Sleep disturbances and assisted reproduction outcomes in women undergoing IVF/ICSI: a systematic review and meta-analysis
Abstract
BACKGROUND: Sleep disturbances are plausible and potentially modifiable clinical and behavioural markers of risk for assisted reproduction outcomes, but their causal role and the most appropriate targets of intervention remain uncertain, and findings across cohorts are mixed. METHODS: We registered a protocol in PROSPERO under CRD420251118366 and followed PRISMA guidance. We searched PubMed, Embase, Web of Science, and the Cochrane Library through August 3, 2025. Eligible studies included adult women undergoing in vitro fertilization or intracytoplasmic sperm injection, measured sleep disturbances including obstructive sleep apnea, subjective sleep quality, or sleep duration, and reported adjusted associations with oocyte yield, fertilization, embryo quality, implantation, clinical pregnancy, or live birth. We pooled adjusted odds ratios using random effects and also presented fixed effects for comparison. Heterogeneity was assessed with Q and I2. We conducted leave one out analyses and used influence diagnostics. RESULTS: Fourteen prospective IVF/ICSI cohorts involving 9,902 women met the inclusion criteria, and seven contributed data to meta-analyses. Sleep-disordered breathing, predominantly obstructive sleep apnea, was consistently associated with lower treatment success: pooled odds ratios were 0.52 (95% confidence interval [CI] 0.36–0.75) for clinical pregnancy and 0.47 (95% CI 0.30–0.73) for live birth, with no between-study heterogeneity. Poor subjective sleep…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 9,902 participants or records.
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