Perceived stress and sleep quality before oocyte pick-up, embryo transfer, and pregnancy test in women receiving in vitro fertilization treatment

Sleep and male (In)Fertility: A comprehensive overview

Infertility affects millions of couples globally, with male factors contributing up to 50 % of cases. Despite the existing Assisted Reproduction Technologies (ART), decreased sperm quality and male infertility persist. Evidence suggests that sleep is crucial for normal reproductive function, and the noticeable increase in infertility rates aligns with the growing prevalence of sleep deprivation, suggesting a connection between both conditions. This literature review explores the possible links between sleep disturbances, with a special emphasis on insomnia, the most prevalent sleep disorder, and male reproductive health. It delves into the latest findings regarding factors such as sperm quality, hormone levels, and overall reproductive function from studies in mammals, both rodents and humans. Through a concise synthesis of these findings, we unveil potential mechanisms and provide crucial insights for clinicians and researchers in the field of reproductive health.

Effect of solution focused approach on women aged 35 or over with in vitro fertilization-embryo transfer: A quasi-experimental trial

BACKGROUND

We aimed to explore the influence of solution-focused approach (SFA) on anxiety and depression, sleep quality, quality of life and clinical pregnancy rate among women aged 35 or over undergoing in vitro fertilization-embryo transfer (IVF-ET).

METHODS

The study was performed at the reproductive center in a public hospital in Lanzhou city. Totally, 112 women were enrolled in this study, and were divided into group SFA (n = 56) and group control (n = 56). The patients in the group SFA completed five sessions (30 minutes/turn), and patients in the group control received routine care.

RESULTS

The intervention group showed a significant decrease in anxiety (t =  11.906, P <  0.001) and depression scores (t =  14.991, P <  0.001), as well as PSQI scores (t =  7.055, P <  0.001), and increased FertiQoL scores (t =  -2.828, P <  0.001). Comparing the two groups after the intervention, the intervention group demonstrated significantly lower SAS scores (t =  -10.348, P <  0.001), SDS scores (t =  -8.416, P <  0.001), and PSQI scores (t =  -5.087, P <  0.001), while FertiQoL scores were higher than the control group (t =  2.389, P =  0.019). The intervention group reported a satisfaction rate of 96.2% to 100% with the SFA.

CONCLUSIONS

SFA can help relieve anxiety and depression, improve sleep quality and reproductive life quality. Improvement in psychological distress might not contribute to increasing female fecundity. Patients in the group SFA were satisfied with the intervention.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2300075444).

Sleep quality during pregnancy following assisted reproductive technology and natural conceiving: a prospective birth cohort study

Purpose

To investigate the association of sleep quality during pregnancy on in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) and natural conceiving (NC), as well as anxiety, depression, and perceived stress.

Methods

This prospective cohort study includes 500 infertile pregnant women undergoing IVF/ICSI and 678 NC women in a Sichuan birth cohort. Data on sleep, anxiety, depression, and stress was collected in the first trimester (T1), second trimester (T2), and third trimester (T3) using integrated questionnaires. Sleep quality is quantified by the Pittsburgh Sleep Quality Index (PSQI) with a cut-point of 5 indicating poor sleep. The Self-rating Anxiety Scale (SAS), the Center for Epidemiologic Study of Depression scale (CES-D), and the Perceived Stress scale (PSS) were used for assessing anxiety, depression, and perceived stress symptoms. Additionally, the matched husbands are surveyed. Multivariable logistic regression models with adjustments for influencing factors were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of sleep quality.

Results

In the IVF/ICSI group, 61.1%, 55.5%, and 66.5% of participants in T1, T2, and T3 reported poorer sleep quality compared to the NC group, which had 43.2%, 37.4%, and 46.4% throughout the same trimesters. Additionally, the IVF/ICSI group exhibited higher levels of negative psychological factors as measured by the CES-D and PSS during T1 and T2, showing statistical significance in T1 (P = 0.008, P < 0.001) and T2 (P = 0.038, P < 0.001), except at T3 (P = 0.107, P = 0.253). In addition to psychological factors and IVF/ICSI treatment, poor sleep quality was also associated with advanced age. However, there was no significant difference in sleep quality between the husbands of the IVF/ICSI and NC groups.

Conclusion

The study reveals that women receiving IVF/ICSI treatment are at a higher risk of experiencing sleep disturbances throughout their pregnancy compared with women with natural conception. While partners typically do not report major sleep problems, they do exhibit increased anxiety levels. These findings underscore the necessity for screening and addressing sleep issues in women pregnant through assisted IVF/ICSI treatment, to promote their well-being during this critical period.

The Association of Anxiety and Perceived Stress with In vitro Fertilization Outcomes in Infertile Women: A Cross-sectional Study

Background

The studies have shown that the effects of psychological distress on the outcome of in vitro fertilization (IVF) treatment are unclear, and there is still no conclusive empirical evidence that lower anxiety levels lead to better outcomes in assisted reproductive technique treatments.

Aim

the present study was conducted to investigate the impact of perceived anxiety and stress on the outcome of IVF in infertile women in Western Iran.

Settings and Design

The current study is a cross-sectional study.

Materials and Methods

This study was conducted on infertile women who were candidates for IVF and visited the infertility center at Fatemiyeh Hospital in Hamadan City in the west of Iran from 8 July 2023, to 15 March 2024. The questionnaires were demographic and midwifery characteristics, the Spielberger State-Trait Anxiety Inventory and Perceived Stress Scale-14.

Statistical Analysis Used

All statistical analyses were performed in SPSS software at a significance level of 0.05.

Results

The stress was significantly associated with metaphase II eggs (r = -0.487), and the number of transferred embryos based on grade (r = -0.562), duration of marriage (r = 0.628), duration of infertility (r = 0.595) and duration of treatment (r = 0.595). There was no significant association between stress and endometrial thickness (P = 0.189). In addition, the anxiety was significantly associated with age (r = 0.509), husband›s age (r = 0.436), endometrial thickness (r = -0.173), metaphase II eggs (r = -0.570), and the number of ‎transferred embryos based on grade (r = -0.610), duration of marriage (r = 0.604), duration of infertility (r = 0.592) and duration of treatment (r = 0.604).

Conclusion

Mean stress and anxiety in infertile women were significantly lower in infertile women with successful IVF. Stress was significantly associated with age, spouse's age, metaphase stage oocytes, embryo grade, duration of marriage and infertility and duration of treatment.

Sleep disturbances and female infertility: a systematic review

BACKGROUND

Sleep disturbances are more prevalent among women with infertility. Current research increasingly highlights the significant relationship between sleep disturbances and female infertility, suggesting that sleep may be a key factor in reproductive health. In this review, we aim to delve into the complex interplay between sleep disturbances and female infertility, as well as to assess the underlying mechanisms involved, and seek to illuminate the causes of sleep-related fertility issues. The understanding of these contents may help clinicians enhance clinical strategies for managing sleep disturbances in women facing infertility challenges and provide timely support to those seeking fertility treatments.

METHODS

A comprehensive literature search was conducted in the PubMed and EMBASE databases. Studies that described sleep patterns or any type of sleep disturbance, sleep breathing disorders and their associations with female infertility or female fecundity, published between January 1, 2010, and November 1, 2023, were identified and extracted. The screening, data extraction, and quality assessment processes were independently performed by paired reviewers. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tools for observational and cohort studies.

RESULTS

A total of 1,179 articles were initially identified from the search strategy (PubMed, n = 377; EMBASE, n = 802). After removing duplicates (n = 83) and screening for eligibility (n = 75), 19 studies were reviewed and determined to be eligible for inclusion. Infertile women generally report poorer sleep quality and exhibit more evening sleep chronotypes. Sleep disorders are significantly associated with infertility. Poor sleep quality, extreme sleep durations, and certain sleep chronotypes are associated with poorer fertility treatment outcomes, such as a reduced number of retrieved oocytes, decreased embryo quality, and lower fertilization rates. Obstructive sleep apnea (OSA) is also more prevalent in women with fertility issues, especially those with polycystic ovary syndrome (PCOS), and may negatively impact reproductive outcomes. The circadian rhythms of the Clock gene system, melatonin and hormone dysregulation, oxidative stress and immune response are considered to be potential mechanisms explaining how sleep disturbance impairs reproductive function, remain to be fully elucidated, and therefore, require further investigation.

CONCLUSIONS

Sleep disturbances are negatively associated with female infertility and poor fertility treatment outcomes. Longitudinal studies are expected to substantiate these findings and inform more nuanced approaches to prior sleep management and lifestyle advisement for infertile women, especially those undergoing fertility treatments.

TRIAL REGISTRATION

This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO, #CRD42024498443).

Association of sleep duration and sleep quality with gestational diabetes mellitus in pregnant women after treatment with assisted reproductive technology: A birth cohort study

Maternal sleep is closely related to subsequent gestational diabetes mellitus (GDM) in natural pregnancies. However, whether this connection exists in pregnant women conceiving with the help of assisted reproductive technology (ART) has not been confirmed. Hence, in this study, we evaluated whether early pregnancy sleep duration or sleep quality is associated with gestational diabetes mellitus in ART-pregnant women, as well as the influence of maternal age on this association. This prospective birth cohort study included 856 pregnant women who successfully conceived with the help of ART treatment. The sleep parameters of ART-pregnant women were assessed using the Pittsburgh Sleep Quality Index (PSQI) in early pregnancy. We explored the association between sleep and the risk of gestational diabetes mellitus using an unconditional binary logistic regression model. Different models were constructed to examine the robustness of the estimation by incorporating different confounding factors. Multivariable logistic regression revealed that sleep duration of more than 10 h among ART-pregnant women was significantly associated with the risk of GDM, and the association between sleep duration and gestational diabetes mellitus varied by maternal age. We found an increased risk of subsequent gestational diabetes mellitus with increasing sleep duration only in pregnant women aged <35 years. Additionally, no statistically significant association between sleep quality and gestational diabetes mellitus was found in this study. In conclusion, excessive sleep duration (≥10 h) is associated with a high risk of gestational diabetes mellitus in pregnant women who conceived with the help of assisted reproductive technology, and maternal age may modify this effect.

Identification of Psychological Symptom Clusters and Their Influencing Factors in Women Undergoing Assisted Reproductive Technology in China: a Cross-Sectional Study

Background

There are multiple psychological symptoms in women undergoing assisted reproductive technology, which seriously affect health-related quality of life and even cause patients to stop treatment.

Aim

This study aimed to identify psychological symptom clusters and their influencing factors in women undergoing assisted reproductive technology.

Methods

A cross-sectional survey was conducted from June to November 2023 at the reproductive centers of Nanjing Women and Children's Healthcare Hospital. Data on demographic and clinical characteristics and Symptom Checklist-90 were collected. Exploratory factor analysis was performed to identify psychological symptom clusters. Univariate logistic regression analysis and multivariate logistic regression analysis were performed to explore influencing factors.

Results

A total of 213 patients were recruited. The study found that the included participants scored higher on all SCL scales than the general Chinese females. The three most common were trouble remembering things (81.7%), feeling easily annoyed or irritated (81.2%), and feeling low in energy or slowed down (70.9%). Six symptom clusters were identified: paranoid ideation, depression, obsessive-compulsive disorder, interpersonal sensitivity, somatization, and sleep disorders. Multivariate logistic regression analysis showed that duration of infertility treatment (>12 months) was identified as a risk factor for sleep disorder cluster (OR=2.833, 95% CI:1.355~5.922), adverse pregnancy history was identified as a risk factor for paranoid ideation cluster (OR=2.961,95% CI:1.406~6.253), depression cluster (OR=2.404,95% CI:1.240~4.660), and obsessive-compulsive cluster (OR=1.810, 95% CI:1.016~3.233), financial burden during treatment was identified as risk factors for all symptom clusters[(OR=5.869, 95% CI:1.717~20.057),(OR=6.490,95% CI:2.210~19.063),(OR=3.034,95% CI:1.560~5.898),(OR=7.078,95% CI:2.420~20.698),(OR=4.532,95% CI:1.845~10.397),(OR=2.151,95% CI:1.129~4.098)].

Conclusion

Women undergoing ART experience various psychological symptoms that are interrelated and exist in the form of symptom clusters. More attention should be paid to the psychological status of patients with longer duration of infertility treatment, adverse pregnancy history, and financial burden during treatment. This study guides the development of targeted and effective psychological interventions to facilitate symptom management in women undergoing ART.

The influence of assisted reproductive technologies-related stressors and social support on perceived stress and depression

BACKGROUND

While assisted reproductive technologies (ART) have helped many people experiencing infertility become pregnant, the ART process can take a psychological toll. This study examined whether and how perceived stress- and depression-related symptoms vary among individuals at different stages of the infertility and ART process, and whether ART-specific stressors and emotional support are associated with mental health symptomatology.

METHODS

Data were collected using an online REDCap survey administered between July 2021 and March 2022. The survey was administered to 240 participants who had experienced infertility, including those who had not yet accessed ART, those undergoing ART but who were not yet pregnant, those currently pregnant through ART, and those who had given birth in the last year through ART. Each participant completed the Cohen Perceived Stress Scale (range 0-40) and the Edinburgh Depression Scale (range 0-30). Participants who had undergone ART were asked about their experience of ART-specific stressors and how helpful partner and provider support had been during the ART process. Survey data were analyzed using ANOVA and multivariate linear regressions.

RESULTS

88% of participants reported medium or high levels of perceived stress, and 43.8% of respondents showed probable indications of depression. Perceived stress and depression symptoms were significantly higher for individuals currently undergoing, but not yet pregnant from, ART treatments. These effect sizes were substantial; for example, depression scores in this group were five points higher than among currently pregnant individuals and nine points higher than among postpartum individuals. For the subset of participants who had used or were currently undergoing ART (N = 221), perceived social stigma and the physical and time demands of ART were significantly associated with higher stress and depression symptoms, while partner emotional support was associated with lower perceived stress.

CONCLUSIONS

The ART process exacerbates perceived stress and depression symptoms among individuals experiencing infertility. Given the potential long-term impacts on both parent and child wellbeing, clinicians and policymaking groups, including the American Society for Reproductive Medicine (ASRM), should consider making access to mental health services a standard of care during infertility treatment.

Sleep quality, perceived stress and associated factors in women undergoing IVF treatment: short-term longitudinal study

BACKGROUND

Despite limited studies in the literature, it is hypothesised that lifestyle factors are modifiable habits that have an impact on couples' fertility health. However, the relationship between sleep quality and infertility is an area that needs to be clarified.

OBJECTIVE

To determine sleep quality and associated factors in women receiving in vitro fertilisation treatment and to evaluate the changes in sleep over the treatment cycle.

METHODS

This is a longitudinal descriptive study conducted on 158 women in two infertility centres in Izmir, Turkey. Data were collected using the Personal Introduction Form, Pittsburgh Sleep Quality Index, Visual Analogue Stress Scale, and Physical Symptoms List. Data were collected during three different treatment periods: beginning of the in vitro fertilisation trial, oocyte pick-up day and the postembryo transfer period.

RESULTS

The sleep quality score of women progressively decreased as treatment progressed (p < .001). A strong positive correlation was determined between stress and sleep quality (p < .001). Additionally, advanced age, low education level, shift work, prolonged treatment and economic distress were associated with poorer sleep quality (p < .001). In addition, breast fullness, abdominal distension, and pain (p < .001) observed until the oocyte pick-up day, as well as nausea and fatigue during the postembryo transfer period (p < .001), were identified as physical symptoms affecting sleep quality.

CONCLUSION

This article provides information on sleep quality during in vitro fertilisation and guides healthcare professionals to encourage and improve women's sleep quality.

Sleep characteristics before assisted reproductive technology treatment predict reproductive outcomes: a prospective cohort study of Chinese infertile women

Sleep disorders affect mental and physical health. Infertile women undergoing assisted reproductive technology (ART) treatment are prone to sleep disorders. Sleep condition, its influencing factors, and the association between sleep condition and ART treatment outcomes before treatment have not been explored within a population with a large sample size. Therefore, we investigated the sleep characteristics of 1002 Chinese infertile women before ovulation induction and investigated the influencing factors (negative and positive psychological factors, demographics, and fertility characteristics). We also examined whether sleep conditions before treatment predicted reproductive outcomes. We found that 24.1% of participants reported poor sleep quality. Women with primary infertility reported poorer sleep than women with secondary infertility. Negative psychological factors, including depression, anxiety, and perceived stress were associated with poor sleep, whereas positive affect was linked with good sleep. Adverse sleep characteristics, including poor subjective sleep quality, sleep disturbances, and poor sleep efficiency, decreased the quantity and quality of oocytes retrieved, fertilization rates, and clinical pregnancy rates. This study indicates that before ART treatment, a large number of females with infertility suffer from sleep problems, which are affected by psychological factors and infertility type, and unhealthy sleep characteristics may impair treatment outcomes. Our findings highlight the importance of screening and treatment for sleep disorders before the enrollment of ART treatment in infertile women.

Effects of care given in line with Levine's Conservation Model on the quality of life of women receiving infertility treatment: A single blind randomized controlled trial

Although infertility is not a life-threatening condition, it decreases the quality of life of people. This single blind randomized controlled trial was conducted with 80 women who received infertility treatment in an IVF Center located in a city center in the west of Turkey between May 2020 and February 2021. It was determined that thanks to the holistic care given in line with Levine's Conservation Model (LCM), fatigue levels of the women in the experimental group decreased, their energy levels increased, their structural, personal and social integrity was conserved and thus their quality of life improved compared to the women in the control group (all p < 0.001).

The need for longitudinal data on the value of fertility treatment for infertile patients' quality of life: A review and pilot study

Infertility threatens the life goal of parenthood and, hence, quality of life (QoL) of (wo)men, but the fertility clinic trajectory might be burdensome. This review of longitudinal studies and pilot longitudinal study examines the impact of the pre-in vitro fertilization (IVF) fertility clinic trajectory on patient-reported outcome measures (PROMs) for emotional well-being, including QoL. A publication found that the diagnostic workup decreases men's infertility-specific distress while publications disagree whether it decreases (wo)men's anxious and depressive reactions. Intrauterine insemination (IUI) was found to increase (wo)men's depressive reactions. Publications on infertility-specific, health-related, and overall QoL were missing. The pilot indicated that (wo)men's overall QoL is not affected by the diagnostic workup but is decreased by the time of the third IUI. Longitudinal studies on the impact of starting the fertility clinic trajectory on PROMs are needed as they are essential for patient-centered clinical decision-making and patient-centered policy-level decision-making.

Women's quality of sleep and in vitro fertilization success

Women undergoing in vitro fertilization (IVF) are emotionally challenged. Anxiety, depression, and sleep disturbances are common complaints. The impact of these symptoms on IVF outcome is however debated. In this study, we aimed at investigating whether sleep quality and psychological health can affect the chances of success of the procedure. Women undergoing IVF were recruited at the time of oocytes retrieval. Women's sleep quality and psychological health was assessed using the Pittsburgh Sleep Quality Index (PSQI), the Fertility Problem Inventory (FPI), and the Hospital Anxiety and Depression Scale (HADS). Baseline characteristics and results of the three scales were compared between women who did and did not succeed. Overall, 263 women were included, of whom 81 had a clinical pregnancy (31%). As expected, successful women were younger, and their ovarian reserve was more preserved. FPI and HADS scores did not differ. Conversely, a statistically significant difference emerged for the PSQI score, the median [interquartile range] in pregnant and non-pregnant women being 4 [3-5] and 5 [3-7], respectively (p = 0.004). The crude and adjusted OR of pregnancy in women with a PSQI > 5 (indicating impaired sleep quality) was 0.46 (95% CI 0.25-0.86, p = 0.02) and 0.50 (95% CI: 0.26-0.94, p = 0.03), respectively. In conclusion, low sleep quality is common in women scheduled for IVF and could influence the success of the procedure.

Depression symptoms and quality of life in women with polycystic ovary syndrome

PURPOSE

To determine depression symptoms and quality of life in women with polycystic ovary syndrome (PCOS).

METHODS

The data were collected using the Participant Information Form, PCOS Quality of Life Questionnaire (PCOSQ-50), and Beck Depression Inventory (BDI). The study was conducted with 131 women.

FINDINGS

The average BDI score was found to be lower in women with PCOS who perceived their income as sufficient (p = 0.033) and who worked (p = 0.003) and was found to be higher in the participants who had hirsutism (p = 0.008) and acne (p = 0.045). The PCOSQ-50 average score was 178.15 ± 27.27 in women without depression symptoms and 139.14 ± 31.33 in women with depression symptoms. The PCOSQ-50 total score was higher in women without depressive symptoms (p = 0.000).

PRACTICE IMPLICATIONS

Healthcare professionals should evaluate depression symptom levels using standard measurement tools and provide appropriate counseling.

Association Between Neighborhood Disadvantage and Fertility Among Pregnancy Planners in the US

IMPORTANCE

Decades of inequitable policies in the US have yielded disparities in neighborhood quality, and some studies show that living in a socioeconomically disadvantaged neighborhood is associated with worse health outcomes, including reproductive health outcomes. However, no US studies to date have directly examined the association between residence in disadvantaged neighborhoods and fertility.

OBJECTIVE

To examine the association between residence in disadvantaged neighborhoods and fecundability, a sensitive marker of fertility with many health implications.

DESIGN, SETTING, AND PARTICIPANTS

This prospective preconception cohort study used the Pregnancy Study Online, for which baseline data were collected from June 19, 2013, through April 12, 2019. The study included 6356 participants who identified as female, were 21 to 45 years of age, were attempting conception without fertility treatment, and provided a valid residential address in the contiguous US at enrollment.

EXPOSURES

A standardized area deprivation index (ADI) derived at the census block group level applied to each residential address.

MAIN OUTCOMES AND MEASURES

Fecundability, the per-cycle probability of conception, via questionnaires that were completed every 8 weeks for 12 months, until conception or a censoring event. Proportional probabilities models were used to estimate fecundability ratios and 95% CIs for associations between ADI and fecundability. Restricted cubic splines were also implemented to examine nonlinearity. Models were adjusted for demographic characteristics and factors associated with fertility. The study's a priori hypothesis was that higher levels of neighborhood disadvantage would be associated with decreased fecundability.

RESULTS

Among 6356 participants, 3725 pregnancies were observed for 27 427 menstrual cycles of follow-up. The mean (SD) baseline age was 30.0 (4.1) years, and most participants were non-Hispanic White (5297 [83.3%]) and nulliparous (4179 [65.7%]). Comparing the top and bottom deciles of disadvantaged neighborhood status, adjusted fecundability ratios were 0.79 (95% CI, 0.66-0.96) for national-level ADI rankings and 0.77 (95% CI, 0.65-0.92) for within-state ADI rankings. Restricted cubic splines showed some evidence of nonlinearity in the association. Associations were slightly stronger among participants with lower annual incomes (<$50 000).

CONCLUSIONS AND RELEVANCE

In this cohort study, residence in a socioeconomically disadvantaged neighborhood was associated with moderately decreased fecundability. If confirmed in other studies, these results suggest that investments to reduce disadvantaged neighborhood status may yield positive cobenefits for fertility.