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

The Association Between Sleep Disorder and Female Infertility: A Mediation Analysis of Inflammatory and Oxidative Markers

Background: Sleep disorder in women of reproductive age may contribute to infertility development, but there is a lack of substantial evidence linking sleep disorder to inflammation and oxidative stress, and the subsequent risk of infertility. Methods: A total of 2365 women aged 18-45 years from the National Health and Nutrition Examination Survey (NHANES) were included in this analysis. Sleep disorder and infertility were assessed according to NHANES questionnaire data module. Inflammatory and oxidative biomarkers such as high-sensitivity C-reactive protein (hs-CRP), white blood cell (WBC), gamma-glutamyl transpeptidase (GGT), albumin, ferritin, and total bilirubin were derived from the laboratory data module, and systemic immune inflammation index (SII), and system inflammation response index (SIRI) were calculated based on complete blood cell counts. A sophisticated multistage sampling design and weighted multivariable adjusted regression models were employed to conduct comprehensive analysis. Mediation models were applied to explicate the mediating role of biomarkers of inflammation and oxidative stress. Results: Compared to the noninfertility group, the infertile participants had a higher incidence of sleep disorder (34% vs. 25%, p < 0.05). In models with fully adjusted covariates, sleep disorder was positively associated with infertility risk (OR: 1.58; 95%CI: 1.01-2.50, p < 0.05), particularly in subgroups of individuals aged over 30 years old (OR: 1.75; 95%CI: 1.00-3.04, p < 0.05) or with a body mass index (BMI) ≥ 30 kg/m2 (OR:2.05; 95%CI: 1.00-4.22, p < 0.05). In terms of mechanisms, there were significant correlations between inflammatory and oxidative markers and both sleep disorder and infertility. Mediation analysis indicated that hs-CRP, SII, SIRI, GGT, and total bilirubin played a significant mediating role in the relationship between sleep disorder and infertility, accounting for 0.4822%, 6.0515%, 1.2485%, 5.1584%, and 0.4738%, respectively. Conclusions: Sleep disorder is a significant risk factor for infertility, particularly in women aged >30 years or with obesity. Furthermore, the presence of inflammation and oxidative stress status in the body, which also significantly mediate the association between sleep disorder and infertility, can be swiftly and repeatedly identified through blood tests. Sleep, as a modifiable behavioral pattern, can be regarded as a new strategy to cope with infertility.

Relationship Between Sleep Disturbances and In Vitro Fertilization Outcomes in Infertile Women: A Systematic Review and Meta-Analysis

BACKGROUND

In vitro fertilization (IVF) has been acknowledged as the primary assisted reproductive technique for fertilizing oocytes outside the female reproductive system. Sleep disorders are likely to affect infertility and its treatment. The present study was to investigate the relationship between sleep disturbances and IVF outcomes in infertile women.

METHODS

Databases, including PubMed, Embase, Cochrane Library, ProQuest, and Web of Science, were searched for the relevant articles published up to September 2023. The Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. Moreover, the random and fixed effects models using the STATA (v.11) software program presented the odds ratio with a 95% confidence interval (CI). Ultimately, a funnel plot was recruited to examine the sensitivity analysis.

RESULTS

During the initial search, 426 articles were retrieved, and ultimately, nine studies remained for systematic review, and among them, four studies entered into the meta-analysis (two cohort and two cross-sectional studies). According to the fixed effects model of the cross-sectional studies, the association between sleep quality and pregnancy rate was not confirmed (OR = 0.94; 95% CI = 0.81-1.07). Regarding the fixed effects model of included cohort studies, the results indicated an association between sleep quality and the pregnancy rate (OR = 1.08; 95% CI = 1.03-1.14). According to the random effects model of the cross-sectional studies, there was no significant association between sleep quality and pregnancy rate (OR = 0.82; 95% CI = 0.37-1.26). Regarding the random effect analysis of included cohort studies, the results indicated an association between sleep quality and the pregnancy rate (OR = 1.08; 95% CI = 1.03-1.14). Based on the total fixed effect analysis of the cross-sectional and cohort studies, the results also showed a significant association between sleep quality and pregnancy rate among infertile women (OR = 1.06; 95% CI = 1.01-1.11). In contrast, according to the random effect of the total studies, this association was not confirmed (OR = 1.02; 95% CI = 0.90-1.14).

CONCLUSION

Although the meta-analysis of the cohort studies showed a significant association between sleep quality and IVF outcomes, such as pregnancy rate, due to the novelty of the subject, more studies have not been published, and this study is considered a preliminary meta-analysis. Therefore, more studies with a strong methodology need to assess the relationship between sleep disorders and IVF outcomes.

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).

The impact of sociocultural and psychological stress on the outcome of assisted reproductive technology in remarried families

OBJECTIVE

In China, there is a unique type of second marriage (SM) family where the woman is remarried, and the man is experiencing his first marriage. Additionally, the woman is older than the man. Therefore, these families experience many challenges: psychological, emotional, and societal pressure. Such family is a typical sample for studying sociocultural and psychological stress influencing on outcome of assisted reproductive technology (ART). This study aimed to investigate the impact of social psychological stress on the live birth outcomes AR.

METHODS

In this retrospective cohort, second marriage (SM) families who visited the Second Hospital of Hebei Medical University reproductive center between January 2012 to December 2022 were screened, and 561s marriage families (the SM group) with 5600 first marriage (FM) families (the FM group) were included undergoing their first ART cycles. The primary outcome of this study was the live birth rate (LBR).

RESULTS

The live birth rate (LBR) of SM group (30.7%) is lower than that of the FM group (43.6%) (p < 0.01). After adjustment by logistic regression, the second marriage group (OR = 1.269, 95%CI 1.031-1.562, p = 0.025) were independent factors associated with the outcome of live birth. After propensity score matching (PSM), the live birth rate of SM group (28.7%) is lower than the FM group (35.9%) (0 = 0.011).

CONCLUSION

The SM family experience higher levels of social and psychological pressure, which lead to lower level of LBR than FM family.

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.

Yoga: As a Transformative Approach to Addressing Male Infertility and Enhancing Reproductive Health in Men: A Narrative Review

Infertility presents multifaceted challenges that encompass both physical and emotional burdens. Yoga, as a comprehensive system of mind-body medicine, serves as an effective intervention for managing male factor infertility, a complex lifestyle disorder with significant psychosomatic elements. This review explores the transformative role of yoga in addressing both the emotional and physical dimensions of infertility. By incorporating physical postures, breath control and meditation, yoga promotes emotional well-being and enhances reproductive health by improving the integrity of nuclear and mitochondrial genomes as well as the epigenome. In addition, yoga contributes to maintaining sperm telomere length through the regulation of seminal free radical levels and increased telomerase activity, which are crucial for optimal embryo cleavage and the development of high-quality blastocysts. Integrating yoga as an adjunctive therapeutic approach fosters a supportive intrauterine environment and facilitates physiological homoeostasis, thereby increasing the likelihood of successful fertilisation and implantation. Gentle asanas and flowing sequences promote relaxation, alleviate tension and cultivate emotional stability, while meditation aids in emotional healing and resilience during the infertility journey. Specific asanas, such as Baddha Konasana (bound angle pose), Bhujangasana (cobra pose) and Sarvangasana (shoulder stand), stimulate reproductive organs, enhance blood circulation and regulate hormone production. Pranayama techniques further support endocrine balance and overall vitality. Moreover, yoga provides a non-invasive strategy for managing fertility-related conditions leading to improved reproductive health and overall well-being. This review aims to elucidate the comprehensive role of yoga in improving male infertility, focusing on its impact on sperm nuclear and mitochondrial genomes, the epigenome and telomere health. In addition, it underscores the importance of self-care, open communication and shared experiences with partners. Practicing yoga regularly supports psychosocial well-being, promotes holistic healing, enhances physical and mental health and probably helps in improving reproductive health, thereby fostering resilience and self-efficacy throughout the journey of fertility and reproduction.