P-457 The overlooked side of sleep quality; can self-reported sleep quality have an impact on the quality of oocytes and embryos in women undergoing IVF treatment?
Authors: Yanık F , Aluş Tokat M , Özöztürk S , Güngör S  S , Kovalı Sezer M , Doğan Ö E 
Published: July 2024

Abstract

Study question
Does sleep quality affect oocyte and embryo quality in women undergoing in vitro fertilization (IVF) treatment?

Summary answer
Sleep quality and number of mature oocytes retrieved were negatively correlated, but not significantly so. In addition, embryo grading was not associated with sleep quality.

What is known already
Some studies have found associations between sleep disturbances or disruption of circadian rhythms and decreased ovarian reserve, menstrual cycle irregularity, and infertility. The literature on the positive effects of quality sleep on oocyte health is growing in importance. Especially sleep hormone melatonin regulates biological rhythms through various receptors and also has strong antioxidant activities to scavenge reactive oxygen species in the ovaries. Taken together, the available evidence on sleep quality during fertility treatment is limited, and our objective was to explore self-reported sleep quality on oocyte and embryo quality in women undergoing IVF treatment.

Study design, size, duration
105 eligible patients who underwent IVF treatment with fresh embryos at an infertility clinic in Izmir between January 2020 and December 2023 were included. However, women with psychiatric disorders, cycles with frozen embryos, and those with low ovarian reserve were excluded. Data were collected through participants’ self-assessment of sleep and embryologists’ assessment of oocyte and embryo quality in a laboratory setting.

Participants/materials, setting, methods
“Pittsburg Sleep Quality Index” (PSQI) was used to assess the sleep quality and “The Balaban and Veeck/Gardner Classification Assessment Form” was used to evaluate oocyte and embryo quality. Sleep quality data were collected face-to-face in a private, quiet and isolated patient room after oocyte pick-up (OPU). Oocytes and embryos were evaluated 2-4 hours and 48-72-96 (Day 2, Day 3, or Day 5) hours after the OPU for quality and development, respectively.

Main results and the role of chance
After the OPU, there were approximately 5.35 (SD:4.24) oocytes which reached at least 16 mm. OPU duration was 11.42 (SD:4.53) minutes and number of oocytes retrieved was 9.02 (SD:7.30). According to Balaban category, 64.8% of the oocytes were grade 4 and 18.1% were grade 2. The number of fertilized oocytes was approximately 4.54 (SD:4.52) and transferred in 2.76 (SD:1.70) days. Of the embryos, 71.9% were grade 1 and 39.0% were grade 2. In addition, sleep quality was found to be above the cut-off score of 5 in all women. A higher score indicated poorer sleep quality. The mean on the PSQI scale was 12.58 (SD: 2.33). Showering, dark and quiet environment, were reported as sleep facilitators and stress, light, and noise as disturbances. 66.7% of the women felt that they had a good quality of sleep. There was a non-significant but negative corelation between sleep quality and the number of mature oocytes retrieved (t=-7.662, p = 0.939). Therefore, as sleep quality deteriorates, oocyte retrieval decreases. According to the result of linear regression analysis, it is difficult to associate the effectiveness of Balaban categorization with sleep quality, and Pearson’s correlation test showed that embryo grades were not associated with sleep quality (p = 0.917).

Limitations, reasons for caution
The inclusion of objective measures such as actigraphy or polysomnography, which are practically challenging, could have validated the PSQI results and provided additional data on the sleep characteristics of women. Secondly, all participants were recruited from single infertility centers; therefore, our results may not apply to all infertile women.

Wider implications of the findings
Our study sheds light on measuring sleep with a self-reported index that can be used in the clinical setting and assessing its impact on oocyte quality. This study could be extended over years to study the long-term effects. The high prevalence of poor sleep quality calls for further research.

Trial registration number
not applicable