For elite female athletes, the drive to achieve peak performance can come at a profound personal cost, with intense training regimens and low body fat frequently disrupting hormonal health and menstrual cycles, creating significant fertility challenges. This physiological reality, long overshadowed by other sports medicine concerns, is now gaining recognition as a critical blind spot in athlete welfare.
Experts point to a condition known as Relative Energy Deficiency in Sport (RED-S), where insufficient energy intake for the body’s training demands can severely disrupt reproductive function. The syndrome can reduce sex hormones like estrogen and progesterone, essential for preparing the body for pregnancy. In more technical terms, intense physical exertion can affect key brain hormones like GnRH, FSH, and LH, sometimes leading to hypogonadotropic hypogonadism, where the signals that stimulate the ovaries to produce eggs are suppressed.
The scale of the issue is substantial, with nearly two-thirds of elite female athletes experiencing irregular or absent periods, which directly complicates natural conception. This disruption forms part of a broader pattern sometimes called the Female Athlete Triad, impacting energy balance, menstrual function, and bone health. Furthermore, an athlete’s competitive prime often coincides with her peak reproductive years, forcing many to delay motherhood and subsequently face the well-documented age-related decline in egg quality and quantity.
While moderate exercise benefits fertility, excessive training can negatively impact outcomes, even reducing success rates for fertility treatments like IVF. For those considering preservation, options like egg or embryo freezing have advanced, though athletes subject to World Anti-Doping Agency rules must navigate Therapeutic Use Exemptions for certain prohibited fertility medications.
Recent reforms to insurance cover, stemming from the government-backed Carney review and announced in March 2026, mark a step toward addressing such health disparities. These changes, part of the “Decade of Change” initiative for women’s sport, are designed to close protection gaps for conditions disproportionately affecting women, including pregnancy, menopause, and RED-S. In a landmark move, personal accident insurance will now cover miscarriage resulting from a sporting accident. The reforms were developed with input from Loughborough University, which collaborated with insurers to redesign products.
However, as Dr Mireia Galian, Medical Director at IVI London, argues, a “crucial blind spot” remains regarding dedicated support for fertility assessment, preservation, and treatment. She contends that paid, protected time off for these purposes should be standard across women’s sports, ensuring athletes are not forced to choose between career and parenthood—a choice rarely demanded of male counterparts.
Progress on the Court: The WTA Leads the Way
In women’s tennis, substantive policy changes are offering a blueprint for other sports. Since June 2025, the WTA Tour has protected the rankings of players within the top 750 who take a minimum of 10 weeks off for fertility procedures such as egg or embryo freezing. These players receive a “Special Entry Ranking” for up to three tournaments upon their return, a policy championed by female players on the WTA’s Player Council.
Former US Open champion Sloane Stephens described the protection as “groundbreaking,” creating a “safe space” for players. The WTA has also introduced paid maternity leave and grants for fertility treatments, with over 320 players eligible for up to 12 months of paid leave regardless of ranking.
The Need for Holistic Support and Systemic Change
The fight for fertility support is inextricably linked to broader, systemic gender inequalities in sport. Historical research bias has meant sports science has long focused on male physiology, leading to a lack of tailored understanding and support for female health. This imbalance is reflected elsewhere: in the underrepresentation of women in coaching and leadership roles, less media coverage for women’s sports, lower pay, fewer sponsorships, and even a historical lack of equipment designed for female athletes.
Addressing the fertility blind spot therefore requires more than isolated policies. It demands a holistic approach that includes education, accessible preservation options, and flexibility, all within a sporting culture that actively works to dismantle the structural barriers facing women. Without this, the progress intended by insurance and ranking reforms risks being undermined, leaving athletes to navigate one of life’s most significant decisions without the support their careers warrant.