November 08, 2011

Last August, Nicole DeBoom won a local triathlon for her age group by several minutes.

Around that same time, the Boulder woman also decided to gain a few pounds and exercise less.

She wanted to have a baby.

And at age 38, even though her body was strong and she exercised 10 to 15 hours a week, DeBoom realized she needed to change her philosophy on fitness. She and her husband, a pro-triathlete, had been trying to get pregnant — unsuccessfully — for six months, which landed them in the “infertile” category.

“My husband rides his bike 20 hours a week for 20 years. We were kind of like, ‘Oh boy, Can I get pregnant? Can he get me pregnant?'” DeBoom says. “We had no idea.

It seemed counter-intuitive: Here, DeBoom was in excellent shape, a high-level elite athlete who’d been a pro triathlete for six years.

But it wasn’t until she put on a few pounds and cut back her exercise by 30 percent, along with acupuncture treatments for fertility, that she says she was able to get pregnant.

“I can’t say for sure, but it may have created a healthier foundation,” DeBoom writes on her blog about being a pregnant athlete (Skirtsports.com/blog). “… I decided not to train for anything rigorous for the foreseeable future. It was very tough to do this, and the extra few pounds … didn’t help emotionally, but I knew there was a bigger goal in mind.”

Local experts say it is possible to be “too fit” to get pregnant, and the problem is even more prevalent in a super athletic community like Boulder. In fact, increasingly more research is beginning to indicate exercise plays an important role in a woman’s ability to conceive.

On one hand, some studies have shown that women who exercise 30 minutes or more daily have a reduced risk of ovulation disorders.

But there is too much of a good thing, according to Robert Gustofson, a reproductive endocrinologist at the Colorado Center for Reproductive Medicine in Louisville.

As women athletes increase muscle mass and decrease the percentage of fat, their periods can become irregular and eventually cease altogether (about 5 percent of the center’s infertility cases).

That number leaps to as many as 55 percent for very elite female distance athletes, according to Robert Mazzeo, with the Department of Integrative Physiology at the University of Colorado in Boulder.

“It’s a lot more common than you would think,” he says. “And it’s a good assumption that it’s higher in Boulder County.”

However, even just shortened or irregular periods may be a sign of a “luteal phase deficiency,” Gustofson says, which can interfere with a woman’s ability to conceive and sustain a pregnancy.

For whatever reason, this tends to be more common among runners, gymnasts and professional ballet dancers, he says.

So how much is too much?

Experts offer suggestions for the recommended duration and level of exercise for pregnant women, but few offer fitness guidelines for women trying to conceive.

The Mayo Clinic echoes Gustofson, reporting that too much aerobic activity can reduce the production of progesterone and inhibit ovulation. The clinic recommends women of a healthy weight limit aerobic exercise to no more than seven hours per week, if they are thinking of becoming pregnant.

One article in Fitness Magazine suggests the “sweet spot” where a body is healthy enough to carry a child may be a BMI between 18.5 and 24.9. The article, citing the chair of the ethics committee of the American Society of Reproductive Medicine, reports that 12 percent of infertility cases may stem from having a BMI below that range.

When the percentage of fat drops below 17 to 19 percent, Gustofson says a woman is at higher risk for irregular cycles.

But there truly is no one critical value below which all women stop ovulating, he says. He knows one local triathlete whose fat level has dropped below 12 percent, and she never stopped ovulating, whereas another woman stopped as soon as she got near 19 percent.

Every woman is different, and about 5 percent of the elite athletes that Gustofson sees also have psychological problems or eating disorders, so treatment is more complicated than saying, “Just gain five pounds.”

And even for the 95 percent of athletes who are mentally healthy, the activity is often connected with stress release and pleasure (and increased stress hormones can adversely affect the ability to conceive). So, Gustofson says, it becomes a matter of compromise; instead of running 100 miles this week, how about 60?

Amy Dickinson, a Boulder acupuncturist, says Chinese medicine recommends everything in moderation, and if you’re running so much that you stop your period, “That’s pretty intuitive.” Chinese medicine also generally advises “nothing that jostles the baby,” which covers running. However, Dickinson says some body types need exercise. For these people, yoga may be a good substitute.

Some elite athletes who stop having a period for five or six years, never regain normal cycles, according to Jason Glowney, a doctor with the Boulder Center for Sports Medicine, who is also a competitive triathlete.

“It’s probably the brain’s way of interpreting ‘Can my body handle the pregnancy?'” he says. “You must have ample nutrition for a thing growing inside you, and if the body is sensing it couldn’t tolerate that, it’s a way of stopping that.”

For other athletic women, it can be tied in with age.

“We see a lot coming in like, ‘I just ran a marathon and I’m 44 years old and in the best shape of my life.’ But the reality is, the ovaries continue to age, regardless of how fit someone is. People, especially in Boulder, have a hard time putting that together,” Gustofson says. “They almost think they’re too fit not to get pregnant.”

For DeBoom, now 34 weeks pregnant and ready to welcome a new daughter, she admits it was challenging to not set long-term competition goals and to choose to temporarily become a “recreational athlete.”

But she says her training background helped her focus on a new goal: motherhood. In a way, she says, slowly cutting down on exercise before getting pregnant was like the warm-up for a different kind of race, where your activity level incrementally slows down over nine months.

“It’s like a race — but the opposite: decelerating when you’re training instead of accelerating,” she says. “Building a base in a different way, as a fertility vessel, instead of a high-powered machine.”

Source: Boulder Daily Camera

Aimee Heckel

Boulder Daily Camera