By Dr. Brian Levine, MD, MS, FACOG | Founding Partner & Practice Director, CCRM Fertility New York
There is a conversation I have regularly with a specific kind of patient: a woman in her late twenties or early thirties who is at the top of her professional game. She is an elite athlete, a corporate executive, a surgeon, a founder. She trains hard, sleeps strategically, optimizes everything she can control. She has spent years doing everything right for her career and her body. And she is only now beginning to ask the questions about her fertility that she probably should have been asking several years ago.
Photo Credit: EvrenKalinbacak
This is not a failure of intelligence or discipline. It is a failure of information. The fertility conversation in medicine has historically been reactive rather than proactive, and the women most likely to benefit from a proactive approach, the ones who are most focused on performance and most likely to delay family building intentionally, are often the ones who receive that information last.
I want to change that. Here is what athletes and high-performance women actually need to know.
The Overlap Nobody Warns You About
The peak reproductive years and the peak performance years are the same years. For most women, fertility is at its highest in the early to mid-twenties and begins a meaningful decline by the early thirties, accelerating significantly after 35. For most elite athletes and high-achieving professional women, those same years are when their career is building toward its most demanding and most rewarding phase.
Female age is the leading predictor of fertility success. The age-related decline in fertility is largely due to diminishing egg numbers and the quality of the eggs. The reproductive window for most women overlaps with their peak athletic performance, meaning athletes may choose to delay starting a family until later and could be more likely to experience difficulties conceiving.<
That overlap is not a problem that medicine has solved. But it is a problem that proactive fertility planning can meaningfully address.
What Intense Training Does to Your Body
High-performance athletes face fertility risks that most women in their demographic do not. Women who exercise frequently and are athletes are often at risk for irregular ovulation and fertility issues later in life due to the intense physicality their bodies are put through.
The specific mechanism is called Relative Energy Deficiency in Sport, or REDs. When the body is in a sustained caloric deficit relative to its energy output, it begins to prioritize survival functions over reproductive ones. The result is hormonal disruption: irregular or absent menstrual cycles, suppressed ovulation, and over time, a reduction in ovarian reserve that can be difficult to reverse. Many elite female athletes experience this without fully understanding what is happening or what the long-term implications are.
The menstrual cycle is not just a reproductive function. It is a vital sign. An athlete whose cycle has become irregular or has disappeared entirely is receiving a signal from her body that deserves a conversation with a specialist, not a dismissal as a normal consequence of training hard.
Egg Freezing: The Option That Changes the Equation
Egg freezing cycles increased 30% year-over-year according to Cofertility's 2024 State of Egg Freezing report, driven by shifting societal norms, greater acceptance of fertility preservation, career aspirations, educational goals, and the desire for later-life family planning. For athletes and high-performance women specifically, egg freezing has become one of the most consequential conversations in reproductive medicine.
Female fertility declines with age, beginning in one's early 30s and more rapidly accelerating at age 35. Both egg quality and quantity start to decrease, making child-bearing more difficult the longer we wait. Given that many athletes extend their careers well into their 30s, egg freezing provides optionality for future family-building to female athletes who are prioritizing their professional careers during their peak reproductive years.
The process typically requires approximately two weeks, during which intense physical activity is restricted. <cite index="18-1">This can make it challenging for those in physically-demanding careers to find time to schedule their cycle.</cite> For athletes with structured competitive seasons, the timing question requires strategic planning — ideally in coordination with both their fertility specialist and their training team.
Elite athletes including tennis stars Sloane Stephens and Maria Sharapova are making egg freezing less taboo by talking about it as a viable option for those who want to preserve their fertility and delay childbirth. The cultural shift is real, and it is making the conversation easier to have.
What a Fertility Evaluation Actually Looks Like
The most important thing a high-performance woman can do is get a baseline fertility evaluation before she needs it. This is not a commitment to a particular path. It is information, and information is what enables good decisions.
A comprehensive fertility evaluation includes an assessment of ovarian reserve through two key markers: Anti-Mullerian Hormone, or AMH, which reflects the quantity of eggs remaining, and an antral follicle count via transvaginal ultrasound, which provides a visual picture of the ovarian reserve. A hormonal panel, a uterine assessment, and a full medical history round out the picture.
The results of that evaluation tell us a great deal about what options are available, what the timeline looks like, and what, if anything, needs to be addressed before family building begins. For athletes who have experienced menstrual irregularity, the evaluation may also reveal hormonal imbalances that are addressable with the right intervention.
The conversation I want every high-performance woman to have is not "should I freeze my eggs?" That is a decision that depends on individual circumstances, values, and goals. The conversation I want her to have is "what does my fertility picture actually look like right now?" Because that question has an answer, and the answer changes everything about what comes next.
The High-Performance Mindset Applied to Fertility
The women I see in my practice who are athletes and executives bring the same approach to fertility that they bring to everything else: they want information, they want a plan, and they want to make the best decision available to them with the data they have. That approach works as well in reproductive medicine as it does in any other high-stakes domain.
What I tell those patients is straightforward: your fertility is a resource, like your training capacity or your cognitive bandwidth. It can be preserved, it can be optimized, and it can be depleted if it is not attended to. The women who come to me early, when they have the most options available, consistently have the best outcomes, whether that means freezing eggs as insurance, pursuing treatment immediately, or simply having a clear picture of where they stand.
The high-performance mindset, applied to fertility, looks like this: do not wait for a problem to start gathering information. The best time to have this conversation is before you need to. The second best time is now.
Dr. Brian Levine, MD, MS, FACOG is the Founding Partner and Practice Director of CCRM Fertility New York, a two-time founder, and the youngest-ever president of the New York Allergy and Asthma Society. He is a Castle Connolly Top Doctor and New York Magazine Top Doctor annually since 2021. For consultations, visit ccrmivf.com/new-york or call 212.620.9290.
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