Age and menstrual cycle may be important in establishing pregnancy in female athletes after retirement from competition

ABSTRACT

Background

Although it has been shown that amenorrhea associated with low energy availability or relative energy deficiency in sport affects body physiology in female athletes, the association between menstrual dysfunction during active sports careers and reproductive function after retirement is not clear.

Objective

To investigate the association between menstrual dysfunction during their active sports career and post-retirement infertility in female athletes.

Methods

A voluntary web-based survey was aimed at former female athletes who had become pregnant and gave birth to their first child after retirement. Nine multiple-choice questions were included, on maternal age, competition levels and menstrual cycles during active sports careers, time from retirement to pregnancy, the time of resumption of spontaneous menstruation after retirement, conception method, and mode of delivery, etc. Regarding cases of primary and secondary amenorrhea among the abnormal menstrual cycle group, only those whose spontaneous menstruation had not recovered from retirement to the time of pregnancy were included in the study. The association between the presence of abnormal menstrual cycles from active sports careers to post-retirement pregnancy and the implementation of infertility treatment was evaluated.

Results

The study population included 613 female athletes who became pregnant and gave birth to their first child after retiring from competitive sports. Of the 613 former athletes, the infertility treatment rate was 11.9%. The rate of infertility treatment was significantly higher in athletes with abnormal than normal menstrual cycles (17.1% vs. 10.2%, p = 0.0225). Multivariable logistic regression analysis showed that maternal age (adjusted odds ratio [OR] 1.194; 95% confidence interval [CI] 1.129, 1.262) and abnormal menstrual cycles (OR and 1.903; adjusted OR 1.105, 3.278) were the relevant factors for infertility treatment.

Conclusion

It was suggested that menstrual dysfunction that persist from active sports careers to post-retirement may be a factor in infertility when trying to conceive after retirement.

KEYWORDS:

• Menstrual dysfunction
• female athlete triad
• after retirement
• infertility
• pregnancy

Acknowledgements

The authors would like to thank the Japan Sport Association, Dr Tomoaki Ikeda, Dr Azusa Sameshima, Dr Naoko Yui, Dr Yukiyo Shimizu, Dr Takako Kuroki, Ms Mayumi Tayanaka, and Ms Noriko Omori for their cooperation in this survey.

Disclosure statement

The authors have no conflicts of interest to declare.

Contributors

Nose-Ogura, Dr Nakamura-Kamoto, Dr Kanatani prepared the questionnaire items, Nose-Ogura prepared the manuscript, and other coauthors, primarily Dr Yoshino, checked the manuscript.

Patient consent

Consent was documented electronically. Participants were required to agree to the terms of the consent form before entering the survey.

Ethical approval information

This study was approved by the Ethics Committee of the University of Tokyo.

Data sharing statement

Data are available on reasonable request from Nose-Ogura.

Additional information

Funding

Funding from the Japan Sports Agency is gratefully acknowledged.