Laura Kenny: Can elite sports harm women’s fertility?

Olympic gold medalist Dame Laura Kenny is Britain’s most successful female athlete. She has two young boys but has also had miscarriages and an ectopic pregnancy, and has always wondered if the physical toll of elite sport has damaged her fertility. The BBC News Health team has investigated.

Dame Laura, 32, has given her body to cycling for more than a decade.

“In every training session I went there to give 100%, in every race I went there to give 100%.

“I pushed it to the limit – if I hadn’t been sick after the race I would have been like, ‘Did I try hard enough?'”

That absolute determination paid off in the velodrome. Two golds in London 2012 Olympics and two more golds in Rio 2016.

She married fellow cyclist Jason Kenny later that year and the couple welcomed their first child, Albie, in 2017. He then won another gold and silver medal at the Tokyo Olympics (to be held in 2021).

But she miscarried in November 2021 and five months later had an ectopic pregnancy, in which the embryo implants outside the uterus, requiring emergency surgery.

“Everything was a shock – I was out of control of my body,” she told Radio 4’s Today programme.

Dame Laura had never worried about her fertility before. Getting Elbie pregnant was straightforward, and the pregnancy went smoothly.

But since first speaking publicly about the loss of her child, other players have told her they’re going through the same thing.

This remains a vexing question – can elite sports have a detrimental effect on female athletes’ fertility?

“Was my body just running on empty, and then it said, ‘Okay, wait, there’s no way we can do this?'” she says.

Miscarriage is common. About one in four pregnancies end before 24 weeks, and many end very early. Most couples never know why.

But are athletes at a higher risk of any type of fertility problem?

Dr Emma O’Donnell, an exercise physiologist at Loughborough University, says the lifestyle of a professional athlete puts a unique strain on the human body.

Elite training burns an extraordinary number of calories and as a result, athletes’ bodies are often lean and muscular, with very little body fat.

Dr. O’Donnell says it’s “very common” to have menstrual problems, such as menstruating or stopping for years, if they don’t eat enough to keep up with the calorie burn.

About two-thirds of female athletes suffer from intermittent claudication, especially in endurance sports. Competitors in sports such as gymnastics, ballet and figure skating have relatively high rates of missing periods. This is compared to only 2-5% of the general population.

Absences may be a sign that ovulation (or egg release) is not occurring.

“We’re not 100% sure,” says Dr. O’Donnell, “but the main idea is that it takes so much energy to produce a baby that the brain will switch to reproduction if it thinks it’s lacking extra energy.” Closes.

It begins in the hypothalamus, a small structure in the center of the brain that senses the body’s nutritional status.

Sitting just below the hypothalamus is the body’s hormone factory – the pituitary gland.

Normally, the gland releases hormones that travel to the uterus and fallopian tubes to regulate the monthly menstrual cycle and egg release, making pregnancy possible.

But if the hypothalamus is not happy, the process breaks down and ovulation does not occur.

“If you’re not ovulating, you can’t have a baby. You can’t get pregnant because no egg is ovulating,” says Dr. O’Donnell.

A major factor in this is the large number of calories burned during training, which can cause athletes to struggle to eat enough food to compensate.

This phenomenon is known as sports-related energy deficiency (RED-S), and was first recognized by the International Olympic Committee. In 2014.

But other factors are likely to be involved, says Professor Geeta Nargand, consultant at St George’s Hospital and medical director of Crate Fertility.

Fat in the body helps make the sex hormone estrogen.

“If sport is affecting body fat content, it clearly has an effect on estrogen levels,” she says.

Psychological stress – possibly from the pressure of training and competition – can also disrupt the menstrual cycle.

“We see this in women who have high anxiety,” Dr. O’Donnell said.

Menstrual disturbances and ovulation are the most clearly recognized effects on a female athlete’s fertility, but should resolve after she retires from competition.

For those who do manage to get pregnant, things can still go wrong. After the egg is fertilized, it must implant in the lining of the uterus. However, in an ectopic pregnancy the egg implants elsewhere, usually in the fallopian tubes that connect the fallopian tubes to the uterus.

Around 11,000 ectopic pregnancies occur in the UK each year. It’s not entirely clear why this happens, although inflammation and scar tissue in the fallopian tubes may increase the risk.

“But in this case, I don’t see a direct link between sports and the increased incidence of ectopic pregnancy,” said Professor Nargand, who has treated athletes struggling with their fertility.

However, she said there was a possible link between very intense exercise in the first three months of pregnancy and miscarriage – although more research is needed to confirm this.

He pointed. A large study of Danish which followed more than 90,000 women and suggested that the more intense the women exercised, the greater the risk. This was specifically for weight lifting and high impact exercises.

“If you get into Laura Kenny territory where you’re an elite athlete, you’re at the top,” Professor Nargand said.

But he explained that the findings needed to be taken “with caution” because the way the study was designed meant there could be other explanations that hadn’t been considered.

Meanwhile, a very small study of 34 Norwegian athletes No increased risk of fertility problems, including miscarriage, was found.

“We need to do a lot more research when it comes to sports, exercise, hormone balance and reproduction,” says Professor Nargand.

Lauren Nicholls played elite-level netball for 10 years, then had two children, before becoming coach of Super League champions Loughborough Lightning. She says the conversation current athletes have about fertility is different from the one she had with her peers.

“I know quite a few players who are a bit older – they’ve frozen their eggs and made those decisions for their families at a later date,” she says. “Because they’re worried about their careers.”

Juggling being an elite athlete and starting a family has always been a tough challenge. For women, their peak fertility years overlap with when they reach their physical peak.

There are also male players. Not immune to fertility problems.. Burning more energy than you take in can affect testosterone levels, cause sperm abnormalities and even erectile dysfunction.

But for Dr Emma Pullen, a sports exercise researcher at Loughborough, the lack of definitive answers about the effects of elite sport is a sign of how poorly researched on female athletes is, from fertility to injury risk. until

She said research is “playing catch-up” with a focus on male sport.

Dr Pullen added: “We are excited about the increasing professionalism of women’s sport and with more female athletes than ever before. Looking at the effects.”

Overall, Professor Nargand says female athletes face more fertility challenges than other women.

“It seems to be causing a fertility problem. [elite sport’s] A possible effect on ovulation, including possibly a higher risk of miscarriage,” she says.

But the exact answer to whether elite-level exercise is too high is unclear. And enough of Dame Laura for now.

“Communication I personally feel is really important because I want people to start talking,” says Laura. “Honestly, I’d love it if it was a lot more open.”

The connection between exercise and fertility affects us all, even if we’re far from Olympic glory.

Most men and women benefit from exercising and losing excess weight before trying to conceive – this is known to boost fertility.

Regular physical activity reduces stress, improves sleep and hormonal balance in people with polycystic ovary syndrome (PCOS).

But amateur female athletes who train hard can also run on empty and find that their periods stop, or become irregular.

“Not quite to the same extent, but it’s there,” says Dr. O’Donnell.

Ensuring that there is a balance between energy intake and energy output is “really important to ovulatory cycles” and is key to maintaining reproductive function.

“[Amateur athletes] They are not aware of the fact that how many calories they really need to put in to meet this energy demand.”