GOOD sleep quality is significantly associated with higher clinical pregnancy and embryo implantation rates in couples undergoing assisted reproductive technology (ART), a 2026 meta-analysis of more than 6,700 patients studied between 2022 and 2025 has found.
ART Pregnancy Rates at Undesirable Level
Amid the continuous improvement of ART technologies to meet increasing global demand, its clinical pregnancy rate remains at approximately 30-40%. This suggests that, beyond technical advances, optimising patient-related and modifiable factors may be critical to achieving further gains in reproductive success.
Physiological Effects of Better Sleep Quality
Patients with good sleep quality were 53% more likely to achieve clinical pregnancy and 41% more likely to achieve implantation.
Good sleep quality was defined as a Pittsburgh Sleep Quality Index (PSQI) score of less than 5 of the absence of sleep disorders. The PSQI is a validated self-reported questionnaire that evaluates sleep quality and disturbances over the previous month, generating a global score from 0–21, with lower scores indicating better sleep quality.
The analysis found that good sleep quality prevents the disruption of the secretion of hormones including melatonin, cortisol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), creating a more favourable environment for implantation.
Combined analysis of three studies showed that good sleep significantly increased embryo implantation rates.
Melatonin aids embryo development by regulating biological rhythms. High quality sleep encourages the nocturnal peak of FSH and LH, promoting successful implantation. It can also enhance endometrial tolerance and improve local blood prefusion.
Further, prolonged poor sleep quality can induce unstable psychological status, including anxiety and depression, shown to be associated with less favourable ART outcomes.
Limitations
Researchers faced challenges in establishing a consistent definition of “good sleep” across the literature, creating potential comparability issues. However, the majority used the PSQI as a standardised assessment tool.
Most studies analysed were observational, making the absolute exclusion of confounding factors, such as psychological state and lifestyle, difficult.
Sleep Management as a Cost-Effective Intervention
The researchers proposed that sleep management be incorporated into patient assessment and treatment in fertility clinics, particularly due to its high modifiability and low cost.
For example, conducting systematic sleep screening, adopting cognitive behavioural therapy for sleep (CBT-I), creating a good sleep environment, and using safe sleep aids were proposed.
The importance of monitoring the patient’s psychological status, disrupted life rhythms and other factors closely related to sleep, was emphasised in optimising ART pregnancy outcomes through a multidisciplinary and personalised approach.
Other Contributing Factors
Lifestyle factors including diet, exercise, smoking, and alcohol consumption have gained traction as influences on pregnancy and implantation rates. These factors are now considered alongside more widely acknowledged determinants of ART success, such as age, body mass index, ovarian reserve function, embryo quality, endometrial thickness, and ovulation regimen. Together, they reflect a growing focus on combining modifiable lifestyle factors with established clinical predictors in reproductive medicine.
Reference
Lin W, M Ma P. Associations between sleep quality and assisted reproductive technology outcomes: a meta-analysis. Arch Gynecol Obstet. 2026;313(1):64.
