Can elite sport damage women’s fertility?

Olympic gold-medallist Dame Laura Kenny is Britain’s most profitable feminine athlete. She has two younger boys but additionally had a miscarriage and an ectopic being pregnant, and has at all times puzzled if the bodily toll of elite sport had broken her fertility. The BBC Information Well being workforce has investigated.

Dame Laura, 32, gave her physique to biking for greater than a decade.

“Each coaching session I went in there to provide 100%, each race I went in there to provide 100%.

“I took it to the restrict – if I wasn’t sick after a race I would be like, ‘Did I attempt laborious sufficient?'”

That absolute dedication was rewarded within the velodrome. Two golds on the London 2012 Olympics had been adopted by two extra at Rio 2016.

She married fellow biking phenomenon Jason Kenny later that yr and the couple welcomed their first child, Albie, in 2017. She then secured one other gold and silver medal on the Tokyo Olympics (held in 2021).

However she miscarried in November 2021 and 5 months later had an ectopic being pregnant, by which the embryo implants outdoors of the womb, requiring emergency surgical procedure.

“All the things was a shock – I went from being so accountable for my physique to being so uncontrolled,” she informed Radio 4’s At this time programme.

Dame Laura had by no means actually apprehensive about her personal fertility earlier than. Conceiving Albie had been simple, and that being pregnant went easily.

However since first speaking publicly about her child losses, different athletes have informed her they’ve been by way of the identical factor.

It is left a nagging query – may elite sport have a dangerous impression on the fertility of feminine athletes?

“Was my physique simply operating on empty, after which it mentioned, ‘Nicely, dangle on, there is no manner we are able to do that?'” she says.

Miscarriage is widespread. About one in 4 pregnancies ends earlier than 24 weeks and plenty of happen at a really early stage. Most {couples} by no means discover out why.

However are athletes at higher threat of any kind of fertility drawback?

Dr Emma O’Donnell, an train physiologist at Loughborough College, says the approach to life of knowledgeable athlete places a singular pressure on the human physique.

Elite coaching burns an outstanding variety of energy and, because of this, athletes’ our bodies are sometimes lean and muscular, containing little or no physique fats.

If they do not eat sufficient meals to maintain up with the calorie burn then points with menstrual cycles, akin to intervals stopping for months and even years, are “quite common”, Dr O’Donnell says.

Almost two-thirds of feminine athletes expertise interrupted intervals, significantly in endurance sports activities. There are comparably excessive charges of intervals disappearing in rivals in sports activities like gymnastics, ballet and determine skating. This compares to solely 2-5% of the final inhabitants.

Absent intervals is usually a signal that ovulation (or egg launch) is not taking place.

“We’re not 100% certain,” says Dr O’Donnell, however the main thought is that having a child is so energy-intensive that the mind shuts off copy if it thinks there may be inadequate spare power.

It begins within the hypothalamus, a small construction within the centre of the mind that senses the dietary state of the physique.

Sitting simply beneath the hypothalamus is the physique’s hormone manufacturing unit – the pituitary gland.

Usually, the gland releases hormones that journey all the way down to the womb and ovaries to regulate the month-to-month menstrual cycle and the discharge of an egg, which makes being pregnant potential.

But when the hypothalamus is not glad, this course of breaks down and ovulation does not occur.

“Should you’re not ovulating you may’t have a child. You’ll be able to’t conceive as a result of there is no egg being launched,” says Dr O’Donnell.

The largest issue on this appears to be the large variety of energy burned whereas coaching, which might go away athletes struggling to eat sufficient meals to compensate.

This phenomenon is named relative power deficiency in sport (RED-S), and was first recognised by the Worldwide Olympic Committee in 2014.

However different elements are additionally prone to be concerned, says Prof Geeta Nargund, a guide at St George’s Hospital and medical director of Create Fertility.

Fats within the physique helps make the intercourse hormone oestrogen.

“If the game is affecting physique fats content material, then fairly clearly there’s an impact on oestrogen ranges,” she says.

Psychological stress – probably from the pressures of coaching and competing – can even disrupt the menstrual cycle.

“We do see this in girls with excessive ranges of hysteria,” mentioned Dr O’Donnell.

Disruption to intervals and egg launch is essentially the most clearly recognised impression on a feminine athlete’s fertility, however this could resolve as soon as they retire from competitors, she notes.

For individuals who do handle to conceive, issues can nonetheless go mistaken. After an egg is fertilised, it ought to implant into the liner of the womb. Nonetheless, in an ectopic being pregnant the egg implants elsewhere, often within the fallopian tubes that join the ovaries to the womb.

Round 11,000 pregnancies a yr within the UK are ectopic. It is not utterly clear why they occur, though irritation and scar tissue within the fallopian tubes can improve the chance.

“However on this case, I do not see a direct hyperlink between sports activities and an elevated incidence of ectopic being pregnant,” mentioned Prof Nargund, who has handled athletes battling their fertility.

Nonetheless, she mentioned there was a possible hyperlink between an excessive amount of intense train within the first three months of being pregnant and miscarriage – though way more analysis is required to make sure.

She pointed to a large Danish study that adopted greater than 90,000 girls and advised the extra intense train girls did, the upper the chance. This was significantly for weight-bearing and high-impact workout routines.

“If you find yourself within the Laura Kenny territory the place you are an elite athlete, you are the very high of that,” Prof Nargund mentioned.

However she defined the findings wanted to be taken “with warning” as a result of the way in which the research was designed meant there might be different explanations that had not been thought of.

In the meantime, a really small research of 34 Norwegian athletes discovered no elevated threat of fertility issues, together with miscarriage.

“We have to do much more analysis relating to sports activities, train, hormone steadiness and copy,” says Prof Nargund.

Lauren Nicholls performed elite degree netball for 10 years then had two kids, earlier than turning into coach of Tremendous League champions Loughborough Lightning. She says the conversations present gamers have about fertility are totally different to those she had along with her teammates.

“I do know just a few of the marginally older gamers – they’ve frozen eggs and made these choices for his or her household for a later date,” she says. “As a result of they’re apprehensive about their profession.”

Juggling being an elite athlete and beginning a household has at all times been a tough problem. For ladies, their years of peak fertility overlap with the time they hit their bodily peak.

Male athletes are additionally not immune to fertility issues. Burning extra power than you might have coming in might have an effect on testosterone ranges, trigger sperm abnormalities and even erectile dysfunction.

However for Dr Emma Pullen, a sports activities train researcher at Loughborough, the dearth of definitive solutions on the impression of elite sport is emblematic of how poorly feminine athletes have been researched, from fertility to harm threat.

She mentioned analysis was “taking part in catch up” with the quantity of consideration on male sport.

“We’re seeing the repercussions of that with rising professionalisation of ladies’s sports activities and extra feminine athletes than ever earlier than,” Dr Pullen provides.

General, Prof Nargund argues feminine athletes are prone to face extra fertility challenges than different girls.

“There appears to be a fertility drawback due to [elite sport’s] potential impact on ovulation, together with probably a better threat of miscarriage,” she says.

However a definitive reply on precisely how a lot elite-level train is an excessive amount of shouldn’t be clear. And that is sufficient for Dame Laura, for now.

“The dialog in itself I really feel is actually necessary as a result of I would like folks to begin speaking,” Laura says. “Actually, I’d like it if it was much more open.”

The connection between train and fertility impacts all of us although, even when we’re a great distance from Olympic glory.

Most women and men profit from exercising and dropping extra weight earlier than attempting to conceive – that is recognized to spice up fertility.

Common bodily exercise reduces stress, improves sleep and makes intervals extra common in these with the hormonal situation polycystic ovary syndrome (PCOS).

However beginner feminine athletes who prepare intensively can even find yourself operating on empty and seeing their intervals cease, or grow to be irregular.

“To not fairly the identical extent, nevertheless it’s there,” says Dr O’Donnell.

Ensuring there is a steadiness between power consumption and power output is “actually necessary to ovulatory cycles” and the important thing to sustaining reproductive operate, she provides.

“[Amateur athletes] usually are not conscious of the actual fact of what number of energy they actually need to place in to fulfill that power demand.”