Evidence map›Paper›PMID 40642844›Full record

ReviewBJOG : an international journal of obstetrics and gynaecology2026

Considerations of Fertility in Elite Sportswomen: A Narrative Review.

Ariadne L'Heveder, Rachel E Roberts, Amal Hassan, Lorraine Kasaven, Srdjan Saso, Timothy Bracewell-Milnes, James Nicopoullos, Meen-Yau Thum, Helen C O'Neill, Noel Pollock and 2 more

Abstract readReview
In one paragraph

Review in BJOG : an international journal of obstetrics and gynaecology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Ariadne L'HevederDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.ORCID https://orcid.org/0000-0002-1642-3011
Rachel E RobertsHammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
Amal HassanInstitute of Sport, Exercise & Health, London, UK.
Lorraine KasavenDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Srdjan SasoDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Timothy Bracewell-MilnesDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
James NicopoullosDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Meen-Yau ThumDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.
Helen C O'NeillGenome Editing and Reproductive Genetics Group, Institute for Women's Health, University College London, London, UK.
Noel PollockInstitute of Sport, Exercise & Health, London, UK.
James BrownNational Performance Institute, British Athletics, Loughborough, UK.
Benjamin P JonesDepartment of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.ORCID https://orcid.org/0000-0002-0391-0443

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIncreasingly more women are participating in professional and recreational sports. Whilst vigorous intensity physical activity is considered beneficial, evidence demonstrates higher rates of menstrual disturbance in elite athletes. There is less clear evidence on the impact of elite-level exercise on fertility outcomes. It is critical to understand this given the optimal age for fertility is likely to coincide with the age of peak performance for many athletes.

aimTo perform a narrative review summarising the impact of elite-level exercise on reproductive function and fertility outcomes, highlighting the importance of relative energy deficiency in sport (REDs). Additionally, to outline the reproductive options for female athletes and summarise the fertility treatment outcomes and challenges for athletes.

methodsA literature search of Medline, Embase, Google Scholar and Web of Science was performed.

resultsThere is clear evidence that elite-level training causing increased risk of menstrual disturbance. This is likely due to REDs, with evidence that increasing energy intake can improve menstrual dysfunction. Whilst there is limited data in athletes, data from the general population suggests exercise may be beneficial for both fertility and assisted reproduction outcomes up to a certain point, beyond which there may be a negative impact, particularly if there was prior menstrual disturbance. It is crucial to be able to counsel athletes on the effect of age upon reproductive outcomes, the impact of their training on reproductive health, and the implications of fertility treatments, including the impact upon training and performance, and whether the medications involved comply with anti-doping regulations.

conclusionElite-level exercise can have a negative impact on menstrual function, however the impact on fertility is less clear. Restoring energy balance may re-establish menstruation and enhance fertility, but some individuals may need fertility treatment. Athletes wishing to wait until after retirement to conceive may encounter age-related reproductive decline, hence some may wish to consider oocyte/embryo preservation. Giving athletes evidence-based information regarding their reproductive health remains challenging due to their underrepresentation in exercise-related research.

Indexed as

AthletesExerciseFertilityMenstruation DisturbancesRelative Energy Deficiency in SportSportsFemaleHumansInfertility, Femaleassisted reproductionathleteexercisefertilityin vitro fertilisationmenstrual disordersportswomanworld anti‐doping agency

Identifiers

PMID40642844
PMCPMC12676207

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.