Sleep in women undergoing in vitro fertilization: a pilot study

Goldstein, Cathy; Lanham, Michael; Smith, Yolanda R.; O’Brien, Louise M.

doi:10.1016/j.sleep.2016.12.007

Cited by 39 publications

(46 citation statements)

References 79 publications

(85 reference statements)

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“…The present study builds on research conducted among populations with known fertility impairments such as PCOS or diagnosed infertility. Although these studies differ methodologically, our findings agree with cross-sectional studies showing associations between infertility and impaired sleep, including hours of sleep, quality of sleep, and sleep disorders (12)(13)(14)(15)30).…”

Section: Discussionsupporting

confidence: 89%

“…In an infertility clinic study population, disturbed sleep was associated with diminished ovarian reserve as measured by follicle-stimulating hormone (FSH), estradiol, inhibin B, and M€ ullerian-inhibiting substance, although the temporality of the association was unclear (14). In a study of women undergoing in vitro fertilization (IVF), the number of oocytes retrieved was positively associated with actigraphmeasured sleep time (15).…”

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confidence: 99%

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Female sleep patterns, shift work, and fecundability in a North American preconception cohort study

Willis

Hatch

Wesselink

et al. 2019

Fertility and Sterility

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North American Women aged 21-45 years attempting pregnancy. Intervention(s): Not applicable. Main Outcome Measure(s): At baseline, self-reported average sleep duration per 24-hour period in the previous month, the frequency of trouble sleeping within the last 2 weeks (as measured by the Major Depression Inventory), and shift work patterns. Pregnancy status determined by follow-up questionnaires completed every 8 weeks for up to 12 months or until conception. Result(s): The analyses were restricted to 6,873 women attempting pregnancy for %6 months at enrollment from June 2013 through September 2018. We used proportional probabilities regression models to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), adjusting for potential confounders. Relative to 8 hours of sleep per day, FRs for <6, 6, 7, and R9 hours of sleep/day were 0.89 (95% CI, 0.75-1.06), 0.95 (95% CI, 0.86-1.04), 0.99 (95% CI, 0.92-1.06), and 0.96 (95% CI, 0.84-1.10), respectively. Compared with no trouble sleeping, FRs for trouble sleeping <50% of the time or trouble sleeping >50% of the time were 0.93 (95% CI, 0.88-1.00) and 0.87 (95% CI, 0.79-0.95), respectively. The results were slightly stronger among women with higher depressive symptoms and perceived stress levels. There was no association between shift work and fecundability. Conclusion(s): Trouble sleeping at night was associated with modestly reduced fecundability. A weaker inverse association was observed between shorter sleep duration and fecundability. (Fertil Steril Ò 2019;111:1201-10. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

Female sleep patterns, shift work, and fecundability in a North American preconception cohort study

Willis

Hatch

Wesselink

et al. 2019

Fertility and Sterility

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“…For this reason, in the MIART trial (Fernando et al , 2014), we chose to examine administration BD in this dose-finding study, aiming to determine whether melatonin given in such a dosing regimen might improve IVF outcomes. As an a priori determined outcome, we also wished to explore the effect of such BD melatonin on sleep and daytime sleepiness because any beneficial effect on sleep in infertile women is likely to have a positive impact on patients (Goldstein et al , 2017) and any negative effects on sleep quality or daytime sleepiness may restrict its use in future clinical trials, in this and other medical disciplines.…”

Section: Discussionmentioning

confidence: 99%

“…Sleep disturbance may interfere with fertility through effects on the hypothalamic–pituitary axis and gonadotrophin regulation (Kloss et al , 2015) or on immunity (Vgontzas et al , 2004; Irwin et al , 2006). It has also been hypothesized that sleep disturbance may have a negative effect on IVF outcomes (Goldstein et al , 2017).…”

Section: Introductionmentioning

confidence: 99%

The impact of melatonin on the sleep patterns of women undergoing IVF: a double blind RCT

Fernando

Biggs

Horne

et al. 2018

Human Reproduction Open

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STUDY QUESTION Does melatonin result in a dose–response effect on sleep quality and daytime sleepiness in women undergoing IVF? SUMMARY ANSWER Melatonin, even when given at high doses twice per day, does not cause significant daytime sleepiness or change night time sleep quantity or quality. WHAT IS KNOWN ALREADY Melatonin is being increasingly used as an adjuvant therapy for women undergoing IVF owing to its antioxidative effects. It is widely considered to be sedative but there are scant objective data on the effects of melatonin on sleep in the setting of IVF. STUDY DESIGN SIZE, DURATION The study was a double-blind placebo-controlled randomized trial of 116 women recruited between September 2014 and September 2016. PARTICIPANTS/MATERIALS, SETTING, METHOD Women who were undergoing their first cycle of IVF at private IVF centers were recruited into the RCT and randomized to receive either placebo, 2 mg, 4 mg or 8 mg of melatonin, twice per day (BD) from Day 2 of their cycle until the day before oocyte retrieval. Each participant wore an accelerometer that provides an estimate of sleep and wake activity for up to 1 week of baseline and throughout treatment (up to 2 weeks). They also kept sleep diaries and completed a Karolinska sleepiness score detailing their night time sleep activity and daytime sleepiness, respectively. MAIN RESULTS AND THE ROLE OF CHANCE In total, 116 women were included in the intention-to-treat analysis (placebo BD ( n = 32), melatonin 2 mg BD ( n = 29), melatonin 4 mg BD ( n = 26), melatonin 8 mg BD ( n = 29)). There were no significant differences in daytime Karolinska sleepiness score between groups ( P = 0.4), nor was there a significant dose–response trend (β=0.05, 95% CI −0.22–0.31, P = 0.7). There were no differences in objective measures of sleep quantity or quality, including wake after sleep onset time, sleep onset latency, and sleep efficiency before and after treatment or between groups. There was an improvement in subjective sleep quality scores from baseline to during treatment in all groups, except 8 mg BD melatonin: placebo (percentage change −13.3%, P = 0.01), 2 mg (−14.1%, P = 0.03), 4 mg (−8.6%, P = 0.01) and 8 mg (−7.8%, P = 0.07). LIMITATIONS, REASONS FOR CAUTION As this was a subset of a larger trial, the melatonin in ART (MIART) trial, it is possible that the sample size was too small to detect statistically significant differences between the groups. WIDER IMPLICATIONS OF THE FINDINGS While this study suggests that melatonin can be used twice per day at high doses to a...

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“…Importantly, polymorphisms of clock genes are present in the peripheral blood of women with recurrent pregnancy losses 10 . Objective (actigraphy and light exposure) and subjective (questionnaires) measures of sleep in women with mixed causes of subfertility undergoing in vitro fertilization has previously shown that there is a trend towards an association between length of sleep and number of oocytes retrieved 11 . However, total sleep time and the quality of sleep are likely to be influenced by medical process, and have not been compared outside a treatment setting, nor compared with a comparison group of fertile women.…”

Section: Introductionmentioning

confidence: 99%

Is sleep deficit associated with infertility and recurrent pregnancy losses? Results from a prospective cohort study

Stocker

Cagampang

et al. 2020

Acta Obstet Gynecol Scand

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Introduction: Biological rhythms, the innate cycle of changes in the body's physiological functions, are circadian if they have a 24-hour period. It is known that sleep is a key feature of human circadian rhythm but the relationship between sleep and female fertility is largely unknown. This paucity of research is surprising given that circadian rhythms are paramount to human physiology and sleep is related to major female reproductive events. This study was designed to investigate whether there is a difference between the sleep and activity parameters of women with poor reproductive outcome compared with healthy, fertile parous women (comparator group) using subjective (questionnaires) and objective (actigraphy and light exposure) measures. Material and methods: A prospective cohort study in a tertiary in vitro fertilization referral centre in the UK; composed of three study groups: women diagnosed with recurrent implantation failure, women with recurrent miscarriage (RM) and a comparison group (fertile women without endometrial pathology). Comparison women were selected gynaecology patients without endometrial disease (ie perineal complaints or altruistic egg donors). Primary outcome was differences in objective length of sleep in each of the participant groups using actigraphy. Secondary outcomes were subjective sleep quality and quantity, using participant questionnaires, light exposure, and the feasibility of machine learning in activity-pattern interpretation. Results: Women with recurrent implantation failure slept daily on average for 7 hours 35 minutes (± 57 min), 53 minutes less than the comparison group (P = .03), although quality of their objective sleep, and quantity of their subjective sleep, were not significantly different. Women with recurrent miscarriage slept less that the comparison women (36 minutes less/night) but more than women with recurrent implantation failure (17 minutes more/night). No difference in light exposure was found between recurrent miscarriage and the recurrent implantation failure and comparison groups. Conclusions: This study demonstrates an objective observation of sleep time reduction in women with subfertility, although it is not yet clear if this association is casual. Given our increased understanding of the internal body clock and circadian rhythm on fertility, our observation warrants further investigation.

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Sleep in women undergoing in vitro fertilization: a pilot study

Cited by 39 publications

References 79 publications

Female sleep patterns, shift work, and fecundability in a North American preconception cohort study

Female sleep patterns, shift work, and fecundability in a North American preconception cohort study

The impact of melatonin on the sleep patterns of women undergoing IVF: a double blind RCT

Is sleep deficit associated with infertility and recurrent pregnancy losses? Results from a prospective cohort study

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