Exercise Training During Multiple Pregnancy Achieved By Assisted Reproductive Technology

Abstract

HISTORY: A previously physically inactive 35-year-old woman (heigh: 170 cm, body mass: 60 kg, BMI: 20.76 kg/m2) visited the Hospital Department of Human Reproduction with her husband, reporting unsuccessful attempts for a sufficient period to become pregnant. PHYSICAL EXAMINATION: The couple underwent basic screening for detecting potential infertility factors. DIFFERENTIAL DIAGNOSIS: The male factor infertility, asthenospermia, was identified. TEST AND RESULTS: The woman underwent controlled ovarian stimulation. After the induction of final maturation and ovulation, intrauterine insemination was performed. FINAL WORKING DIAGNOSIS: Biochemical testing of circulating Beta-human Chorionic Gonadotropin (B-hCG) in the woman and later transvaginal ultrasound confirmed a twin pregnancy. TREATMENT AND OUTCOMES: At the 10th week of gestation, the pregnant woman joined an individualized exercise program, which was modified during pregnancy depending on her current physical condition, symptoms and trimester of pregnancy. Specifically, the exercise program consisted of 3 sessions/week, each session lasted 30-50 minutes and contained moderate-intensity aerobic, strength-training and flexibility exercises. The exercise intensity was continuously monitoring via heart rate responses using a smart watch. The pregnancy progressed normaly and after 23 weeks of exercise training, i.e., at the 33rd week of pregnancy, the medical examinations showed satisfactory respiratory maturity, physical development and weight of the fetuses, amount of amniotic fluid and maturity of the placenta. Analysis of blood flow to the fetus and placenta did not reveal any pathological conditions. Pregnant woman's HbA1c levels were within the normal values (16wk: 4.2%, 20wk: 4.3%, 22wk: 4.4%, 31wk: 4.5%), her body weight increased by 14 kg throughout the pregnancy, while her blood pressure did not exhibit any pathological changes remaining within the normal range. By scheduled cesarean section at the 37th week of pregnancy, the two female infants were born weighing 2,500 and 2,200 gr, with an Apgar Score 10 both at the 1st and 5th min.