical Practice

A limitation of this study is the small sample size, as it is a pilot study. However, it has been well documented that weight has a strong correlation with the outcome of assisted fertilization [​2,4]. Physiotherapists may be well positioned to assist patients with this aspect of their fertility journey. The first step for physiotherapists is to become educated on the topic and aid in educating the public on the importance of exercise and weight management in fertility. Physiotherapists can have a more direct role through creating and implementing an exercise program to suit the needs of their clients. Exercise is a relatively inexpensive addition to “usual care” in improving the outcomes of assisted fertilization. Additionally, exercise may aid in the mental health of clients during this challenging time. The ultimate goal is to aid individuals in reaching their fertility goals and it is important that as healthcare providers we are informative and proactive regarding the breadth of issues that could be affecting their assisted fertility outcomes.

References

  1. ​Government of Canada. Fertility. Available from https://www.canada.ca/en/public-health/services/fertility/fertility.html​ (accessed 1 March 2019).
  2. ​Kiel IA, Lundgren KM, Mørkved S, Kjøtrød SB, Salvesen Ø, Romundstad LB, Moholdt T. Women undergoing assisted fertilisation and high-intensity interval training: a pilot randomised controlled trial. BMJ open sport & exercise medicine. 2018 Jul 1;4(1):e000387.
  3. Hakimi O, Cameron LC. Effect of exercise on ovulation: a systematic review. Sports Medicine. 2017 Aug 1;47(8):1555-67.
  4. ​Zain MM, Norman RJ. Impact of obesity on female fertility and fertility treatment. Women’s health. 2008 Mar;4(2):183-94.

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