title: Sleep in women undergoing in vitro fertilization: a pilot study.
abstract: OBJECTIVE
  Sleep disturbances are thought to be frequent in women undergoing IVF despite minimal research of this hypothesis. Our goal was to longitudinally assess sleep duration and disturbances in women undergoing IVF and assess impact of habitual sleep duration on oocytes retrieved, an important outcome in IVF.
  
  
  METHODS
  Actigraphy and questionnaire batteries containing sleep and psychometric instruments were performed prior to and throughout 24 IVF cycles.
  
  
  RESULTS
  TST <7 h was present in 46%, 57%, 69%, and 42% of baseline, stimulation, post-oocyte retrieval, and post-embryo transfer recordings. ESS >10 was noted in 24%, 33%, and 36% of cycles during baseline, stimulation, and post-embryo transfer. PSQI >5 was noted in 57%, 43%, and 29% of cycles during baseline, stimulation, and post-embryo transfer. TST (F = 2.95, p = 0.04) and ESS (F = 4.36, p = 0.02) were the only sleep metrics in which a significant main effect of time was found by mixed models analysis. The final linear regression model chosen by stepwise selection to best explain the variability in oocytes retrieved included anti-mullerian hormone, day three follicle stimulating hormone, and baseline TST and explained 40% of the variance in oocytes retrieved (adjusted R2= 0.40, p = 0.03). Although not statistically significant, a trend towards a linear association between baseline TST and oocytes retrieved was seen with an increase of oocytes retrieved by 1.5 for every hour increase in TST (p = 0.09).
  
  
  CONCLUSIONS
  This is the first study to describe, with subjective and objective measures, sleep disturbances present throughout the IVF cycle. Importantly, a trend towards a linear relationship between TST and oocytes retrieved was found in this pilot study. Sleep may be a modifiable target to improve outcomes in women undergoing IVF and further investigations are needed.
authors.affiliation: Sleep Disorders Center, Department of Neurology, University of Michigan Health System, 1500 East Medical Center Drive, Med Inn C728, Ann Arbor, MI 48109-5845, USA. Electronic address: cathygo@med.umich.edu.
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Goldstein
authors.affiliation: Department of Obstetrics & Gynecology, University of Michigan Health System, Von Voigtlander Women's Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lanham
authors.affiliation: Department of Obstetrics & Gynecology, University of Michigan Health System, Von Voigtlander Women's Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
authors.forename: Yolanda R
authors.initials: YR
authors.lastname: Smith
authors.affiliation: Sleep Disorders Center, Department of Neurology, University of Michigan Health System, 1500 East Medical Center Drive, Med Inn C728, Ann Arbor, MI 48109-5845, USA; Department of Obstetrics & Gynecology, University of Michigan Health System, Von Voigtlander Women's Hospital, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
authors.forename: Louise M
authors.initials: LM
authors.lastname: O'Brien
mesh_terms: D056044:Actigraphy; D000328:Adult; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D054315:Oocyte Retrieval; D010865:Pilot Projects; D012890:Sleep; D011795:Surveys and Questionnaires
keywords: Actigraphy; Infertility; In vitro fertilization; Sleep duration