Exercise in first trimester

[KittyKatSmile]

Hi all

Just had my fifth BFP (no babies). All previous losses down to natural killer cells which I hope are now being managed. I generally exercise a lot. Let's say 5 times a week, a mixture of spinning, running, weights, anything else that takes my fancy at the gym. I was planning to carry on, as I always have done, as long as I'm still feeling good.

This pregnancy is IVF so I've been taking it easy through egg collection and embryo transfer but have now gone back to the gym and have in fact done two spin classes since my test yesterday morning.

I've now just received a leaflet from my clinic telling me to stop all exercise apart from walking until 12weeks at which point I can start yoga and swimming....

Firstly: I'm freaking out slightly that I will have harmed this baby but secondly: wtf? I'm going to go crazy if I can't exercise and I feel like the impact on my mental health will be far worse than the impact of the exercise.

Any tips please? Advice seems to be so conflicting.

Thanks for listening to this ramble

@KittyKatSmile congratulations mine was bfp too! I was told if I have to ask then best not to do it but I’m like you I want to get back to the gym!! But am worried as it’s so early but I suppose I can walk on the treadmill!!

P.s I am sure if you have been exercising you will be fine what about all the people who don’t know they are pregnant to start with!

Congrats @KittyKatSmile and @finallytakingtheplungewithIVF !!! I'm delighted to see you both over here.

I got very different advice about exercise, I was told to rest after EC and ET but that I could continue exercise I was already used to through the first trimester (I do salsa, yoga and swimming) but not to do anything too intense (anything that leaves me out of breath or sweaty).

It must be quite subjective because women will have very different levels of fitness to begin with and NHS encourages women to be active rather than sedentary during pregnancy.

Argh, when I did IVF I hated all the exercise restrictions - like you, I relied on it to boost my mood and make me feel in control of my body. NHS advice is absolutely to keep on exercising in pregnancy, and to try to maintain the same level for as long as you can (without going mad/training for anything extreme, obviously). After IVF, though, I have a feeling the exercise restrictions might be linked to your ovaries still being inflamed - I remember during stimms they told me not to run or jump (stationary cycling was OK) to prevent them getting tangled up like a bunch of grapes. And in pregnancy all the hormones can make the swelling linger, so the risk remains for a while. Does that sound plausible?

If I were you I might keep away from running and aerobics for that reason, but if non-IVF pregnancies benefit from exercise I can't see why IVF ones would be different, at least in principle. It may be that IVF advice is just trying to eliminate anything that has ever been considered a risk (e.g. some clinics tell you not to have sex for 12 weeks!) on a just-in-case basis - but it's your body, your baby and your sanity and if there's no obvious rationale it seems very extreme to cut it out entirely.

Maybe compromise and go with non-bouncy exercise?

Oh and congratulations!

As others have said, exercise is perfectly fine in early pregnancy. However in your situation I'd want to know why they were giving you these restrictions - they must have a reason, and I think you're entitled to know why! Can you contact the clinic and speak to someone about it? Good luck OP!

I didn't know ivf meant restrictions and I would be interested to know why.

As a fit person, but no ivf, I continued running, spinning, horse riding and body pumping - and I managed to keep exercising 4x per week until 39 weeks.

Pre-pregnancy I thought I would go crazy if I couldn't exercise. Turned out that from 6 weeks in I've been completely pole-axed with exhaustion. I've exercised once in three weeks. I'm just too tired. I would probably miss it if I wasn't too busy fantasising about sleep.

I used to run 4x a week and train martial arts 4x a week, for comparison.

I'm hoping to be able to be more active in the second trimester.

Throughout my pregnancy I did spinning 3 times a week until I was 36 weeks (couldn't balance at that point!).
I suppose it depends why there are extra restrictions for IVF pregnancies.

Thank you all, this has been really helpful. I called my clinic and no-one answered. I'm planning on doing Parkrun in the morning and I think I'm still going to go (as will be quite awkward to get out of it at this stage) but won't do anything on Monday until the clinic has called me back.

I've been doing some googling and it's all about keeping fit and healthy throughout.

So as an update, my clinic called me back today and I fully expected they'd say 'oh no, that was just lowest common denominator, safe rather than sorry, do what feels right for you' etc etc. They didn't.

They said 'yeah we'd recommend you do nothing, especially heavy weights on your abdominal area (what sort of gym does she go to?!)'. I explained my very real concerns about my mental health and she said sort of lamely 'well you've just come so far....' I said it seemed sort of odd that they were contradicting NHS guidance and in the end she let herself be talked into it by me and said 'well yes do whatever feels right for you if you were very active before'. Oh, this is after she'd said 'you can walk'. I said 'yeah; that won't really cut it for me'

I'm now more confused than ever. It sort of feels like if I want to keep doing what I want to do and what feels good then I'll have to do it against medical advice which is obviously not great.

I might try and see my GP who is lovely and a very pragmatic man. My best friend is also a GP although I haven't yet told her but could of course.

Sorry for the brain dump. Just so confused.

@KittyKatSmile I'm so sorry they still haven't given you a proper answer. Who at the clinic did you speak to? Was it an actual consultant? Did they actually say why? I would probe again and ask what their evidence is that exercise is a bad idea. Wishy washy answers are not acceptable medical advice as far as I'm concerned!

Thank you @Weathergirl1. It was one of the nurses and she didn't give any reasons other than 'you've come so far' which to my mind is not a reason. I'll try to speak to one of the consultants on Monday and will book in to see my GP next week as well. Argh.

Hi Kat - I've had two ivf pregnancies and exercised throughout my first and currently 25 weeks with second and still exercising although running is a struggle. Id definitely hold off high impact (either running or weights) post fresh transfer as your ovaries are likely to be inflamed and it can cause quite severe complications but only for the early weeks. I found with both my pregnancies that I spotted/bled quite a bit if I did exercise during first tri which was v stressful so that's something else to be mindful of. I think the issue is in the first tri you're likely taking a cocktail of drugs which make your uterus etc etc more sensitive and increase blood flow. Sorry also brain dump from me - personally I'd keep yourself low impact during first tri but increase once you're off the drugs/had a scan etc. Good luck - I know it's hard and I was/am exactly the same re exercise and mental health

Don’t bother with the GP, my experience of very many of them (and in working as a nurse) is that they leave antenatal stuff to midwives and consultant obstetricians. They often give out of date and/or contradictory information. Can you speak to your local midwife-led unit?

As per PP with IVF experience, inflammation can cause a real problem for you in early Post-transfer window. And the cramps and bleeding can be terribly alarming. I don’t think it’s necessarily s case of the embryo falling out of you....not quite anyway.

On that, your cervix in the first tri is also much softer as it is affected my the relaxins generally, and cervical compromise is untested at this stage.

I do understand the impact of reduced impact physical activity on your mental health, but to be blunt, can you go through endless cycles of IVF?? Perhaps look into prenatal personal trainers and other classes that are suitable for pregnancy, weights and strength classes generally are ok if you’re used to it.

Also be prepared for exhaustion and/or nausea and vomiting... my training schedule was laughable during this period. But I was just kinda grateful to be pregnant...maybe my priorities were different 🤷‍♀️

I'd be following the clinics advice to the letter? You've had to go through all the heartache and stress of ivf so to jeopardise a healthy outcome for the sake of a few months of putting your feet up I'm not really sure why you would want to risk it?
Surely the loss of a pregnancy would be far worse for your mental health than the feel good endorphins that exercise gives? If god forbid something happened even if it was nothing to do with exercising you might always think "what if" and I'm not sure I'd be able to deal with the guilt and self blame

Sorry if that all sounds really harsh and blunt x

KitKatSmile - couldn’t read this and not post. I also have immunological infertility (NKs and cytokines), but had a natural BFP (now a DS aged two and a half) after immune treatment the month before I was due to have a first cycle of IVF.

Anyhow, have just gone back for #2 with a clinic who, like yours, had a silly list of exercise restrictions for the 2WW (inc. walking only and not using your abdominal muscles too much!). I’m a hardcore exerciser so have looked in detail at the evidence for those restrictions and, as I was doing a frozen cycle and didn’t find anything, I completely ignored those restrictions!

What I found is the following: With a fresh cycle, the hormones to support a pregnancy can keep your ovaries enlarged for several weeks after the 2WW and there have been cases of ovarian torsion up to six weeks after egg collection. When I did my egg collection (I did a freeze-all cycle), I stopped running almost immediately because I had ovarian pain and was scared of torsion. So I’d be cautious about ovarian torsion, although my experience was that my body told me when to take it easy on the high-impact exercise.

If you’re doing a frozen cycle, there is no clear evidence whatsoever for restricting exercise in the 2WW or afterwards (I looked) - provided you’re not a professional athlete. Most miscarriages are due to chromosomal factors and, potentially for us ladies, by our immune systems - not by exercise (there are exceptions, but they’re usually gynae problems that ladies know about beforehand). Several IVF clinic websites I Googled justified their exercise restrictions by quoting one study that showed that women who’d exercised intensively have poorer IVF outcomes. However - when I looked into this - I discovered that it only applied to women who’d been exercising less than ten years and it has been subsequently contradicted by other studies. Also, it only applied to women’s exercise in the run-up to their cycle - it did not cover exercise restrictions in the 2WW or in pregnancy - so, even if that study was correct, you’d need to give up exercise before your IVF cycle. Giving up exercise afterwards wouldn’t help.

Further to reassure you, I exercised madly throughout my natural pregnancy. Half-marathons up to 26 weeks, Zumba, squatting 20kg weights for 100 reps... I did my last weights class (with the aforementioned 20kg weights) two days before I gave birth. My son was induced at 41 weeks, weighed 8lb 5oz, and is now a lively athletic two-year-old boy.

So, in short, be VERY careful of ovarian torsion if you did a fresh cycle, but otherwise ignore your clinic.

P.S. I’ve just re-read your original message. Only walking up to 12 weeks... It’s not ARGC, is it? In which case, completely ignore them (except for the ovarian torsion issue).

My clinic says no strenuous exercise until pregnancy test - nothing mentioned afterwards - and they get better results per embryo transfer than ARGC. I should mention that I ignored their restrictions before pregnancy test and got a BFP.

Hope that helps.

My pregnancy wasn't IVF so I don't know much about the reasoning why. I just wanted to say though that I understand the impact of exercise on mental health. I have a heart condition and was advised to stop exercising but I just couldn't. I felt terrible as I felt I was putting the baby at risk but I wouldn't have coped with no exercise. I did change what I did though and switched to swimming and in the later months when I needed to slow down but needed to do something, switched to aqua jogging.

I actually found the swimming really relaxing, and it helped me stay in shape for the birth. I also recovered really quickly. I wasn't expecting to feel like that after a swim as I didn't get the same buzz as a gym session but it really worked (I was swimming between 1.5 and 2km 5 days a week).

I would say if your prone to miscarriage then don’t exercise so much. Do walking and that’s it. Especially if it’s advising during ivf for first trimester. If you are turning to IVF you want to do everything to help up the chances of it working, which means listening to the doctors advice. If you really need to exercise, perhaps speak with your ivf doctor to see if there are safe options for first trimester. But also, Taking a short break shouldn’t be that difficult. It’s only a couple months.

@MamaBear12 Sorry to disagree with you, but I think it’s important to avoid IVF and infertility being more stressful than it needs to be due to misinformation.

My consultant points out, correctly, that 90% of the cause of unexplained infertility/recurrent miscarriage is for chromosomal reasons. And, if you have junk embryos, either due to problems with sperm or eggs, you are going to get BFNs or miscarry, and it doesn’t matter how much exercise you do (or don’t do). Those junk embryos can look great under a microscope too because, with current proven technology, IVF clinics can’t reliably check the genetics of embryos. I’m speaking from experience here. I got six brilliant-looking embryos and, using an experimental screening technology, all but one were chromosomal junk. We have no idea if the embryo I’m currently carrying is normal at the DNA level because they can’t check that.

Likewise, the OP (and I) believe our problem is largely immunological. In my case, I have an as-yet-undiagnosed symptomatic autoimmune disease. When it was untreated, I was totally infertile. Shortly after it got treated, I conceived my DS naturally. Other ladies have recurrent miscarriage. Again, exercise makes f**k all difference to that.

When clinics make unnecessary non-evidence-based exercise restrictions (and when you go to the HFEA website, you’ll see that most of what clinics do is non-evidence-based, including those immune treatments), it adds a lot of stress and anxiety to what’s already a stressful process. They give those restrictions because some clinics simply don’t care about women’s mental health (mentioning no names) or want to prevent women second-guessing themselves or blaming the clinic if it doesn’t work/goes wrong. And, in general, success rates at most IVF clinics is very low.

There are cases of miscarriage where restricting exercise might help - they’re usually due to ‘plumbing issues’, which ladies typically know about quite early in treatment. However, given there’s actually no medical evidence for prescribing bedrest in pregnancy either, it’s unclear this does anything except make the clinician and patient feel they’re doing something.

All that said, it’s important to stay hydrated and avoid overheating, but that applies to all pregnant ladies and just requires a bit of common sense.

The ovarian torsion issue in fresh cycles is real, especially in clinics that stimm aggressively.

@Londonwriter thank you, that's really helpful. All of my miscarriages are indeed due to my immune issues, to the extent anyone can say these things with any certainty. I should also say that I'm having this baby on my own so it hasn't been a struggle that has led me to IVF, rather that i need assistance to get off the starting blocks. (It's not ARGC actually. I went to see them and couldn't stand their approach!)

I have been reading up on this a fair bit as you can imagine and ovarian torsion is the only thing I can see. I would have liked if the clinic had just explained that to me. Their timing was also questionable as they only told me this the day after BFP (by which time I'd already done two spin classes) rather than at embryo transfer which would have been the time to say it if the concern was ovarian torsion.

@voxnihili Thank you for your tips and your understanding. Unfortunately I can't really swim and I'm quite afraid of the water (vicious circle!) You have made me think maybe I should try to change this. I'll look into this, thank you.

I think anyone telling me to put my feet up or rest for a few months underestimates the impact exercise can have on mental health; this is not me being selfish. My family has got a history of depression and a friend of mine doing the same thing as I am took her own life after having her baby last year.

Thank you all for commenting