Olympic gold medalist Dame Laura Kenny is Britain’s most successful female athlete. She has two young boys, but she also had a miscarriage and an ectopic pregnancy, and she always wondered whether the physical effects of elite sports had harmed her fertility. The BBC News Health team has investigated.

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

“Every training session I went to give 100%, every race I went to give 100%.

“I took it to the limit – if I wasn’t sick after the race I would be like, ‘Did I work hard enough?'”

That complete commitment was rewarded in the velodrome. Two golds at the London 2012 Olympics were followed by two more golds at Rio 2016.

She married fellow cycling athlete 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 suffered a miscarriage in November 2021 and five months later had an ectopic pregnancy, in which the embryo implants outside the uterus, requiring emergency surgery.

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

Dame Laura had never previously worried about her fertility. Conceiving Albie was easy and the pregnancy went smoothly.

But since speaking publicly for the first time about his child’s death, other athletes have told him they’ve been through the same thing.

It’s a troubling question – could specific sports have harmful effects on the fertility of female athletes?

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

Abortion is common. About one in four pregnancies end before 24 weeks and many at very early stages. Most couples never know the reason.

But are athletes at greater risk of any type of fertility problem?

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

Specific training burns unprecedented numbers of calories and as a result, athletes’ bodies are often lean and muscular, with very little body fat.

If they don’t eat enough food to burn calories, problems with the menstrual cycle, such as stopping periods for months or years, are “very common,” says Dr. O’Donnell.

Approximately two-thirds of female athletes experience menstrual irregularities, especially in endurance sports. Competitors in sports such as gymnastics, ballet and figure skating have comparatively high rates of missing periods. This is compared to only 2-5% of the general population.

Missing a period may be a sign that ovulation (or the release of an egg) is not occurring.

“We’re not 100% certain,” says Dr. O’Donnell, “but the leading idea is that childbirth is so energy-intensive that the brain shuts down reproduction when it senses there is insufficient extra energy.

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

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

Normally, the gland releases hormones that travel to the uterus and ovaries to control the monthly menstrual cycle and the release of eggs, making pregnancy possible.

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

“You can’t have a baby if you’re not ovulating. You can’t conceive because no egg is being released,” says Dr. O’Donnell.

The biggest factor in this appears to be the large number of calories burned during training, which may leave athletes struggling to eat enough food to compensate.

This phenomenon is known as relative energy depletion (RED-S) in sport, and was first recognized by the International Olympic Committee in 2014,

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

Fat in the body helps produce the sex hormone estrogen.

“If sport is affecting body fat content, then clearly there is an impact 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 with higher levels of anxiety,” Dr. O’Donnell said.

She says that menstrual disruption and interference with egg release are the most clearly identified effects on a female athlete’s fertility, but should be resolved after retirement from competition.

For those who succeed in conceiving, things can still go wrong. After the egg is fertilized, it must implant into the lining of the uterus. However, in an ectopic pregnancy the egg implants itself elsewhere, usually in the fallopian tube that connects the ovary to the uterus.

About 11,000 pregnancies in the UK each year are ectopic. 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 any direct link between sport and the increased incidence of ectopic pregnancy,” said Professor Nargund, who has treated athletes struggling with their fertility.

However, they said there is a possible link between too much intense exercise in the first three months of pregnancy and miscarriage – although more research is needed to be sure.

he pointed A large Danish study It followed more than 90,000 women and suggested that the more intensely 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 of that,” Professor Nargund said.

But he pointed out that the findings need to be taken “with caution” because the way the study was designed means there may be other explanations that have not been considered.

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

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

Before becoming coach of Super League champions Loughborough Lightning, Lauren Nicholls played elite level netball for 10 years, then had two children. She says current players’ conversations about fertility are different than the conversations they have with their teammates.

“I know some older players – they’ve frozen eggs and made these decisions for their families at a later date,” she says. “Because they’re worried about their careers.”

Becoming an elite athlete and starting a family has always been a difficult challenge. For women, their years of peak fertility coincide with the time they reach their physical peak.

there are male athletes too Not immune to reproductive problemsBurning more energy than you are getting can affect testosterone levels, lead to sperm abnormalities and even erectile dysfunction.

But for Dr Emma Pullen, a sports exercise researcher at Loughborough, the lack of definitive answers on the impact of specific sports is a symbol of how poorly researched female athletes have been on everything from fertility to injury risk.

He said the research is “catching up” with the amount of attention paid to male sports.

“We are seeing the impact of this with the increasing professionalization of women’s sports and more female athletes than ever before,” says Dr. Pullen.

Overall, Professor Nargund argues that female athletes may face greater reproductive challenges than other women.

She says, “It appears that there are reproductive problems due to the potential effects of (elite sports) on ovulation, including a potentially higher risk of miscarriage.”

But there’s no clear answer to how much a specific level of exercise really is. And that’s enough for Dame Laura for now.

“I think the conversation itself is really important because I want people to start conversations,” says Laura. “To be honest, I would have liked it to be 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 status and makes menstruation more regular in people with polycystic ovary syndrome (PCOS).

But amateur female athletes who train intensely may also have to run on an empty stomach and their periods may stop, or become irregular.

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

She adds that making sure there’s a balance between energy intake and energy production is “really important for the ovulation cycle” and is key to maintaining reproductive function.

“(Amateur athletes) are not aware of the fact how many calories they actually need to meet energy demands.”