Should I exercise during fertility treatment?
At the Tennessee Center for Reproductive Acupuncture in Knoxville, TN, we like to look to research to help support our patients' informed decisions regarding their care. When it comes to movement during your fertility journey, we often hear patients ask, "Am I doing too much?" or "Am I not doing enough?"
New data—including some of the first studies to use objective wearable technology like Fitbits—is finally giving us some specific answers with consideration paid to type of cycle, BMI, PCOS and more. Here is a technical mini-deep dive into three landmark studies and key takeaways to help you discuss the best exercise plan with your RE.
Fitbit data collected throughout an FET cycle compared to pregnancy rates.
Study: The Impact of Physical Activity and Stress on FET Cycles (the SSTEP Trial) (Jacobs et al., 2026)
When I started in reproductive acupuncture, the most common clinical approach after a Frozen Embryo Transfer (FET) was bed rest. That has since shifted to encourage light activity but there are still often questions around what this means. This study, referred to as the SSTEP Trial, got really specific and used Fitbits to monitor 82 women 24/7 throughout (an average 40 days of data) their FET cycles tracking steps, active minutes, sleep quality and heart rate. They also monitored salivary cortisol levels and took information from a questionnaire given to participants regarding stress levels during the cycle.
The Results: When comparing those who became pregnant with those who did not, there was no difference in step counts, sleep metrics, calories burned, or activity intensity between the groups. Additionally, there was no significant difference between perceived stress or cortisol levels between the two groups.
The Clinical Takeaway: One of the most empowering takeaways from this recent research is that your daily movement and your stress levels did not influence the pregnancy rate in FET cycles. For our patients, this is a breath of fresh air. It means that the "perfect" exercise routine or the "perfect" zen state of mind isn't a requirement for success. Your body is resilient, your treatment is robust, and you can trust that a little bit of movement (and even some stress) isn't going to get in the way of your goals.
16 week increase in physical activity in women in larger bodies and live birth rates.
Study: Physical Activity and Live Birth Rates in Unexplained Infertility (Vitek et al., 2023)
This next study is the second analysis of the FIT-PLESE trial and looked at women with a higher BMI and unexplained infertility who began an exercise program prior to IUI. Starting 16 weeks prior to fertility treatment, participants were enrolled in a lifestyle modification program that increased physical activity through increasing steps per day up to 10,000. Afterwards, they underwent a maximum of 3 clomiphene/IUI cycles.
The women were then separated into two groups, an active group and an inactive group (the upper and lower third based on actual step counts). The active group averaged over 10,000 steps per day, while the inactive averaged around 6,400 steps.
The Results: While the active group saw significant improvements in insulin sensitivity (lower triglycerides and blood sugar), the live birth rates were identical (19% vs 20%).
The Clinical Takeaway: For our patients in larger bodies, exercise is a powerful metabolic tool. It improves the "soil" (your internal environment) without any affect on your reproductive outcomes. You can pursue a high-activity lifestyle for your cardiovascular and mental health leading up to your cycle without fearing it will lower your success rates.
The Mini-Review: Fertility Markers in health active women, women with PCOS, and women undergoing IVF or FET.
Study: The Effect of Physical Activity on Fertility (Mussawar et al., 2023)
This mini-review examined data across three populations: healthy women trying to conceive naturally, overweight PCOS patients, and IVF patients, focusing on the mechanism of how exercise affects the HPO (Hypothalamic-Pituitary-Ovarian) axis.
Healthy Women:For women trying to conceive naturally it is well known, consistent vigorous exercise can cause luteal phase defect or stop ovulation entirely. In this study, they found that exercise wasn’t the problem, but the energy deficit from exercise was. The fix isn't necessarily to stop moving—it's to replace the additional calories burned or temporarily shift to moderate intensity to give our bodies more energy to work. Once our fuel tanks are full, ovulation returns and many luteal phases issues resolve.
For Women with PCOS: If you are navigating PCOS, don't be afraid of tough workouts! The research explicitly encourages vigorous aerobic exercise or resistance training over moderate exercise. These higher intensity activities help your body regulate insulin levels and help restore natural ovulation. This is true even if the number on the scale doesn't change.
The IVF "Safety Net": Research consistently shows that physical activity has either no or a slight positive effect on IVF or FET outcomes. Why? Because fertility medications (the stimulation meds, trigger, progesterone) allow your doctor to precisely time ovulation or bypass it completely. Since your doctor is carefully controlling the cycle, the exercise-induced hormonal interference that might happen naturally is effectively bypassed.
The Clinical Takeaway: If you are undergoing IVF, the energy deficit of exercise is less likely to stop ovulation because your doctor is in the driver's seat. For our PCOS patients, vigorous exercise was actually found to be more effective than moderate exercise for restoring spontaneous ovulation by lowering androgen and insulin levels regardless of weight. And healthy women trying naturally need to pay careful attention to their caloric intake to make sure they are not in an energy deficit or switch to more moderate activity to allow for more fertile cycles.
Navigating Recommendations: Questions for Your RE
Your physician’s job is to mitigate risk, but "risk" can mean different things—from a failed cycle to a rare physical complication like ovarian torsion. Always run your exercise plans by your RE prior to starting to make sure it is best for you and your treatment plan. Here are some things to ask your doctor so you understand their advice.
Regarding Ovarian Torsion:"Based on my current follicle count and the displacement of my ovaries, at what point in the stimulation phase do I need to stop high-impact or twisting movements (like yoga or running) to prevent torsion?"
Regarding Energy Availability:"Since I am a high-intensity exerciser, do you see any signs in my progesterone levels or lining thickness that suggest I am in a calorie deficit or that my activity is affecting my cycle?"
Regarding Post-Transfer Activity:"The SSTEP trial suggests that normal daily activity doesn't decrease FET success. Are there specific clinical reasons in my case that would make bed rest a better option for me personally?"
The Acupuncture Perspective
At our clinic, we focus on the autonomic nervous system and improving blood flow. While the research says exercise is safe, we want to ensure your body isn't in a "fight or flight" state. We use acupuncture to down-regulate the sympathetic nervous system and increase uterine and ovarian blood flow, ensuring that whether you are hitting 10,000 steps or resting on our table, your body feels safe, nourished, and ready for pregnancy.
Have more questions or want to schedule an appointment? Call us at 865-315-3845 or book online now!
References:
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. Fertil Steril. 2026;125:401-410. https://doi.org/10.1016/j.fertnstert.2025.08.039
Vitek WS, Sun F, Cardozo E, et al. Moderate and increased physical activity is not detrimental to live birth rates among women with unexplained infertility and obesity. Fertil Steril Rep. 2023;4:308-312. https://doi.org/10.1016/j.xfre.2023.06.004
Mussawar M, Balsom AA, Totosy de Zepetnek JO, Gordon JL. The effect of physical activity on fertility: a mini-review. Fertil Steril Rep. 2023;4:150-158. https://doi.org/10.1016/j.xfre.2023.04.005