Elite athletes have spoken out about how training at the highest level of a sport can affect a person’s mental health and lifestyle in some really damaging ways. We’re aware that many athletes are robbed of their childhood and teen years — instead of going to prom and homecoming and hanging out by their lockers with friends, they’re training around the clock and carrying enormous pressure on their shoulders.
But there’s one aspect of the athlete experience people may not be aware of: The way athletes often face barriers when building their families due to the demands of their training.
Research suggests that reproductive issues may be more common in athletes, and studies are underway to identify why. There are a few theories as to why female athletes may experience fertility challenges: One study suggests that athletes may experience exercise-related ovarian suppression and neuroendocrine dysfunction, which can delay or stop their menstruation. This is referred to as functional hypothalamic amenorrhoea, and the study’s authors have observed this in athletes whose sports demand a lean body type (think ballet dancers, gymnasts, runners), as they may exercise intensely, eat restrictive diets, and be underweight.
Another study found that intense training may be associated with infertility as well — and the researchers suggested that the body simply doesn’t have enough energy to support the physical demands of both rigorous training and conception.
But in 2023, both awareness and options exist, and both of those factors can influence the way athletes plan their families.
Alexander Kucherov, MD, a fertility specialist at Illume Fertility, sheds some light on why athletes may experience reproductive issues — and what steps they can take preemptively.
“Female athletes may have fertility issues for multiple reasons,” says Dr. Kucherov. “Female athletes may have what is known as hypothalamic amenorrhea. Essentially, in the setting of low body fat, the part of the brain that controls the menstrual cycle pauses itself. This leads to the cessation of ovulation, which is a cause of infertility.”
There’s also the lifestyle element. In some cases, athletes dedicate a huge portion of their young lives to their sport, and when they’re finally able to step back and focus on family, their fertility has begun to decline. As bobsledder Kaillie Humphries told USA Today Sports, “you give a lot of your prime reproductive years to being the best athlete in the building.” You can listen to Kaillie speak about her IVF journey in her own words on the Dear (In)Fertility podcast here.
Dr. Kucherov speaks to this as well. “Another common cause of infertility in female athletes, and is common in women in general, is related to delaying childbearing,” he explains. “As childbearing is delayed, the number of eggs in the ovaries, as well as the quality of the eggs, decreases. This process starts in the mid-30s and accelerates towards the late 30s.”
As Dr. Kucherov mentions, this isn’t unique to athletes: Many non-athletes also devote their twenties and early thirties to building their careers before starting families. Dr. Kucherov points out that the fertility preservation options that exist today can address this factor for athletes.
“On a positive note, there are now excellent options for fertility preservation for people who are considering delaying childbearing, such as egg or embryo freezing,” he shares. “When you freeze eggs or embryos [they] can be used whenever you are ready to begin your family. In addition, the age they are frozen is the age they stay forever. For instance, eggs frozen at age 30 will stay age 30, and have the same reproductive potential as a 30-year-old, even if the person using them is age 35 or 40 or beyond.”
Female athletes are centered in the research and discourse around athletes and reproductive health — and that’s incredibly frustrating. Paralympic swimmer Mallory Weggemann, for one, has been open about her own family’s fertility story and the role male-factor infertility played in their journey — and Weggemann and her husband intentionally chose to do this to dispel incorrect assumptions that exist about fertility challenges being attributed to the female partner.
But, according to Dr. Kucherov, the effects of hard training can be more prevalent among female athletes “These effects typically do not occur for male athletes,” he says.
“However, using certain medications, such as exogenous testosterone or other androgens, can decrease sperm numbers and lead to infertility,” Dr. Kucherov adds.
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Of course, none of this means that athletes will automatically struggle to build their families — but it’s a conversation worth having, as informing all people of their family-building options and realities is crucial. It’s important that we identify the issues athletes may face, both biologically and socially, as they work to build their ideal families — and it’s arguably even more important that we make them aware of all the options that are available.
Dr. Kucherov breaks down his best advice for athletes who may be concerned about how their reproductive futures may be affected.
“I would recommend being thoughtful and honest with yourself about your family goals,” he says. “In my experience, people may not want to have a family for a long time, but then decide they want to start a family (and want to start as soon as possible). Planning can take a lot of the pressure off your timeline, and egg or embryo freezing can relieve the burden that many people feel to start their families, without sacrificing the chance to have a family or compromising their prime athletic years in the process.”
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Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, Marie Claire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.