Research has shown a clear link between sleep apnea, a rather serious sleep disorder, and the risk of having infertility. But a January 2018 study suggests that other sleep disorders that interfere with quality sleep may also increase the risk of a woman having infertility.
Causes of fertility problems
As a sleep medicine expert, I am aware of the many health impacts that sleep apnea has. And it has been clearly linked to infertility in women of childbearing years. But this 2018 study is interesting because it looks at other sleep disorders and whether they are linked to infertility. Adequate, restorative sleep is a vital health habit, and these findings may emphasize that even further.
Current data suggests that one in 10 women may have “difficulty getting pregnant.” Usual culprits are problems with ovulation (often related to polycystic ovarian syndrome, or PCOS), and less commonly, blocked fallopian tubes; structural problems with the uterus; uterine fibroids; and a past history of the woman’s mother taking the synthetic estrogen hormone DES, which can cause female offspring to have a higher risk of miscarriages and premature deliveries). Trying to conceive at an older age, excessive drinking, poor lifestyle, having a diagnosis of obesity, or a past history of a sexually transmitted disease can also contribute to difficulties with fertility.
The study: Are women with sleep disorders more likely to be infertile?
The 2018 study, published in the journal Sleep, looked at 16,718 Taiwanese women diagnosed with sleep disorders between 2000 and 2010. The research used a comparison group of 33,436 women who did not have any sleep issues. Women ranged in age from 20 to 45, with an average age of 35. After a five-year follow up, 29 women in the research group had developed infertility, while 34 women in the control group had developed infertility.
After cross-referencing for all potential causes, the researchers found that subjects with a sleep disorder were 2.7 times more likely to have infertility. The risk was even higher when they factored in age and other health issues: A diagnosis of a sleep disorder made infertility 3.7 times more likely.
It’s important to recognize the limitations of the study. It was not a “controlled study” designed to explain the mechanism behind the findings. Considering the number of women included in the study, those found with infertility were a small number. The study did not isolate specific contributory factor impact from smoking, drinking, exercise habits, socioeconomic factors, or family medical history which makes it a rather simplistic approach to finding the link.
Other research on sleep and fertility
Despite the 2018 study’s limitations, it does make sense that an important fundamental habit like getting enough sleep would impact fertility. A 2015 study suggested that the outcomes from lack of sleep, which can include elevated stress levels and circadian rhythm disruptions could certainly impact menstruation and ovulation. What’s also interesting is that a 2011 study published in Sleep and Breathing recommended that couples examine their sleep patterns and work on their sleep health if infertility was a problem. Clearly, men are part of the conception process too, so it’s not just women who should focus on sleep if pregnancy is desired.
A 2014 study also looked at sleep-disordered breathing (SDB) and the role it may play in fertility. Because sleep influences several hormonal cycles, including estrogen, progesterone, prolactin, luteinizing hormone, and follicle-stimulating hormone, it suggested that sleep disturbance had the potential to have an adverse impact on a woman’s ability to get pregnant. The research also suggested the potential to contribute to miscarriages because of the intermittent hypoxemia that might occur.
The bottom line: Address your sleep problems
I certainly think that most doctors don’t necessarily talk to women about their sleep (problems) or look at sleep as a possible significant contributor to infertility problems. Sure, there may be a passing conversation about sleep habits as overall lifestyle is examined when infertility is diagnosed, but based on this new research and the other studies mentioned here, it should be looked at more seriously and treated quickly and effectively. What’s also clear from this discussion is that weight, diet, exercise, and sleep should be discussed with the couple, not just the woman trying to get pregnant. Men’s health and lifestyle issues also contribute to a couple’s infertility issues.
If a couple is planning to get pregnant or having difficulty conceiving or maintaining a pregnancy, then I would urge the couple to get assessed for any sleep issues that may potentially be interfering with fertility. If there is a history of sleep apnea or any other sleep disorder, then it is reasonable to assume that there may be some degree of difficulty getting pregnant or maintaining the pregnancy. Learn about sleep hygiene and instigate these habit changes even as you explore a precise diagnosis of your sleep issue and treatment options.
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Eli Hendel, M.D., is a board-certified internist/pulmonary specialist with board certification in Sleep Medicine. An Assistant Clinical Professor of Medicine at Keck-University of Southern California School of Medicine, and Qualified Medical Examiner for the State of California Department of Industrial Relations, his areas include asthma, COPD, sleep disorders, obstructive sleep apnea, and occupational lung diseases. Favorite hobby? Playing jazz music. Find him on Twitter @Lung_doctor.