Sleep disturbances and assisted reproduction outcomes in women undergoing IVF/ICSI: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of prospective observational cohort studies
PubMed 41709190 · doi:10.1186/s12884-026-08808-9
What was done
Authors conducted a systematic review and meta-analysis following PRISMA guidelines (PROSPERO CRD420251118366), searching PubMed, Embase, Web of Science, and the Cochrane Library through August 2025. They identified prospective cohort studies of adult women undergoing IVF or ICSI that measured sleep disturbances (obstructive sleep apnea, subjective sleep quality via the Pittsburgh Sleep Quality Index [PSQI], or sleep duration) and reported adjusted associations with reproductive outcomes. Adjusted odds ratios were pooled using random-effects and fixed-effects models.
What was found
Fourteen prospective cohorts (9,902 women) met inclusion criteria, with seven contributing to meta-analyses. Sleep-disordered breathing, predominantly obstructive sleep apnea, was associated with lower clinical pregnancy (pooled OR 0.52, 95% CI 0.36 to 0.75) and lower live birth (pooled OR 0.47, 95% CI 0.30 to 0.73), with no reported between-study heterogeneity. Poor subjective sleep quality (PSQI > 5) was associated with lower clinical pregnancy under fixed-effects models (pooled OR 0.78, 95% CI 0.67 to 0.91), but the random-effects estimate was imprecise and compatible with no association. Sleep duration and timing could not be quantitatively pooled due to heterogeneity in exposure definitions, assessment windows, and endpoints.
Why it matters
This review identifies sleep-disordered breathing as a potential modifiable risk factor associated with roughly halved odds of IVF/ICSI success. However, it indicates that current evidence does not support routine screening for general subjective sleep complaints during fertility workups.
Limits
All included data are observational and cannot establish whether treating sleep apnea improves assisted reproduction outcomes. Only 7 of 14 cohorts provided poolable data. Residual confounding by BMI, metabolic status, psychological stress, or circadian disruption remains possible, and varied exposure timing prevented quantitative synthesis for sleep duration.
Cited by
- context Women who get less sleep yield fewer eggs during an IVF retrieval cycle.
- partial Self-reporting poor sleep is associated with double the rate of infertility.