{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T06:31:13Z","timestamp":1768545073903,"version":"3.49.0"},"reference-count":44,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T00:00:00Z","timestamp":1735257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Government PhD fellowship fund","award":["DA9CGI-2021"],"award-info":[{"award-number":["DA9CGI-2021"]}]},{"name":"Government PhD fellowship fund","award":["STIA-OTKA-2021"],"award-info":[{"award-number":["STIA-OTKA-2021"]}]},{"name":"Semmelweis Science and Innovation Fund","award":["DA9CGI-2021"],"award-info":[{"award-number":["DA9CGI-2021"]}]},{"name":"Semmelweis Science and Innovation Fund","award":["STIA-OTKA-2021"],"award-info":[{"award-number":["STIA-OTKA-2021"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>According to World Health Organization (WHO) data, 16% of people are affected by infertility across the globe. One underlying factor is the age-related decline of ovarian reserve (DOR), which can lead to a higher chance of infertility and has no widely accepted treatment currently. Specific supplements and moderate exercise have been shown to improve fertility; however, there is no consensus to date on the type of exercise providing the best results. Our goal is to develop a novel exercise program combined with natural supplements for the improvement of fertility. We also propose a single-centered, randomized, open-label clinical trial using our newly developed exercise in the intervention group, compared to walking and no exercise in the other groups, to investigate the benefits of this exercise program in the future. In this study, we developed a structured, novel combination of exercises focusing on the pelvic and ovarian regions, core strengthening and improvement of blood circulation in this region. The 70 min full body \u201creproductive gymnastics\u201d, includes strengthening, stretching, and relaxation exercises combined with yoga-inspired moves and diaphragmatic breathing with meditation elements to activate the parasympathetic pathway and stress relief. We believe we can improve fertility through the combination of natural supplements and our targeted, moderate physiotherapy program in women with DOR.<\/jats:p>","DOI":"10.3390\/life15010018","type":"journal-article","created":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T09:13:32Z","timestamp":1735290812000},"page":"18","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Unlocking Female Fertility with a Specific Reproductive Exercise Program: Protocol of a Randomized Controlled Clinical Trail"],"prefix":"10.3390","volume":"15","author":[{"given":"Barbara Petra","family":"Kov\u00e1cs","sequence":"first","affiliation":[{"name":"Doctoral College, Semmelweis University, 1085 Budapest, Hungary"},{"name":"Workgroup for Science Management, Semmelweis University Doctoral College, 1085 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4914-8797","authenticated-orcid":false,"given":"J\u00falia","family":"Balog","sequence":"additional","affiliation":[{"name":"Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2358-307X","authenticated-orcid":false,"given":"Barbara","family":"Seb\u0151k","sequence":"additional","affiliation":[{"name":"Workgroup for Science Management, Semmelweis University Doctoral College, 1085 Budapest, Hungary"},{"name":"Dr. Manninger Jen\u0151 Trauma Center, 1081 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4886-3481","authenticated-orcid":false,"given":"M\u00e1rton","family":"Keszthelyi","sequence":"additional","affiliation":[{"name":"Workgroup for Science Management, Semmelweis University Doctoral College, 1085 Budapest, Hungary"},{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, 1082 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Szabolcs","family":"V\u00e1rb\u00edr\u00f3","sequence":"additional","affiliation":[{"name":"Workgroup for Science Management, Semmelweis University Doctoral College, 1085 Budapest, Hungary"},{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, 1082 Budapest, Hungary"},{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Szeged University, 6720 Szeged, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.clinbiochem.2018.03.012","article-title":"Fertility and infertility: Definition and epidemiology","volume":"62","author":"Wyns","year":"2018","journal-title":"Clin. Biochem."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1093\/humupd\/dmv016","article-title":"Infertility around the globe: New thinking on gender, reproductive technologies and global movements in the 21st century","volume":"21","author":"Inhorn","year":"2015","journal-title":"Hum. Reprod. Updat."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1093\/humupd\/dmn042","article-title":"Infertility and the provision of infertility medical services in developing countries","volume":"14","author":"Ombelet","year":"2008","journal-title":"Hum. Reprod. Updat."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1093\/humupd\/dmp036","article-title":"Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART)","volume":"16","author":"Sighinolfi","year":"2010","journal-title":"Hum. Reprod. Updat."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.ajog.2017.02.027","article-title":"Ovarian reserve testing: A user\u2019s guide","volume":"217","author":"Tal","year":"2017","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1007\/s10815-015-0595-y","article-title":"Diminished ovarian reserve, premature ovarian failure, poor ovarian responder\u2014A plea for universal definitions","volume":"32","author":"Cohen","year":"2015","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"181","DOI":"10.5653\/cerm.2023.06485","article-title":"Systematic Review of the roles of Inositol and Vitamin D in improving fertility among patients with Polycystic Ovary Syndrome","volume":"51","author":"Katyal","year":"2024","journal-title":"Clin. Exp. Reprod. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"509","DOI":"10.3109\/09513590.2011.650660","article-title":"Effects of myo-inositol in women with PCOS: A systematic review of randomized controlled trials","volume":"28","author":"Unfer","year":"2012","journal-title":"Gynecol. Endocrinol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Gambioli, R., Forte, G., Buzzaccarini, G.A.-O., Unfer, V., and Lagan\u00e0, A.A.-O. (2021). Myo-Inositol as a Key Supporter of Fertility and Physiological Gestation. Pharmaceuticals, 14.","DOI":"10.3390\/ph14060504"},{"key":"ref_10","first-page":"52","article-title":"Folic Acid supplementation and pregnancy: More than just neural tube defect prevention","volume":"4","author":"Greenberg","year":"2011","journal-title":"Rev. Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Tamura, H., Jozaki, M., Tanabe, M., Shirafuta, Y., Mihara, Y., Shinagawa, M., Tamura, I., Maekawa, R.A.-O.X., Sato, S., and Taketani, T. (2020). Importance of Melatonin in Assisted Reproductive Technology and Ovarian Aging. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21031135"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Espino, J.A.-O., Macedo, M., Lozano, G., Ortiz, \u00c1., Rodr\u00edguez, C., Rodr\u00edguez, A.B., and Bejarano, I. (2019). Impact of Melatonin Supplementation in Women with Unexplained Infertility Undergoing Fertility Treatment. Antioxidants, 8.","DOI":"10.3390\/antiox8090338"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Wang, Y., Liu, S., Gan, F., Xiong, D., Zhang, X., and Zheng, Z. (2024). Melatonin levels and embryo quality in IVF patients with diminished ovarian reserve: A comparative study. Reprod. Biol. Endocrinol., 22.","DOI":"10.1186\/s12958-024-01296-6"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2665","DOI":"10.2174\/1381612826666200303115552","article-title":"Administration of Antioxidants in the Infertile Male: When it may have a Beneficial Effect?","volume":"27","author":"Kopa","year":"2021","journal-title":"Curr. Pharm. Des."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Md Amin, N.A., Sheikh Abdul Kadir, S.A.-O., Arshad, A.A.-O., Abdul Aziz, N., Abdul Nasir, N.A.-O., and Ab Latip, N.A.-O. (2022). Are Vitamin E Supplementation Beneficial for Female Gynaecology Health and Diseases?. Molecules, 27.","DOI":"10.3390\/molecules27061896"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Iervolino, M., Lepore, E., Forte, G., Lagan\u00e0, A.A.-O., Buzzaccarini, G.A.-O., and Unfer, V. (2021). Natural Molecules in the Management of Polycystic Ovary Syndrome (PCOS): An Analytical Review. Nutrients, 13.","DOI":"10.3390\/nu13051677"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.fertnstert.2012.11.031","article-title":"The aging oocyte\u2014Can mitochondrial function be improved?","volume":"99","author":"Bentov","year":"2013","journal-title":"Fertil. Steril."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.1007\/s10815-020-01906-3","article-title":"Does coenzyme Q10 supplementation improve fertility outcomes in women undergoing assisted reproductive technology procedures? A systematic review and meta-analysis of randomized-controlled trials","volume":"37","author":"Florou","year":"2020","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"American College of Obstetricians and Gynecologists (2019). Committee Opinion No. 762: Prepregnancy Counseling. Obstet. Gynecol., 133, e178\u2013e189.","DOI":"10.1097\/AOG.0000000000003013"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"Bull","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3380","DOI":"10.1589\/jpts.28.3380","article-title":"The effects of forced breathing exercise on the lumbar stabilization in chronic low back pain patients","volume":"28","author":"Ki","year":"2016","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_22","first-page":"62","article-title":"Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: A randomised controlled trial","volume":"19","author":"Thabet","year":"2019","journal-title":"J. Musculoskelet. Neuronal Interact."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S1443-8461(04)80007-8","article-title":"Breathing pattern disorders, motor control, and low back pain","volume":"7","author":"Chaitow","year":"2004","journal-title":"J. Osteopath. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1007\/s00586-009-1020-y","article-title":"Altered breathing patterns during lumbopelvic motor control tests in chronic low back pain: A case-control study","volume":"18","author":"Roussel","year":"2009","journal-title":"Eur. Spine J."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Vostatek, P., Nov\u00e1k, D., Rychnovsk\u00fd, T., and Rychnovsk\u00e1, S. (2013). Diaphragm postural function analysis using magnetic resonance imaging. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0056724"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Ma, X., Yue, Z.-Q., Gong, Z.-Q., Zhang, H., Duan, N.-Y., Shi, Y.-T., Wei, W., and Li, Y.-F. (2017). The Effect of Diaphragmatic Breathing on Attention, Negative Affect and Stress in Healthy Adults. Front. Psychol., 8.","DOI":"10.3389\/fpsyg.2017.00874"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s10484-015-9279-8","article-title":"Self-regulation of breathing as a primary treatment for anxiety","volume":"40","author":"Jerath","year":"2015","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"156","DOI":"10.4103\/ijoy.ijoy_218_23","article-title":"Reducing Stress with Yoga: A Systematic Review Based on Multimodal Biosignals","volume":"16","author":"Khajuria","year":"2023","journal-title":"Int. J. Yoga"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"487","DOI":"10.2466\/pr0.2002.90.2.487","article-title":"Yoga-based guided relaxation reduces sympathetic activity judged from baseline levels","volume":"90","author":"Vempati","year":"2002","journal-title":"Psychol. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e7586","DOI":"10.1136\/bmj.e7586","article-title":"SPIRIT 2013 explanation and elaboration: Guidance for protocols of clinical trials","volume":"346","author":"Chan","year":"2013","journal-title":"BMJ"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1016\/S0140-6736(05)61034-3","article-title":"Sample size calculations in randomised trials: Mandatory and mystical","volume":"365","author":"Schulz","year":"2005","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Fontana, R., and Della Torre, S. (2016). The Deep Correlation between Energy Metabolism and Reproduction: A View on the Effects of Nutrition for Women Fertility. Nutrients, 8.","DOI":"10.3390\/nu8020087"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Cong, J., Li, P., Zheng, L., and Tan, J. (2016). Prevalence and Risk Factors of Infertility at a Rural Site of Northern China. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0155563"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1555","DOI":"10.1007\/s40279-016-0669-8","article-title":"Effect of Exercise on Ovulation: A Systematic Review","volume":"47","author":"Hakimi","year":"2017","journal-title":"Sports Med."},{"key":"ref_35","first-page":"44","article-title":"The Effect of Moderate Physical Activity on Ovarian Reserve Markers in Reproductive Age Women Below and Above 30 Years","volume":"10","author":"Kiranmayee","year":"2017","journal-title":"J. Hum. Reprod. Sci."},{"key":"ref_36","first-page":"162","article-title":"Impact of physical activity on ovarian reserve markers in normal, overweight and obese reproductive age women","volume":"58","author":"Surekha","year":"2014","journal-title":"Indian J. Physiol. Pharmacol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Joseph, D.N., and Whirledge, S. (2017). Stress and the HPA Axis: Balancing Homeostasis and Fertility. Int. J. Mol. Sci., 18.","DOI":"10.3390\/ijms18102224"},{"key":"ref_38","first-page":"1","article-title":"ACSM Position Stand: The Female Athlete Triad","volume":"29","author":"Otis","year":"1997","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1677\/joe.0.1700003","article-title":"The effects of intense exercise on the female reproductive system","volume":"170","author":"Warren","year":"2001","journal-title":"J. Endocrinol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.fertnstert.2016.04.011","article-title":"Body mass index, physical activity and fecundability in a North American preconception cohort study","volume":"106","author":"McKinnon","year":"2016","journal-title":"Fertil. Steril."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Foucaut, A.A.-O., Faure, C., Julia, C., Czernichow, S., Levy, R., and Dupont, C. (2019). Sedentary behavior, physical inactivity and body composition in relation to idiopathic infertility among men and women. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0210770"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"L\u00e4\u00e4nelaid, S.A.-O., Ortega, F.A.-O., Kunovac Kallak, T.A.-O., Joelsson, L., Ruiz, J.A.-O., Hreinsson, J., W\u00e5nggren, K.A.-O., Stavreus-Evers, A., Kalda, R., and Salumets, A.A.-O. (2021). Physical and Sedentary Activities in Association with Reproductive Outcomes among Couples Seeking Infertility Treatment: A Prospective Cohort Study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18052718"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1007\/s10815-020-01864-w","article-title":"Maternal physical activity and sedentary behaviour before and during in vitro fertilization treatment: A longitudinal study exploring the associations with controlled ovarian stimulation and pregnancy outcomes","volume":"37","author":"Nuut","year":"2020","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1123\/jpah.2022-0487","article-title":"Impact of Physical Activity and Sedentary Behavior on Spontaneous Female and Male Fertility: A Systematic Review","volume":"20","author":"Brinson","year":"2023","journal-title":"J. Phys. Act. Health"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/1\/18\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T17:01:28Z","timestamp":1760115688000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/1\/18"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,27]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["life15010018"],"URL":"https:\/\/doi.org\/10.3390\/life15010018","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,27]]}}}