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

Abstract

Abstract Background and Aim: Infertility means failure to achieve a clinical pregnancy after 12 months of regular unprotected intercourse or reproductive disorders. In this respect, in vitro fertilization has been acknowledged as the primary assisted reproductive technology technique for the fertilization of oocytes outside the female reproductive system, which is steadily increasing thanks to its prenatal safety. However, stress and anxiety, inextricably linked to sleep disorders, are likely to affect infertility and its treatment. Against this background, the present study was to investigate the relationship between sleep disturbances and IVF outcomes in infertile women. Materials and Methods: Considering no language limits, the databases of PubMed (1996), Embase (1980), the Cochrane Library (2010), ProQuest (1995), and Web of Science (1997) were searched for the relevant articles published up to April 2023. The Newcastle-Ottawa Scale was then used to assess their methodological quality. Moreover, the random effects model and the STATA (v.11) software program were utilized to present the odds ratio with 95% confidence interval. Ultimately, the Begg’s test and funnel plots were recruited to examine publication bias and sensitivity analysis, thereby determining the impact of each study on its final results. Findings: During the initial search, 425 articles were retrieved; however, five studies remained after the exclusion of the unrelated ones, including two and three cross-sectional and cohort studies, respectively. The review findings demonstrated that sleep disturbances were more common in women undergoing the IVF techniques than the general population. In addition, such disorders were associated with getting pregnant, oocyte retrieval, ovulation, live birth, and fetal weight. After combining the ORs reported in the cross-sectional studies with 95% CI based on the I2 index (OR=0.42, 95% CI=[0.23, 0.60], I2=0.0%) and the p-value of 0.901 for heterogeneity according to the fixed effects model, the relationship between sleep and pregnancy was approved. On the other hand, upon combining the ORs revealed in the cohort studies with 95% CI based on the I2 index (OR=1.02, 95% CI=[0.86, 1.18], I2=77.9%) and the p-value of 0.011 for heterogeneity with reference to the random effects model, the relationship between sleep and pregnancy was not confirmed. Results: The study results established that sleep, as a modifiable parameter, could affect IVF outcomes. Therefore, health policymakers must develop effective interventions for the youth population along with childbearing policies to improve sleep as an important factor.