How Not Getting Enough Sleep May Affect Your Fertility

Santina M

How Not Getting Enough Sleep May Affect Your Fertility

As you likely know, certain lifestyle factors can weigh on your ability to conceive. If you’re underweight or overweight, follow a poor diet, smoke, drink, abstain from physical activity and generally are in poor health you could be impacting your fertility in a negative way. But what about something as simple as sleep? Can sleep affect your fertility? And if so, how? Let’s dive in!

Unfortunately, according to the Centers for Disease Control and Prevention, more than one-third of Americans don’t get enough sleep. If you’re one of them, and you’re also concerned about your fertility, here’s information that may surprise you:

  • In both men and women, the same part of the brain that regulates sleep-wake hormones (such as melatonin and cortisol) also triggers the daily release of reproductive hormones.
  • The hormones that trigger ovulation in women and sperm maturation in men may be linked to the body’s sleep-wake cycle. For example, if you are a woman, long-term sleep deprivation can directly affect the release of luteinizing hormone (LH) – the hormone that triggers ovulation as part of the regulation of your menstrual cycle. The resulting irregularity of menstruation may mean that it takes longer for you to become pregnant.

Importance of the quality of the sleep when trying to conceive

The importance of sleep is not only tied to the number of hours, but also to the quality of sleep: waking up frequently during the night disrupts the normal sleep cycle, which includes a deep sleep stage during which the body restores itself. Consistent poor-quality sleep can contribute to:

  • High blood pressure
  • Weight gain
  • Hormone imbalance

all of which can lead to fertility problems.

What else connects sleep and fertility?

Long-term lack of sleep can disrupt more than your hormonal balance. It can affect your fertility indirectly too.

Studies show that Obstructive Sleep Apnea is more commonly seen in infertile women and increases the odds that a woman will be infertile. More studies need to be done and we still have a lot to learn about how exactly sleep disorders may affect infertility. Even so, the results suggest that women can add infertility to the long list of health reasons to get help when they can’t fall or stay asleep.

Five suggestions for improved sleep

Stick to a sleep schedule

Do not schedule more than eight hours for sleep. The recommended amount of sleep for a healthy adult is at least seven hours. Most people do not need more than eight hours in bed to be well rested. Go to bed at the same time every day and get up at the same time, even on weekends. Being consistent will strengthen your body’s sleep-wake rhythm. If you do not fall asleep within 20 minutes of going to bed, leave your bedroom and do something relaxing. Read or listen to soothing music. Go back to bed when you are tired. Repeat as needed, but continue to maintain your sleep and wake-up rhythms.

Pay attention to what you eat and drink

Do not go to bed hungry or full. Especially avoid heavy or large meals within a couple of hours before bedtime. Discomfort could keep you awake. Also be careful with nicotine, caffeine and alcohol. The stimulating effects of nicotine and caffeine take hours to wear off and can interfere with sleep. And even if alcohol makes you sleepy at first, it can disrupt sleep later in the night.

Create a restful environment

Keep your room cool, dark and quiet. Light in the evening can make it difficult to fall asleep. Avoid prolonged use of light-emitting screens just before bedtime. Consider using blackout blinds, earplugs, a fan or other devices to create an environment that suits your needs. Calming activities before bed, such as taking a bath or using relaxation techniques, can promote sleep.

Include physical activity in your daily routine

Regular physical activity can promote better sleep. However, avoid being active too close to bedtime. Spending time outside every day might be helpful, too. Try going out for an hour or more out in the sunlight each day. 

Manage worries

Try to sort out your worries or concerns before you go to bed. Write down what is on your mind and set it aside for tomorrow. Stress management can help. Start with the basics, like getting organized, setting priorities, and delegating tasks. Meditation can also relieve anxiety.

You’re now familiar with at least some ways to get more and better sleep. Try them! And remember, if your sleep and fertility problems continue, it may be time to talk to your doctor to find out if an underlying medical condition may be a factor.

How stress can affect your ability to get pregnant

Infertility can affect relationships with family and friends, cause financial difficulties, affect the relationship between partners, and negatively affect the couple’s sexual relationship. In short, infertility can cause stress affecting your ability to get pregnant.

But does this stress have an impact on fertility? Is it a fact that you can be infertile due to stress? Let’s dive in!

How stress affects your ability to get pregnant

The Research Behind Stress and Fertility


Researchers have long been trying to figure out exactly how stress limits fertility. A study published in the Journal Fertility and Sterility found that women with high levels of alpha-amylase, an enzyme that correlates with stress, have a harder time getting pregnant. In this study, saliva samples were collected from 274 women over six menstrual cycles (or until they became pregnant). It showed that the women with the highest levels of alpha-amylase during their first menstrual cycle were 12% less likely to become pregnant than women with lower levels of the enzyme.


Another Emory School of Medicine study, conducted by Sarah Berga, MD, found that women who had not ovulated for more than 6 months had high levels of cortisol, a stress hormone. The same brain regions that can regulate hormones needed for ovulation also respond to stress hormones such as cortisol. Of these women, seven of the eight participants who received stress management therapy began ovulating again, compared to only two of eight participants who did not receive therapy. The same link between stress and fertility exists in men, in whom high levels of stress can reduce testosterone production, so both partners may be affected by stress.

Depression & Anxiety

Finally, a study in Taiwan found that 40% of participants who received treatment for infertility were diagnosed with depression or anxiety. Other researchers have found that women struggling with infertility are affected by anxiety and depression at the same rate as women diagnosed with HIV or cancer. Since infertility is a real medical problem with a significant impact on lives, it is not surprising that it can cause the same anxiety as other serious medical problems.

Many researchers have also pointed out that most women who cannot conceive have physical reasons, but this is not always the case. Regardless, the woman feels more and more stress over time. So even if a physical cause is medically treated, it is possible that high stress levels make conception difficult.

Does stress actually cause infertility?

While it’s unlikely that stress alone can cause infertility, stress interferes with a woman’s ability to get pregnant. Research has shown that women with a history of depression are twice as likely to experience infertility. Anxiety also can prolong the time needed to achieve pregnancy.

Stress can affect the part of your brain (the hypothalamus) that regulates your hormones, which in turn regulate your menstrual cycle. If stress takes a toll on your body, then it could mean you ovulate later than usual, or not at all (stress-induced anovulation).

If you’re stressed, your cervical mucus may indicate that something’s not right. Rather than noticing increased wetness as you approach ovulation, you might find patches of wetness interspersed with dry days. It’s as if your body is trying to ovulate but the stress continues to delay it.

Being very stressed for a long time may make it harder to conceive. But trying for a baby can also be stressful in itself. In general, it makes sense to take steps to reduce stress while you’re trying for a baby, if only for your own peace of mind.

Does stress affect the ability to get pregnant?

Yes, and no.

The American Psychological Association notes that “psychological factors–while important–are secondary to biological ones.” Another leading authority on fertility research, the American Society of Reproductive Medicine explains that “even though infertility is very stressful, there isn’t any proof that stress causes infertility.”

A review of over 50 studies in Fertility and Sterility noted that, in men:

“Although some trends have been identified, larger-scale studies that adequately control all confounding variables are needed before conclusions can be made about the relationship between stress, psychotropic agents, and male infertility.”

A 2015 study in Nature Reviews Urology notes a similar sentiment.

If you have a stressful job or work long hours, you can stop beating yourself up about it. How you react to stress—whether channeling it into exercise or unhealthy habits like overeating—plays a bigger role.

What about everyday stressors/unhealthy habits?

There is some evidence that everyday stressors can have an impact on your chances of getting pregnant. Most experts, however, believe that this isn’t due directly to the stress, but from the unhealthy habits that most people turn to when they’re stressed out.

These may include:

  • Smoking
  • Drinking
  • Overeating
  • Avoiding sex
  • Neglecting to exercise

Unhealthy habits affect both women and men when it comes to fertility.

5 tips to reduce stress when trying to get pregnant

Tips to reduce stress when trying to get pregnant
Tips to reduce stress

If you are currently struggling with infertility, or just stress in general, there are many ways to reduce stress! Give one of the following options a try:


Educate yourself about the normal responses to infertility. Talk to other people going through infertility. Understand your medical condition and ask about treatment options.


Talk to your partner about your feelings and needs, and allow your partner to feel and cope differently. Talk about your differences and avoid conflict. Keep communicating with family and friends to avoid isolating yourself. Understand that you can talk about your situation without going into details and tell others how they can support you.

Stay active/exercise

Doing activities you enjoy or exercising lightly can help release endorphins and serotonin, both of which improve your mood. Try moderate exercises such as swimming or walking. Even just setting aside time to do your favorite activities can relieve stress. 

Meditation or yoga

Meditating can help clear your mind and relax your body. Not into sitting still? Try doing an hour of yoga a few times a week. Hatha yoga specifically focuses on breath and movement, without concentrating on mediation specifically. Both meditation and yoga can reduce stress hormones.

Deal with sexual stress

Sexual stress is common among couples with infertility, mostly because couples feel that this is an obligation or a duty rather than a fun activity. Couples can deal with this in several ways, including taking a break from baby-making, distinguishing between work and fun sex, and learning sensual contact that doesn’t lead to pregnancy.

Best diet when trying to get pregnant

Greek Salad is a part of mediterranean diet known to help when trying to get pregnant

When trying to get pregnant the food you consume can make a big difference. We firmly believe that a mediterranean diet can help a lot when trying to conceive.

The Mediterranean diet is a way of eating that is traditionally followed in countries surrounding the Mediterranean Sea, such as Greece, Italy, and Spain. It is based on a primarily plant-based diet that includes a variety of vegetables, fruits, nuts, seeds, legumes, whole grains, and olive oil, as well as moderate amounts of fish, dairy, and poultry. It also includes red wine in moderation, which we do not advocate for at all (just keep in mind). This diet is known to help especially when trying to get pregnant naturally.

Greek Salad is a part of me Mediterranean diet known to be the best when trying to get pregnant

The Mediterranean diet is generally considered to be a healthy eating pattern because it is rich in monounsaturated fats, fiber, and a wide range of nutrients. In addition to being best when trying to conceived, it has also been associated with a lower risk of heart disease, diabetes, and some forms of cancer, as well as improved mental health and cognitive function.

What is important in a diet when trying to get pregnant

A healthy diet is important for all individuals, including those who are trying to get pregnant. Some key considerations for a diet when trying to get pregnant include:

1. Adequate intake of key nutrients: It is important to consume a varied and balanced diet that includes all of the essential nutrients, including folic acid, iron, calcium, and zinc. Folic acid is especially important for women who are trying to get pregnant, as it can help prevent birth defects of the brain and spine.

2. Plenty of fruits and vegetables: These are good sources of vitamins, minerals, and fiber, and can help ensure that you are getting all of the nutrients you need.

3. Adequate protein: Getting enough protein is important for fertility and fetal development. Good sources of protein include lean meats, poultry, fish, eggs, dairy products, nuts, seeds, and legumes.

4. Healthy fats: Monounsaturated and polyunsaturated fats, such as those found in olive oil, avocados, and nuts, can help support reproductive health.

5. Limited intake of processed and sugary foods: These types of foods can be high in empty calories and low in nutrients, and may contribute to weight gain and other health problems.

It is also important to stay hydrated by drinking plenty of water and to avoid alcohol and tobacco, as these can have negative effects on fertility. If you have any concerns about your diet or fertility, it is a good idea to speak with a healthcare provider for personalized advice.

Tabbouleh salad is a part of a Mediterranean diet known to be the best when trying to conceive

Addressing underlying conditions when trying to eat healthy

While eating healthy in general is important, if you have a condition like PCOS or Endometriosis, the foods you consume have even greater impact. Above mentioned conditions can be cause by a hormonal misbalance in your body, so eating health is crucial when trying to get pregnant.

Getting Pregnant after 30, 35 or even 40, written by a fertility specialist.

Is it possible to get pregnant after 30, 35 or even later?

According to research over the last 40 years, a healthy 30 year old woman has about a 20% chance of getting pregnant each month. A healthy, ovulatory 40-year-old woman’s chance per month is 5% (1,6). The decline is slow and steady up until the age of about 35. After that the decline becomes steeper. These ranges and time frames have been established through multiple studies and have been consistent for the last 30+ years. The decline in fertility is attributed to depletion of ovarian oocyte (eggs) reserve and is determined by genetic, environmental, and lifestyle factors.(2).

How hard is to get pregnant after 40
How likely is to get pregnant at certain age

What makes it hard to get pregnant after 35 or 40?

Although your changes of getting pregnant after 35 or 40 are decreasing, there are good news. Age at conception does have bearing on time to pregnancy in a healthy, ovulatory woman. In general, fecundity (a woman’s physiological ability to have a child) is reported as age ranges because it is difficult to correlate a specific age to a specific chance of success. There are also factors that can affect reproductive aging. These include other medical conditions that can have an effect such as endometriosis, fibroids, genetic conditions (errors in number of chromosomes), environmental influences, obesity, smoking, thyroid gland dysfunction, history of sexually transmitted diseases (STDs), and ovulatory dysfunction, to name a few (2,3).

PCOS stands for Polycystic Ovarian Syndrome, it is the most common form of ovulatory ovarian dysfunction.  The pathology of PCOS makes ovulation irregular and unpredictable, making the timing of intercourse for conception difficult. 

There could also be issues with male fertility such as erectile dysfunction and sperm quality issues. Male evaluation initially consists of a semen analysis and potentially other endocrine blood testing to evaluate any severe sperm abnormality.

How can fertility specialist can help to conceive after 35 or 40?

Most of the factors other than extreme reproductive age are usually treatable. When you get started, the first step is a comprehensive evaluation of both you and your partner (if applicable). We test your ovarian reserve to gauge likelihood of adequate number of eggs produced per cycle, prolactin levels since the elevated levels can affect regularity of ovulation, and PCOS testing. If there are any positive findings, we can offer prescription medications or supplements beneficial for conception (5).

There are supplements that both partners can take that have been shown to be beneficial for conception.  Lifestyle modification and diet changes (such as following the Mediterranean diet) can also positively impact your chances.  Controlling your stress and regular moderate exercise also confer benefits (3,4).

Please click the link below for a consultation with an experienced Reproductive Endocrinologist. You can also follow us on Facebook or return to our website for updated information about your fertility journey.


1.   Menken J, Trussell J, Larsen U. Age and infertility.  Science. 1986;233:1389-1394.

2.   Utting, D., & Bewley, S. (2011). Family planning and age-related reproductive risk. The Obstetrician & Gynaecologist, 13(1), 35–41.

3.   Collins GG, Rossi BV. The impact of lifestyle modifications, diet, and vitamin supplementation on natural fertility. Fertil Res Pract. 2015 Jul 25;1:11. doi: 10.1186/s40738-015-0003-4. PMID: 28620516; PMCID: PMC5424364.

4.   Dimitrios Karayiannis, Meropi D Kontogianni, Christina Mendorou, Minas Mastrominas, Nikos Yiannakouris. Adherence to the Mediterranean diet and IVF success rate among non-obese women attempting fertility. Human Reproduction, 2018; DOI: 10.1093/humrep/dey003

5.   Unfer, V., Nestler, J. E., Kamenov, Z. A., Prapas, N., & Facchinetti, F. (2016). Effects of Inositol(s) in Women with PCOS: A Systematic Review of Randomized Controlled Trials. International journal of endocrinology, 2016, 1849162.

6. Sozou PD, Hartshorne GM (2012) Time to Pregnancy: A Computational Method for Using the Duration of Non-Conception for Predicting Conception. PLOS ONE 7(10): e46544.

Understanding Your Menstrual Cycle

Menstrual Cycle

By Fertility Cloud Head Nurse Svetlana Izrailevsky, BSN, RN.

What is a menstrual cycle? 

In reality, a menstrual cycle consists of 3 broad categories of cycles:  Ovarian (follicular) cycle, Endometrial lining cycle, and Cervical mucus development cycle.  It is important to understand that these cycles are taking place in tandem, and in relationship to each other.  That means that what happens in one of these cycles will affect the developments in the other ones.  

First, lets review the hormones involved in the menstrual cycle:

FSH – FSH helps control the menstrual cycle and stimulates the growth of eggs in the ovaries. FSH levels in women change throughout the menstrual cycle, with the highest levels happening just before an egg is released by the ovary. This is known as ovulation.

LH – LH helps control the menstrual cycle. It also triggers the release of an egg from the ovary. This is known as ovulation. LH levels quickly rise just before ovulation.

Estradiol, also called E2, is the main estrogen in nonpregnant females of childbearing age. It’s mostly made in the ovaries and is important for uterine lining development.

Progesterone is a hormone that’s made mainly by the ovaries. Each month, progesterone prepares your uterus for pregnancy. During a normal menstrual cycle, an ovary releases an egg and your progesterone levels begin to rise. Progesterone makes the lining of your uterus grow thicker so that a fertilized egg can attach (implant) inside of the uterus and grow into a baby. If you don’t become pregnant, your progesterone levels will fall. The lining of your uterus will become thinner again. When your uterus starts to get rid of the extra blood and tissue, your menstrual period will begin.  If you become pregnant, progesterone levels will continue to rise to about 10 times higher than usual to support the pregnancy.

3 main time frames of the cycle:

menstrual cycle - 3 phases
follicular phase
Ovulatory phase of menstrual cycle
post ovulation and endometrial secretory phase
Luteal phase
These different cycles communicate via hormone messengers. For example, when the egg inside the follicle is mature, it sends a signal to the pituitary gland via the increased levels of Estradiol hormone. This stimulates the rise in LH hormone levels which finishes the maturation of the egg and allows it to break out of the follicle–ovulate. At the same time, Progesterone level rises to support the uterine lining and the uterine lining undergoes a transformation where the receptors for the embryo become activated and stand ready.

The connection between different cycles

menstrual cycle phases


What is the best time to get pregnant during my cycle? What should I be doing to maximize the potential for conceiving?

When we are speaking of a regular 28-30 day cycle, your fertility window is between cycle day 10-15.  We would recommend intercourse every other day starting on cycle day 10.  Once you note your LH surge by using ovulation predictor kits, you should have intercourse daily on the day of the LH peak/surge and the subsequent 2 days.  

Please remember that LH hormone stays elevated for a very short time, just about 24 hours so we do not recommend that you keep checking your LH after you see the peak.  

Male partners, if applicable, should do ejeculation every 2-3 days starting with your cycle day 1.  We would like to have the freshest sperm sample available for insemination.  Please do not hold off on regular ejaculation because that increases the number of dead and dying sperm in the sperm sample that will be produced for the insemination.

Wait!  What if my cycles are not regular?

For some patients, the cycles are regular and predictable, but long.  It is possible to have a regular ovulatory cycle with the overall length of 35 days, for example.  However, there are also women who have irregular ovulatory cycles due to ovarian dysfunction.  This dysfunction is usually related to improper hormone levels of Estradiol and FSH.

What does the follicle stimulating hormone (FSH) do again?

FSH – FSH helps control the menstrual cycle and stimulates the growth of eggs in the ovaries. FSH levels in women change throughout the menstrual cycle, with the highest levels happening just before an egg is released by the ovary. This is known as ovulation.  

What about Estradiol?

Estradiol, also called E2, is the main estrogen in nonpregnant females of childbearing age. It’s mostly made in the ovaries and is important for uterine lining development.  As you can see in the diagram above, Estradiol rises slowly before ovulation and stays elevated for a period of about 7 days after the ovulation.  This is so that there is no ovarian follicular recruitment happening during the period of potential fertilization and implantation.   Elevated levels of Estradiol can interfere with production of FSH so if the Estradiol levels are high at the beginning of the cycle it impacts the regular growth and development of the follicles. 

Estradiol can be elevated as a result of conditions such as polycystic ovarian syndrome (PCOS) or presence of elevated levels of BPA in the system. Bisphenol A (BPA) is a chemical produced in large quantities for use primarily in the production of polycarbonate plastics. It is a part in various products including shatterproof windows, eyewear, water bottles, and epoxy resins that coat some metal food cans, bottle tops, and water supply pipes.  

I ovulated 2 days past normal ovulation days, does that mean my period will start two days later than expected?

The next menstrual period will start once the Progesterone and Estradiol levels fall, if there is no conception.  They typically occur 10-14 days after ovulation occurs.  If you ovulate 2 days later than you usually do, your menses mostly likely will be 2 days late.

I have been taking Progesterone to support my uterine lining.  Will that impact my menses?

Yes!  If you are taking Progesterone, you are not likely to start menses even if you are not pregnant. Take a home pregnancy test, and if it is negative stop taking the Progesterone. You can expect your menses 2-5 days after stopping the medication.  Some patients may begin spotting even before stopping Progesterone.  The spotting/bleeding you will get after the Progesterone may be a little heavier than your usual menses and the first day of bleeding will count as cycle day 1 for next treatment.

It was my first time taking Clomid, is it normal that I expect menses to be delayed even with negative HPT?

Clomid does not directly impact the length of menses.  However, it does help regulate the ovulatory process so your menstrual cycle will look different.  For some patients, cycles are a bit shorter and for others they are longer as Clomid works to increase production of FSH hormone.

What does LH hormone timing look like in the cycle?

LH rises slowly only a few days before ovulation and then has a sharp rise known as LH peak or surge, 24-36 hours before ovulation.  It only stays elevated for about 24 hours and then drops sharply.  It does not begin to rise again with the start of the menses, at least not right away.

How to get pregnant with Unexplained Infertility.

Our hearts melt when our patients text us: “We did it! I can’t believe it.” We want to share a story of one of our patients who underwent IVF and other procedures and lost her hope. However this story does have a happy end.

I would like to introduce to you the story of Alice (name changed for the purposes of this blog post).

Alice is a patient that came to us with the diagnosis of unexplained (undiagnosed) infertility. Alice had an evaluation that demonstrated normal ovarian reserve, her AMH was 3.58 ng/mL (the lab norm is from 1 to 7.6 ng/mL), her fallopian tubes were open as documented by a hysterosalpingogram test and her spouse’s sperm evaluation was completely normal. In addition, her male partner had two prior children from a previous relationship. Alice had been trying to conceive for over fourteen months prior to seeking care with us. She underwent a few cycles of letrozole and then underwent IVF and did not get pregnant with a frozen embryo transfer.

After seeing her through our, always accessible, telehealth platform, we realized that Alice likely suffers from LPD. We discussed additional testing for PDG monitoring and confirmed our suspicions.

We discussed her treatment options, and she underwent ovarian stimulation and progesterone support and got pregnant on her second treatment cycle. She was ecstatic, as her experience at FC allowed her to be successful and receive an answer to the question that has been unanswered for a long time providing much needed closure in a much more affordable manner.”