Rising rates of infertility over the last several decades parallel the increasing rates of sleep deprivation and disruption. On average, people get around 6.8 hours of sleep each night. 100 years ago, people averaged about 9 hours of sleep per night. This shift is likely related to how we work and our lifestyle changes.
It’s estimated that 1 in 3 infertile women report poor or disrupted sleep.
Our Circadian Rhythm is an internal physiological process that regulates our sleep/wake cycle. It allows us to feel more energized and productive during the day and more sleepy and restful during the night. This rhythm is highly regulated by the amount of light that our eyes take in. Our eyes signal an area of our brain- the suprachiasmatic nucleus (SCN) that acts as our internal clock.
This area of our brain also regulates release of reproductive hormones in a rhythmic pattern. This is controlled by something called ‘clock genes’. Yes, the scientific name for these are actually called clock genes.
This same rhythmic pattern helps to regulate sex hormone production, ovulation, and implantation required for pregnancy. Some research has shown that because of this influence, if there are issues with the clock genes, it may impact fertility- either difficulties conceiving or difficulties maintaining a pregnancy.
Poor Sleep + Polycystic Ovarian Syndrome (PCOS)
For example, LH and FSH are hormones released by the brain during the first half of the cycle. These are released in a rhythmic manner, and if measured throughout the day, will have peaks and valleys. These hormones contribute to development of follicles within the ovary. As the cycle progresses, one of these follicles will become the dominant egg that is released at ovulation. Women with PCOS commonly have elevated levels of LH.
This constant elevation creates a miscommunication between the brain and the ovaries. Since there isn’t a rhythmic release of this hormone, the follicles continue to grow and grow and can become cysts on the ovaries. This can have a huge impact on ovulation and the ability to conceive, oftentimes leading to infertility.
Poor Sleep + Progesterone
Progesterone is the hormone that dominates the second half of the menstrual cycle. Adequate levels are essential for implantation and maintenance of pregnancy. If progesterone levels are low after implantation, there is a high likelihood that the woman will miscarry her pregnancy.
One small study found that for every hour increase in daily sleep duration, progesterone levels increased by 9.4%. Stress is associated with decreased levels of progesterone as well as poor sleep. Progesterone also acts as a sleep inducer, anxiolytic and respiratory stimulant. Meaning, when progesterone levels are where they should be, women should get better sleep. This also correlates with menopausal women reporting poor sleep (their progesterone levels begin to drop).
Poor Sleep + Thyroid Health
High levels of TSH, the hormone from the brain that tells the thyroid to produce hormones like T4 and T3, are associated with anovulation (no ovulation), irregular periods, amenorrhea (lack of period), and recurrent miscarriage. TSH is also released in a rhythmic pattern. It increases prior to sleep and continues to increase over the course of the night when it peaks. It will then begin to decrease throughout the day.
Sleep deprivation can have impacts on this secretion. Chronic sleep deprivation suppresses the secretion of TSH. Some research has shown in women (and men) with major depression, insomnia ratings correlated with low levels of TSH.
Since the thyroid regulates production of other hormones as well as influences pregnancy, low levels of these hormones can lead to infertility and miscarraige(s).
Poor Sleep + Stress hormones
Glucocorticoids are released in a rhythmic pattern as well. These hormones help with production and release of stress hormones like cortisol. The pattern of cortisol release is high in the morning and slowly decreases throughout the day, with its lowest levels being at night. It is released in almost an exact opposite way of melatonin.
Glucocorticoids also regulate the hypothalamic-pituitary-adrenal axis (HPA axis), which controls our fight-or-flight response. Issues with this axis show significant impacts on pregnancy and if disrupted enough, can cause miscarriages to occur.
With significant stress, glucocorticoids increase, this increased production can disrupt the normal sleep/wake cycle due to the effects that it has on cortisol secretion. So, increased stress can lead to poor sleep which can lead to increased stress. This causes a vicious cycle which can impact how the body produces melatonin, making it more difficult to get good quality sleep.
Poor Sleep + Melatonin
Melatonin is the hormone that helps us fall asleep and stay asleep at night. Like the other above, it is released in a rhythmic manner (opposite of cortisol). It is low during the day when we are awake, and high at night when we are asleep.
Melatonin is present in ovarian follicles and protects these cells from oxidative stress (inflammation/damage). Remember, the follicles will eventually develop into an egg released at ovulation. When melatonin levels are low due to poor sleep, these follicles may not be as protected and can be more easily damaged.
Follicular melatonin levels have been found to be significantly lower in women with idiopathic infertility. Melatonin also plays a role in keeping the uterus healthy and can help to support attachment or implantation of a fertilized egg as well as development of the placenta.
Irregular production and low levels of melatonin are associated with lower implantation rates, recurrent miscarriage, and premature birth. Melatonin is also a hormone that crosses the placenta, which can help reduce stress to the fetus.
Reproductive Outcomes
Unfortunately, it isn’t as simple as supplementing melatonin, as this doesn’t seem to have a major impact on impaired sleep. Meaning, fertility might be somewhat improved, but melatonin supplementation may not correct some of the other fertility related issues discussed above.
Disruption of circadian rhythmicity due to impaired sleep, can impact the production of sex hormoes, HPA Axis function, thyroid function, and function/development of follicles into eggs, and implantation that has to occur for pregnancy.
Fortunately, there are things that can help to improve this. This may include working on the gut to decrease stress to the HPA Axis, practicing techniques like meditation or yoga to help calm the brain and increase melatonin production, working on improving sleep through therapy, hypnosis, and reducing overall stress. This oftentimes requires us to investigate any underlying health issues that could be interfering with all of these hormonal pathways and areas of the brain.
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About Dr. Zaremba:
Dr. Zaremba received her bachelor's degree from Western Michigan University in Biomedical Sciences and minored in Chemistry and Psychology. She completed her doctoral training at Palmer College of Chiropractic. During her time in school, she took post-doctoral training through The Clinic on Disease and Internal Disorders (CDID) earning her a Diplomate from the American Board of Chiropractic Internists (DABCI).
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References:
Beroukhim, G., Esencan, E. & Seifer, D.B. Impact of sleep patterns upon female neuroendocrinology and reproductive outcomes: a comprehensive review. Reprod Biol Endocrinol 20, 16 (2022). https://doi.org/10.1186/s12958-022-00889-3
Coomarasamy A, Devall AJ, Brosens JJ, Quenby S, et al. Micronized vaginal progesterone to prevent miscarriage: a critical evaluation of randomized evidence. Am J Obstet Gynecol. 2020 Aug;223(2):167-176. doi: 10.1016/j.ajog.2019.12.006. Epub 2020 Jan 31.
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