Dame Laura Kenny, Britain’s most decorated female Olympian, has sparked an important conversation about the potential impact of elite sports on women’s fertility. With five Olympic gold medals and a career spanning over a decade, Dame Laura’s experience highlights the physical and emotional toll of pushing the body to its limits.
After enduring two pregnancy losses—a miscarriage in 2021 and an ectopic pregnancy five months later—Dame Laura began to question whether her intense training and demanding career as a cyclist could have affected her fertility.
“Was my body just running on empty?” she wondered.
Her story raises a critical question for female athletes and researchers alike: can the extreme physical demands of elite sports impact fertility and reproductive health?
The Physical Toll of Elite Sports
Elite athletes often maintain lean and muscular bodies with minimal fat due to the high-calorie burn of intense training. This lifestyle places unique physiological demands on the body.
According to Dr. Emma O'Donnell, an exercise physiologist at Loughborough University, one of the most common effects is menstrual irregularity. Nearly two-thirds of female athletes experience disrupted or absent periods—known as amenorrhea—compared to only 2-5% of the general population.
Amenorrhea occurs when the hypothalamus, a part of the brain responsible for regulating reproductive hormones, senses an energy deficit. This can disrupt ovulation, making it difficult to conceive.
"If you’re not ovulating, you can’t have a baby," says Dr. O'Donnell.
The phenomenon, known as Relative Energy Deficiency in Sport (RED-S), was officially recognised in 2014 by the International Olympic Committee. It highlights how inadequate energy intake relative to output can impact not just fertility but overall health.
Fertility Challenges Beyond Ovulation
For those who conceive, pregnancy complications such as miscarriage or ectopic pregnancy may still arise.
While the link between elite sports and ectopic pregnancy is unclear, some research suggests that intense physical activity during early pregnancy could slightly increase miscarriage risk. A large Danish study found that women engaging in high-impact or weight-bearing exercises during the first trimester were at a higher risk of miscarriage, though more research is needed to confirm this.
“The findings should be taken with caution,” says Prof. Geeta Nargund, medical director of Create Fertility. “There may be other explanations we haven’t considered.”
Navigating Fertility as an Athlete
With the growing professionalisation of women’s sports, conversations around fertility and reproductive health are becoming more common among athletes.
Lauren Nicholls, a former elite netball player and now coach, says she’s seen a shift in attitudes: “I know a few older players who’ve chosen to freeze their eggs to focus on their careers without sacrificing their chance to have a family later.”
The overlap between peak fertility years and an athlete’s prime competitive years poses unique challenges. Many athletes face difficult decisions about whether to prioritise their careers or start a family.
The Need for More Research
Despite growing awareness, there’s still a significant gap in research on the long-term impact of elite sports on women’s fertility.
“We’re playing catch-up when it comes to understanding the effects of intense exercise on female athletes,” says Dr. Emma Pullen, a sports exercise researcher at Loughborough University.
Historically, sports science has focused on male athletes, leaving many unanswered questions about the unique needs of female competitors, from injury prevention to fertility.
“We need to invest in more research to fully understand how elite sports impact reproductive health,” adds Dr. Pullen.
Lessons for Non-Elite Athletes
While elite athletes face unique challenges, the relationship between exercise and fertility is relevant to everyone. Regular exercise can boost fertility by reducing stress, improving sleep, and regulating hormones, particularly for those with conditions like polycystic ovary syndrome (PCOS).
However, amateur athletes should also be mindful of energy balance. Training too intensely without adequate nutrition can lead to menstrual irregularities, mirroring the challenges faced by elite athletes.
Dr. O'Donnell emphasises, “Making sure there’s a balance between energy intake and output is crucial for maintaining reproductive health.”
The Importance of Conversation
For Dame Laura Kenny, the key takeaway from her experience is the importance of breaking the silence around fertility and female athletes.
“Honestly, I would love it if this was talked about more openly,” she says.
As women’s sports continue to grow, so too must the conversations about the unique challenges female athletes face—including their fertility. By fostering open dialogue and investing in research, we can better support women both on and off the field.
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