Part 1 - Sleep and Fertility

This corona crisis has demanded patience, perseverance, and faith. Most of us have been stuck at home, unable to engage in our daily routines just waiting for this to end. For women trying to conceive this crisis has been extra frustrating with IVF clinics closed. Hopefully we are beginning to emerge, but the immediate future is still unclear.

However,  as Dr. Jordana Hyman mentioned in her video message to the Gefen community, this time at home is also an opportunity; an opportunity to invest in ourselves, an opportunity to strengthen our bodies, an opportunity to perhaps maximize our fertility.

If you’re trying to conceive - the most powerful assistance you can give yourself right now is education and appropriate choices. Creating health and balance in your body leads to improved fertility. Studies show a direct correlation between targeted lifestyle choices and the chances of becoming pregnant. 

In addition, successful pregnancies come from healthy eggs. When it comes to creating healthy eggs you need to understand the time factor. An egg is not nurtured only in the 14 days before ovulation.  An egg undergoes a 120 day cycle of maturation and growth before it is ovulated! That means that the changes you make now will improve the eggs that will be ovulated in 3-4 months from now. Don’t wait. Start now.

I’d like to share with you the four fundamental pillars of fertility that can immediately begin to boost your fertility. I recommend these practices to all of my fertility clients. Each practice can be done at home and is entirely free.

This blog will address the first one. 

Fundamental Pillar #1: Sleep

Get a good night’s sleep. Seriously.  Getting enough quality sleep at the right times can help protect your mental health, physical health, quality of life, and safety. Sleep is so important and yet  when push comes to shove it is often the first thing we cut when we are feeling stressed.

We all instinctively know that getting a good night’s sleep is good for our mood, our concentration, our energy levels and our performance . This may be surprising but studies show that moderate sleep deprivation can negatively impact certain aspects of our performance to a similar degree as being drunk!

But you might not know that sleep also affects many other systems in the body. Let’s take a look at a few:

Sleep is the time when our body restores and replenishes itself from the activities of the day. It allows the body to repair the heart and the blood vessels which is important for blood flow. And better blood flow in the body means that there is a chance of better blood flow to the pelvic region and to the ovaries and uterus which could improve egg quality and uterine lining. 

Nighttime sleep is also vital for hormonal regulation. There are specific hormones that get secreted when we sleep. For example - our body secretes Human Growth Hormone (HGH) at night, which is obviously important for growing children and teens. But growth hormone is also important for adults, especially those who want to conceive. Growth hormone promotes production of IGF-I (insulin growth factor) which is essential during the early follicle growth stages and plays a big role in follicle development. That means that growth hormone is vital for egg development.  In fact, although controversial, there are some IVF clinics that use growth hormone (HGH) to improve chances for women with low ovarian reserve. And a few clinics have tried a new tactic -  supplement HGH in the six weeks before the IVF cycle and not during the actual IVF treatment. So why not encourage your body’s own Human Growth Hormone naturally and help your egg follicles by getting a good night’s sleep?

Melatonin is another hormone associated with sleep. It is connected to the way our bodies perceive light and dark and is secreted by the brain at around 9 pm to help prepare our bodies for sleep. Sometimes people with sleep disturbances or jet lag take synthetic melatonin to help regulate their sleep cycles. But here is where it gets interesting - melatonin has also been found in the fluid inside the egg. Researchers believe that it acts as an antioxidant in the egg - which means that it reduces the effects of oxidative stress and damage inside the egg. So melatonin might improve egg quality. In fact, melatonin is an experimental treatment for women with unexplained infertility! The best way to  get our bodies to make melatonin is to stick to a set bedtime - preferably around 10-11 pm.

Sleep is also important for another hormone that regulates our metabolism - insulin. Insulin is what ushers the sugar from our blood and into our cells where it is used to give us energy. The problem is that sleep deprivation makes our cells less receptive to the insulin-  keeping the sugar in our blood instead of moving it into the cells. This is called insulin resistance (IR) and  is associated with the risk of weight gain and pre-diabetes. If this wern’t bad enough this insulin resistance (IR) is also associated with PCOS and lack of ovulation, longer time to achieving pregnancy, and higher risk of miscarriage. So sleep is important for keeping blood sugar levels steady, especially if you have PCOS. Remember - steady sugar levels are important for everyone’s fertility.

So getting some shut eye is paramount for hormonal balance that can directly influence egg quality and fertility. But there’s more. There’s a growing body of research showing that lack of sleep raises levels of inflammation in the body. Raised levels of inflammation mean that the body is in “fight or flight” mode and that the immune system is trying to fight off threats. Obviously, having a healthy immune system that can protect us from external threats is crucial. However, the inflammation becomes problematic if it is chronic. Then the immune system is in perpetual fight mode: it is constantly activating disease-fighting cells even when there is no external threat. Over time, these fighter cells can attack, wear down, and cause damage to healthy cells, tissues, organs, and systems throughout the body, leading to chronic illness like heart disease, stroke, diabetes  ...and infertility. 

Inflammation can affect fertility in a variety of ways. Inflammation is associated with endometriosis. Inflammation can affect ovulation and hormones levels. And, perhaps most significantly,  inflammation can alter endometrial receptivity - meaning that the fertilized egg is less likely to implant in the uterine wall and develop into a healthy pregnancy. 

One final important point about sleep. Both sleep and inflammation are regulated by our  circadian rhythm - our body’s internal  24 hour clock that controls many of the biological processes in our body. Our circadian rhythm is controlled by our brain and is key to maintaining healthy sleep cycles. But the circadian rhythm is also linked to other processes like hormone production, including fertility hormones. Hormones like FSH and LH - which are key for follicle growth and progesterone which is vital for implantation and supporting a pregnancy are linked to circadian rhythm. That means that these hormones are pulsed based on our internal 24 hour clock. If our clock is not calibrated to the rhythm of day and night our hormone levels suffer.  In fact, research shows that night shift workers have altered levels of fertility hormones. 

One way to help keep circadian rhythms in sync is to maintain a consistent sleep routine. Our bio rhythms thrive on consistency. Going to bed at the same time and waking at the same time every day reinforces the healthy circadian rhythms that govern both our sleep, our  immune function, and our hormonal function.

So we see how fundamental sleep is to our health and also for our fertility. It balances hormones that support egg quality and growth, makes sure our sugar metabolism is efficient which encourages ovulation and repairs our blood vessels so that circulation is improved in the whole body and specifically to the ovaries and uterus. Reduced sleep can lead to inflammation which can interfere with implantation. 

It is not surprising then that when IVF outcomes of 670 women were studied and broken down according to sleep habits researchers discovered that moderate sleepers - women who slept 7-8 hours per night had significantly more pregnancies than short (4-6 hours) sleepers.

How much sleep do I need? Aim for 7-8 hours of sleep per night.

How to get a good night’s sleep:

• Aim for a set bedtime and wake up time every day
• Don’t ingest caffeine after 2 pm
• Don’t drink alcohol or eat within 3 hours of bedtime
• Exercise in the morning; don’t exercise within 4 hours of bedtime
• Get sun exposure during the day; best in the morning
• Create a relaxing bedtime routine which includes powering down electronics. In fact it's best if you can leave the devices outside the bedroom or put them in airplane mode

The bottom line is - getting 7-8 hours of sleep per night, at night, is crucial for your fertility. Pleasant dreams!