EVALUATING THE IMPACT OF PHYSICAL ACTIVITY AND STRESS ON FROZEN EMBRYO TRANSFER CYCLE OUTCOMES: THE STEP AND STRESS TRACKING TO ESTIMATE PREGNANCY (SSTEP) TRIAL

Emily A. Jacobs; Karen M. Summers; Bradley J. Van Voorhis

doi:10.1016/j.fertnstert.2024.07.161

OBJECTIVE To investigate the relationship between objectively measured physical activity and stress on standard hormone therapy replacement (HRT) frozen embryo transfer (FET) outcomes. MATERIALS AND METHODS This longitudinal study involved 82 women undergoing a HRT FET. Each participant wore a FitBit Charge 5 health tracker for the duration of their FET cycle (on average for 4-6 weeks). Variables tracked included daily average steps, activity zone minutes, daily calories burned, heart rate, and sleep duration. Participants were also asked to complete The Fertility Problem Inventory (FPI) at the start of their cycle to measure infertility related perceived stress. In addition, 6 salivary cortisol samples were obtained the two days before embryo transfer and cortisol levels were compared to their FPI score as well as their cycle outcome. Participants also tracked their sexual activity during the study period to investigate the relationship between intercourse frequency and pregnancy outcomes. Results were statically analyzed by Students t-test (p<0.05). RESULTS Approximately 5,340,962 minutes of health data were collected and analyzed. Physical Activity There were no differences in average daily steps pre- and post- embryo transfer between participants who achieved pregnancy after FET and those who did not. Participants who achieved pregnancy after FET increased their average daily step count after embryo transfer (140 ± 1774) and those who did not achieve a pregnancy decreased their step count after embryo transfer (-650 ± 1020), which was statistically significant (p=0.027). However, multivariable logistic regression analysis found no difference when controlling for age and body mass index (AOR 0.98, 95% CI 0.96-1.00). Activity zone minutes, daily heart rate, and daily calories burned did not differ between the two groups. Stress There was no difference in awakening cortisol, 30-minute post awakening cortisol, bedtime cortisol, or average cortisol awakening response between the two groups. For perceived stress, those who achieved pregnancy after FET had a lower score for “rejection of a childfree life” category of their FPI (24.86 ± 6.79 vs. 28.12 ± 5.58, p=0.44). Sexual Activity Sexual activity did not differ between the two groups (including around the time of transfer). However, those who were not pregnant after FET were more likely to not have any sexual activity during their FET cycle (4/20 20% vs. 4/39 10.3%). Sleep Sleep patterns did not differ between the two groups. CONCLUSIONS In our study, physical activity, stress (both perceived and as measured by cortisol levels), sexual activity habits, and sleep patterns did not influence pregnancy outcomes in standard HRT FET cycles. To our knowledge, this is the first studying examining lifestyle behaviors and embryo transfer outcomes using wearable health trackers. Larger, prospective studies are needed to confirm our findings. IMPACT STATEMENT Infertile patients should be reassured that physical activity and stress do not impact FET cycle outcomes. Providers should be cautious recommending bedrest or reduced activity following embryo transfer as this may incur undue stress on patients without improvement in pregnancy rates.

EVALUATING THE IMPACT OF PHYSICAL ACTIVITY AND STRESS ON FROZEN EMBRYO TRANSFER CYCLE OUTCOMES: THE STEP AND STRESS TRACKING TO ESTIMATE PREGNANCY (SSTEP) TRIAL

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