Exercise intervention improves fertility outcomes in females and males: an umbrella review of meta-analyses.

BACKGROUND

Infertility is a major global health burden, yet scalable lifestyle strategies to improve reproductive outcomes remain limited. Exercise is low cost and biologically plausible, but evidence on its association with fertility-related outcomes is dispersed across multiple meta-analyses. We therefore conducted an umbrella review of meta-analyses of randomised controlled trials evaluating exercise and fertility-related outcomes in females and males.

METHODS

Six databases (PubMed, Cochrane Library, Web of Science, Scopus, EBSCOhost, and Google Scholar) were searched from database inception to 24 November 2025. Eligible studies were systematic reviews with meta-analyses of randomised controlled trials. Overlap among reviews was managed using citation matrices. Methodological quality, risk of bias, and certainty of evidence were assessed using AMSTAR 2, ROBIS, and GRADE, respectively.

RESULTS

Thirteen meta-analyses were included, covering 24,470 females and 8068 males. In females, exercise showed positive effects in reproductive hormonal profiles, including sex hormone-binding globulin and anti-Müllerian hormone. It also associated with higher ovulation rate, pregnancy rate and clinical pregnancy rate. In males, exercise was linked to amelioration in sperm quality, regarding concentration, morphology, count, and semen volume. Moreover, exercise in male participants was accompanied by higher pregnancy rate in their female partners.

CONCLUSIONS

Exercise is associated with improved fertility and reproductive health outcomes in both females and males, supporting its potential role as an adjunctive, low-cost, noninvasive component of fertility management. However, the certainty of evidence ranged from high to very low across outcomes, with most evidence rated as low or very low certainty. Heterogeneity across populations and exercise intervention components also limited confidence in these findings. Further high-quality trials are needed to clarify optimal exercise prescriptions and strengthen the certainty of evidence.

REGISTRATION: PROSPERO: CRD42025638675.