Abstract
Study question
Does in vitro fertilization (IVF) treatment affects the sleep quality of women and which factors reduce the sleep quality in different stages of this treatment?
Summary answer
The sleep quality decreased as the IVF treatment process progresses. Advanced age, prolonged treatment, economical concerns, stress ect. were factors that adversely affected women sleep.
What is known already
According to worldwide research, women receiving IVF treatment may suffer from physiological and psychological symptoms and even experience sleep disturbance. Sleep disturbances are thought to be frequent in women undergoing IVF despite minimal research of this hypothesis. The literature emphasizes the positive effect of quality sleep on oocyte health. Especially sleep hormone melatonin is effective in development of oocytes quality. During sleep, hormones such as melatonin and growth hormone can protect oocytes from the effects of harmful metabolites and improve oocyte quality. Routine evaluation of sleep quality and affecting factors may be an important issue in women receiving IVF treatment.
Study design, size, duration
It was longitudinal study with repeated measures. The sample consisted of 158 women from 218 eligible patients who received IVF treatment in two infertility centers in Izmir between December 2017 and March 2019. Treatment-related side effects, cancellation of embryo transfer, and women could not be reached after embryo transfer were excludation reasons. According to the statistical analysis, the effect size was calculated as 0.496 and the statistical power as 100%.
Participants/materials, setting, methods
Data were collected via a structured questionnaires, “The Descriptive Data Form”, “Pittsburgh Sleep Quality Index”, “Visual Analog Stress Scale” and “Treatment Related Physical Symptoms List”. The sleep quality and effecting factors were evaluated in three stages; the data related to pre-treatment period in beginning of IVF trial, in oocyte pick up (OPU) day induction-OPU process data and 1-2 days before pregnancy test, post embryo transfer data were collected.
Main results and the role of chance
The average sleep quality score was 6.96 in the pre-treatment period, 8.03 in the induction-oocyte pick up process, and 8.87 in the post embryo transfer (p < 0.001), the higher score it is evaluated as lower sleep quality. There was also a strong positive correlation between the stress scores and sleep quality before and during the treatment periods (r = 7.638 p < 0.001, r = 0.672 p < 0.001, r = 0.694 p < 0.001). Among the descriptive features; advanced age, low education level, shift work, prolonged marriage duration, among infertility features; prolonged treatment, female and male factor, economic distress and sleep habit; such as being exposed to light were associated with poorer sleep quality (p < 0.001). Related to physical symptoms such as the abdominal distention, abdominal pain and breast fullness observed induction-OPU period (t = 4.79 p= .00, t = 2.93 p= .00, t = 2.77 p= .00) and besides nausea and fatigue in post embryo transfer period where symptoms that significantly affect sleep quality (t = 9.38 p= .00, t = 4.20 p= .00, t = 4.06 p= .00, t = 4.27 p= .00, t = 4.33 p= .00). According to results it was determined that women sleep quality decrease along with progress of IVF trial. Consequently health professionals should assess women’s sleep quality and give support in most risky periods.
Limitations, reasons for caution
The fact that some women cannot be reached by phone after embryo transfer during the data collection process can be shown as the limitations of the study. At the same time, the subjective evaluation of sleep quality can be expressed as another limitation of the study.
Wider implications of the findings
There is a need for an experimental, randomized controlled study with objective evaluation of sleep outcomes. Therewithal examining the effect of sleep outcomes on the oocytes quality and pregnancy rates will guide clinical practise during IVF and other assisted reproductive treatments.
Trial registration number
There is no number
A comparative study between cleavage stage embryo transfer at day 3 and blastocyst stage transfer at day 5 in in-vitro fertilization/intra-cytoplasmic sperm injection on clinical pregnancy rates
