Background <p>Spiritual health and self-regulation are important factors influencing exercise behavior, which is crucial for physical and mental well-being, especially among infertile women. This study aimed to determine the relationship between spiritual health and self-regulation with exercise behavior (EB) among infertile women.</p> Methods <p>This cross-sectional study was conducted among 483 infertile women in Sanandaj, Iran, in 2024, selected through consecutive sampling from 35 healthcare centers. Data were collected using a four-section questionnaire that assessed demographic factors, spiritual health (existential and religious; reliability 0.82, validity 0.84), self-regulation (reliability 0.86, validity 0.89), and stages of exercise behavior change (Kappa coefficient 0.78). Binary logistic regression was performed using SPSS version 21 to analyze the relationships between exercise behavior, spiritual health, and self-regulation.</p> Results <p>The average age for infertile women was 33.88 ± 8.34. One-third of women (143/438) engaged in exercise behavior; 21.5% of them were in the pre-contemplation stage, 30.2% in the contemplation stage, 18.6% in the preparation stage, 16.8% in the action stage, and 12.8% in the maintenance stage of exercise behavior. The analysis revealed a statistically significant mean difference in self-regulation and existential health between two groups of women with high scores (≥ 160) and those with primary infertility. Binary logistic regression analysis of EB showed that the odds of EB adoption increased with self-regulation (OR = 1.02, 95% CI; 1.009-1.049, p = 0.001). Spiritual health did not have a significant effect on EB among infertile women.</p> Conclusion <p>The findings indicated that self-regulation, rather than spiritual health, was strongly associated with EB in infertile women. Spiritual health must be bolstered in infertile women due to their mental and emotional conditions, even though it did not have a substantial impact on their exercise behavior.</p>