Association of pre-treatment sleep characteristics with reproductive outcomes among women undergoing assisted reproductive technology: a retrospective cohort study
- 1School of Public Health, Hunan Normal University
- 2Clinical Research Center for Reproduction and Genetics in Hunan, Reproductive and Genetic Hospital of CITIC-Xiangya
- 3University Medical Centre Mannheim, University of Heidelberg
Abstract
Objective: To investigate the associations between pre-treatment sleep characteristics and reproductive outcomes in infertile women undergoing assisted reproductive technology (ART) and to explore whether embryo development may represent a potential pathway linking sleep characteristics with cumulative live birth.
Methods: In this retrospective cohort study, pre-treatment sleep characteristics before ovarian stimulation were assessed using the Pittsburgh Sleep Quality Index (PSQI). The primary outcome was cumulative live birth, while secondary outcomes included embryo developmental parameters. Associations with ovarian reserve indicators were also evaluated. Multivariable regression, restricted cubic spline, exploratory mediation, and sensitivity analyses were performed.
Results: In an analysis of 11,090 included oocyte retrieval cycles, women with very poor sleep quality had a lower 1-year cumulative live birth rate (CLBR) (RR = 0.927, 95% CI: 0.881–0.977, P = 0.004). Sleep duration of 5 to less than 6 hours significantly reduced both 1-year (RR = 0.788, 95% CI: 0.737–0.843, P < 0.001) and 2-year CLBR (RR = 0.798, 95% CI: 0.748–0.852, P < 0.001). Furthermore, severe impairment in sleep efficiency, severe sleep disturbances, and severe daytime dysfunction were associated with lower CLBRs (P < 0.05). Secondary outcomes showed that poor sleep quality, short sleep duration of less than 5 hours, and use of sleeping medication 1–2 times per week correlated with lower available embryo rates (P < 0.05). Very bad subjective sleep quality was associated with an increased slow-cleaving embryo rate and high fragmentation rate (P < 0.05). Restricted cubic spline analyses suggested non-linear associations between sleep characteristics and ovarian reserve indicators. Exploratory mediation analyses suggested that embryo development may partially explain the associations of very bad subjective sleep quality and mild impairment in sleep latency with CLBRs.
Conclusion: Poor sleep quality was associated with lower cumulative live birth outcomes and poorer cleavage-stage embryo development among women undergoing ART. Exploratory mediation analyses suggested that embryo development may partially explain the observed associations between sleep characteristics and CLBRs. As a potentially modifiable factor, sleep characteristics may represent an important consideration in optimizing reproductive care, although further prospective studies are needed.
Related
- Trace Element Concentrations in Follicular Fluid and Serum and Their Association with Assisted Reproductive Technology Outcomes: Preliminary Evidence
- Oocyte Maturation and Fertilization-Related Outcomes Following a Pro-Fertility Diet Combined with Omega-3 Supplementation in Women Undergoing Assisted Reproductive Technology: A Secondary Analysis of a Randomized Controlled Trial.
- PLATELET-RICH PLASMA FOR ENDOMETRIAL MODULATION IN INFERTILE WOMEN UNDERGOING ASSISTED REPRODUCTIVE TECHNOLOGY: A SCOPING REVIEW
- Clinical and anamnestic characteristics of infertile patients with ovarian endometriomas in assisted reproductive technology programs
- High-risk factors associated with persistence and progression of cervical intraepithelial neoplasia 2 in women of reproductive age undergoing conservative management: a retrospective analysis
BibTeX
@article{li2026association,
title = {{Association of pre-treatment sleep characteristics with reproductive outcomes among women undergoing assisted reproductive technology: a retrospective cohort study}},
author = {Yating Li and Su Chen and Pengcheng Xu and Yangqin Peng and Jianxiang Fang and Zixiang Huang and Berthold Hocher and Junhua Zhou and Shujuan Ma},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1965444},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1965444/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association of pre-treatment sleep characteristics with reproductive outcomes among women undergoing assisted reproductive technology: a retrospective cohort study
AU - Yating Li
AU - Su Chen
AU - Pengcheng Xu
AU - Yangqin Peng
AU - Jianxiang Fang
AU - Zixiang Huang
AU - Berthold Hocher
AU - Junhua Zhou
AU - Shujuan Ma
PY - 2026
DA - 2026/10/30
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1965444
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1965444/full
AB - Objective: To investigate the associations between pre-treatment sleep characteristics and reproductive outcomes in infertile women undergoing assisted reproductive technology (ART) and to explore whether embryo development may represent a potential pathway linking sleep characteristics with cumulative live birth. Methods: In this retrospective cohort study, pre-treatment sleep characteristics before ovarian stimulation were assessed using the Pittsburgh Sleep Quality Index (PSQI). The primary outcome was cumulative live birth, while secondary outcomes included embryo developmental parameters. Associations with ovarian reserve indicators were also evaluated. Multivariable regression, restricted cubic spline, exploratory mediation, and sensitivity analyses were performed. Results: In an analysis of 11,090 included oocyte retrieval cycles, women with very poor sleep quality had a lower 1-year cumulative live birth rate (CLBR) (RR = 0.927, 95% CI: 0.881–0.977, P = 0.004). Sleep duration of 5 to less than 6 hours significantly reduced both 1-year (RR = 0.788, 95% CI: 0.737–0.843, P < 0.001) and 2-year CLBR (RR = 0.798, 95% CI: 0.748–0.852, P < 0.001). Furthermore, severe impairment in sleep efficiency, severe sleep disturbances, and severe daytime dysfunction were associated with lower CLBRs (P < 0.05). Secondary outcomes showed that poor sleep quality, short sleep duration of less than 5 hours, and use of sleeping medication 1–2 times per week correlated with lower available embryo rates (P < 0.05). Very bad subjective sleep quality was associated with an increased slow-cleaving embryo rate and high fragmentation rate (P < 0.05). Restricted cubic spline analyses suggested non-linear associations between sleep characteristics and ovarian reserve indicators. Exploratory mediation analyses suggested that embryo development may partially explain the associations of very bad subjective sleep quality and mild impairment in sleep latency with CLBRs. Conclusion: Poor sleep quality was associated with lower cumulative live birth outcomes and poorer cleavage-stage embryo development among women undergoing ART. Exploratory mediation analyses suggested that embryo development may partially explain the observed associations between sleep characteristics and CLBRs. As a potentially modifiable factor, sleep characteristics may represent an important consideration in optimizing reproductive care, although further prospective studies are needed.
SN - 1664-2392
ER -