In 2009, a study by the Norwegian University of Science and Technology found that intense physical exercise can negatively impact female fertility. Men too can be at the receiving end of unfavorable effects from rigorous training and anabolic steroids: effects on semen and hormonal parameters are all too possible. If you’re especially keen on athletics and also trying to get pregnant, it might be wise to review your workout schedule and diet.

Dreaming of Baby speaks with Dr. Vasiliki Moragianni from CCRM Northern Virginia on the link between athletics and infertility in both men and women, and what you should stay on the alert for.

CJ DeGuara: Welcome to Dreaming of Baby! Today we have with us Dr. Vasilliki Moragianni who has kindly joined us so that we may learn about athletics and infertility. Dr., would you be so kind as to tell our readers a little about yourself?

Dr. Vasiliki Moragianni: Hello and thank you very much for inviting me back! It is always a pleasure to answer questions for your readers. I am a board-certified reproductive endocrinology and infertility specialist at CCRM Northern Virginia, which is a national leader in fertility care and research.

How does sport affect fertility?

CJ DeGuara: Today we are discussing an interesting subject; I’d like to start by getting a general overview for our readers about athletics and fertility; how do the two work together, what are some of the common issues especially with high-performance athletics?

Dr. Vasiliki Moragianni: This is indeed a very interesting subject, as it affects many individuals. Sports relates to fertility either through a hormonal or a mechanical pathway. By hormonal, I refer to the changes in hormones resulting from strenuous exercising. By mechanical, I refer to direct trauma to the body that can affect fertility.

CJ DeGuara: Let’s focus first on hormonal as I believe these would be easier to correct?

Dr. Vasiliki Moragianni: It depends. Exercising can have effects on both the male and female reproductive systems. In terms of women, intense exercising that leads to a reduction of body fat in exchange for muscle mass can lead to menstrual irregularities, problems with ovulation, and even cessation of menses, and thus infertility. Furthermore, in men or women using anabolic steroids or performance-enhancing agents, the reproductive system can “shut down” temporarily or in some cases irreversibly.

Dr. Vasiliki Moragianni: “Exercising can have effects on both the male and female reproductive systems. In terms of women, intense exercising that leads to reduction of body fat in exchange for muscle mass can lead to menstrual irregularities, problems with ovulation, and even cessation of menses, and thus infertility.”

Athletics and female fertility: what you need to know

CJ DeGuara: Wow, ok so as to focus a little; let’s learn a little more about women and hormone-related instances of infertility or sub-fertility. Are there situations where the damage cannot be reversed?

Dr. Vasiliki Moragianni: In general, a healthy balance of fat and muscle tissue is required to maintain a healthy reproductive system. Fat is an important source of estrogen and by severe drops in fat tissue, estrogen levels can drop as well. As a result, we get manifestations similar to the typical “female athlete triad”. This includes (a) disordered eating, (b) menstrual dysfunction, and (c) decreased bone density.

CJ DeGuara: Is this also harmful to an athlete’s long-term health and ability to perform in athletics or is the consideration only as it pertains to fertility? I ask because I understand that for some individuals the drive to excel in athletic endeavors is extremely high so it is important that we fully understand the situation.

Dr. Vasiliki Moragianni: Absolutely, and this is what makes this even harder for individuals to deal with. Eating disorders, as well as poor bone and overall health, are long-term consequences that can sometimes remain irreversible.

CJ DeGuara: In your experience, can athletic excellence exist alongside healthy reproductive health or is this somewhat of a trade top performing athletes find themselves having to make?

Dr. Vasiliki Moragianni: It definitely requires an overall change in the culture of athletics in general. As with everything else in life, a healthy balance needs to be maintained at all times. High-performance athletes should be followed closely by trained specialists in the medical field who are attuned to these issues so they can prevent them or detect them early enough when they can still be reversed.

CJ DeGuara: In short then, it is important to have more awareness; in some cases though if I am understanding correctly an athlete may have to make a decision with regards to their priorities in this regard?

Dr. Vasiliki Moragianni: Health should always be the first priority; therefore, athletes, as well as their coaches and teams, should only focus on that.

CJ DeGuara: Understood and agreed. So how would one go about identifying these issues? I am guessing catching this early is extremely important to the long-term reproductive health of the athlete; what should they be asking?

Dr. Vasiliki Moragianni: In terms of reproductive health, asking about frequency and pattern of menstrual cycles is a great place to start.

CJ DeGuara: How early on in an athlete’s life can the potential for harm to the reproductive system begin? I know for example gymnastics is an extremely competitive sport started at a young age, in some cases prior to a menstrual period may have begun.

Dr. Vasiliki Moragianni: Extreme physical activity can lead to irregularities (or cessation) of menses once the menstrual cycle has begun or to delayed puberty (i.e. menses starting much later than anticipated). Both of these circumstances warrant further testing and evaluation by a physician.

CJ DeGuara: So, in effect, we need to be keeping an eye on this as early as puberty? If that is the case, I want to make sure we are not scaring people unnecessarily, how prevalent is this problem and what can be done once an issue is diagnosed? Would the athlete have to cease or pull back on their training?

Dr. Vasiliki Moragianni: We definitely do not need to alarm athletes or cause unnecessary anxiety. As long as they maintain a healthy balance of exercise and diet, they should address any health issues as and if they arise. These issues certainly do not affect all athletes and once diagnosed can, in the majority of cases, be reversed.

Dr. Vasiliki Moragianni: “As long as they maintain a healthy balance of exercise and diet, they should address any health issues as and if they arise. These issues certainly do not affect all athletes and once diagnosed can, in the majority of cases, be reversed.”

CJ DeGuara: I am assuming mechanical issues are less common in women?

Dr. Vasiliki Moragianni: That is correct. However, for both men and women, head trauma can also affect the reproductive system. The hormones that “speak” to ovaries and testes are secreted in the brain and therefore any injury to that area can disrupt the communication.

CJ DeGuara: Ok, so how does that impact female reproduction?

Dr. Vasiliki Moragianni: It depends on the severity of the injury, it can be temporary or irreversible. It can lead to changes in menstrual pattern, cessation of menses, and infertility.

CJ DeGuara: Wow ok, so any injury to the head; which of course should always be checked may also impact fertility. Is there any way to test for this?

Dr. Vasiliki Moragianni: Any head injury could affect the reproductive system but of course not all of them do. It depends on the area of the brain that is affected and the severity of the injury. The main “symptom” that would warrant further evaluation would be menstrual irregularity.

CJ DeGuara: So, if we had to summarize on the female fertility side one of the most prominent indicators is irregular menstrual activity and in younger females delayed puberty?

Dr. Vasiliki Moragianni: Exactly.

CJ DeGuara: Also, things to watch out for are extremely low body fat and any disordered eating patterns that could impact fertility. Are there any supplements or ways to reduce the likelihood of these issues apart from of course adjusting the training regimen?
Dr. Vasiliki Moragianni: There are no supplements that can help. Avoiding performance-enhancing supplements and especially anabolic steroids is very important as well!

Athletics and male fertility

CJ DeGuara: You mentioned that sport relates to fertility also in terms of mechanical pathways. How does this happen and what should we be watching out for?

Dr. Vasiliki Moragianni: Direct injury to the lower back or testicular area can affect an athlete’s reproductive health in several ways. It can lead to sexual dysfunction (difficulty with erection or ejaculation), as well as compromise the health of sperm (which are produced and stored in testicles).

CJ DeGuara: Focusing on men; especially in terms of anabolic steroids; what are the major impacts and risks of using such products?

Dr. Vasiliki Moragianni: Anabolic steroids, similar to testosterone supplements, affect the male reproductive system in the following way: your body normally uses levels of Testosterone as a signal to “drive” testicular function. If Testosterone levels drop, testicles are forced to produce more and vice versa. By taking anabolic steroids or testosterone supplements your body is tricked into thinking there is already a lot of testosterone present and therefore the testicles do not need to work as hard. Eventually, with prolonged use, the testicles become less functional and shrink in size, a process that can ultimately become irreversible.

Dr. Vasiliki Moragianni: “By taking anabolic steroids or testosterone supplements your body is tricked into thinking there is already a lot of testosterone present and therefore the testicles do not need to work as hard.”

CJ DeGuara: Apart from anabolic steroids are there any other hormonal concerns for males that arise from intense athletic performance?

Dr. Vasiliki Moragianni: The issues of trauma (brain, back, testicles) as we discussed above, as well as increased sustained temperature in the testicular area that can result from intense prolonged exercising.

CJ DeGuara: To clarify then, for males the issues are more related to mechanical than hormonal except for steroids, any harmful substances and continued heat: I believe continued heat stress would generally be temporary in terms of harm?

Dr. Vasiliki Moragianni: Well, it depends. As with other factors, prolonged exposure to increased temperatures in the testicular area can cause irreversible effects.

CJ DeGuara: Wow, ok so that is definitely something to take note of. With this in mind, especially in the more aggressive sports some of these injuries may not be given much attention; what are some of the signs that one should look out for?

Dr. Vasiliki Moragianni: Unfortunately, there are no warning signs necessarily so avoiding these risk factors in general is the best approach to prevent damage.

CJ DeGuara: Is there anything a male that is concerned can do to diagnose? Would they be able to get a sperm analysis done even if they have not been diagnosed with infertility?

Dr. Vasiliki Moragianni: Definitely, a semen analysis can be performed outside of the context of infertility evaluation.

Dr. Vasiliki Moragianni: “A semen analysis can be performed outside of the context of infertility evaluation.”

CJ DeGuara: You have been so helpful today in answering all our questions and providing our readers with the important information they need. I do have one last question for you and it pertains to egg and sperm banking. In situations where we are talking about professional athletes and Olympians for example that although never advised – may choose to take the risk; would storing their sperm or eggs be a good idea or insurance policy so to speak? Briefly, how does this work?

Dr. Vasiliki Moragianni: Fertility preservation (egg/sperm banking) is definitely an option for any individual who is interested in preserving their current fertility status, either because they wish to delay childbearing or because they are at risk for reduced fertility potential (such as in the case of cancer or other treatments that can negatively affect fertility).

CJ DeGuara: Is the process generally easy? I know for males it is definitely a very simple process; for women how much downtime from their activities would they require; can you outline the basic process of fertility preservation?

Dr. Vasiliki Moragianni: The process always begins with an assessment of the current fertility status. This includes a semen analysis for men and an assessment of egg supply (ovarian reserve) for women. Once these results are discussed with the patient and the decision is made to proceed with fertility preservation, the process is as follows: (a) for men, a semen sample is obtained, evaluated and if deemed appropriate frozen for future use, (b) for women, the process is a little bit more involved. Their ovaries are stimulated to produce more than just the one egg that is normally released per month and these eggs are removed from the body and, if deemed mature, frozen for future use.

CJ DeGuara: Thank you so much for your time Dr. Vasiliki, if you have something you would like to share with our readers that we didn’t cover today please do so. We absolutely appreciate your time today!

Dr. Vasiliki Moragianni: You are welcome. As always, it is my pleasure! I would like to leave your readers with the very important message that a healthy lifestyle that includes a balanced diet and exercise routine is invaluable. Exercise in moderation and in consultation with a healthcare provider contributes to great reproductive, and overall health, and I recommend it to all my patients. Thank you again!

For additional information about this and any other fertility-related subjects, patients can call CCRM Northern Virginia at 571-789-2100 or visit www.ccrmnova.com.

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