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We dive into the powerful connection between sleep and fertility with guest Oluyemisi Famuyiwa, a fertility specialist. Discover how sleep impacts reproductive hormones, gamete quality, and the success of assisted reproductive technologies (ART). Learn actionable tips to improve sleep health, restore hormonal balance, and enhance fertility outcomes for both men and women.
Oluyemisi (Yemi) Famuyiwa is a fertility specialist and founder, Montgomery Fertility Center.
She discusses the KevinMD article, “The impact of sleep on fertility: Why rest matters for reproductive health.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Yemi Famuyiwa. She is a fertility specialist and founder of the Montgomery Fertility Center. Today’s KevinMD article is “The impact of sleep on fertility: why rest matters for reproductive health.” Yemi, welcome back to the show.
Yemi Famuyiwa: Thank you. Thank you for having me.
Kevin Pho: So tell us what your latest KevinMD article is about.
Yemi Famuyiwa: Well, you know, I’m always looking for ways to help my patients. And this came about when I had a patient who complained of severe sleep—like she can’t get any sleep. I had to brainstorm ways to help her, do some research. I think she’s on sleep medications, too; she’s with her internist. And I said, you know what, let’s look at what sleep is doing to fertility—how is it affecting patients, and what can I dig up, and how can I share it with my patients so that they have something actionable?
Kevin Pho: So what are some of the connections between sleep and fertility?
Yemi Famuyiwa: Well, interesting, there are several articles that have come out. I think initially the exact mechanism is still being worked out, but observational studies always lead to experimental studies. And they found out, in sleep observation, that a quarter of—there’s a huge Chinese database where they looked at almost three thousand patients, a quarter of whom—we’re talking about fertility patients. A quarter of these patients reported sleep disorders, sleep disruption. So patients who have infertility have high sleep disturbance.
So when you look at sleep disorders like sleep apnea, what else can go with abnormal sleep? That’s really important for patients.
Kevin Pho: Now, you talk a little bit about the physiology of how sleep disturbances affect fertility. So go more into the physiology. How does that affect regulating fertility?
Yemi Famuyiwa: So when you have sleep disruption, it affects the hypopituitary. It affects your GnRH; it affects your hypothalamic–hypogonadotropic axis. You can get hypogonadotropic hypogonadism if you have a sleep disorder. So it has to do with your hypothalamus, right? If you have sleep disruption, then you have disruption of your GnRH going to your pituitary, affecting the production of FSH and LH.
So if you have disruption in your sleep parameters, then what we found out is that you may have abnormal production of testosterone in men with abnormal sleep parameters. It could also affect your prolactin production; all those things indirectly affect the function of the eggs and the function of the sperm as well. And when you have disrupted sleep, we found that patients have what is called stress. So when you look at patients who have oxidative stress, if you have high oxidative stress, then it starts to affect your egg and your sperm, right? So the lack of sleep leads to stress, and increased stress disrupts both the function of the egg and the sperm.
We also look at patients who have—there were studies where they looked at, I think in the Chinese population, if you have too little sleep and too much sleep, you have a U-shaped curve of the function of fertility, the fecundability, the ability to conceive. And then they also went a little deeper. They looked at sperm count, sperm motility, sperm morphology. The only thing that sleep did not disrupt was the semen volume, but it affected sperm concentration. But semen volume is not dependent on the testes, really; it’s dependent on the sperm being produced from the testes itself. So it affected what’s going on with the testes.
Kevin Pho: So how do you ask about sleep when you see patients in your evaluation in the fertility clinic?
Yemi Famuyiwa: Yeah, so what I usually do is just talk to patients to see what bothers them the most—what is bothering them? When you start to talk to a patient about what bothers them, you start hearing patients talk about, “Oh, I can’t get any sleep.” So when people start complaining about not being able to get enough sleep, then I start looking into what—you know, you ask them questions: “How are you getting sleep? What’s going on? Do you need sleep medication to get any sleep?” That’s when we start to get an indication that there may be a problem.
So now there are actually sleep specialists out there. So if I have a patient who’s complaining a lot, I refer them to some of these sleep doctors who can hopefully help them figure out what to do to straighten out their sleep going forward.
Kevin Pho: Now, in terms of medication to help people sleep, are there any specific medications that would be safer than others, especially when one considers fertility?
Yemi Famuyiwa: So what I have done is, I don’t really go into the exact medications per se. What I try to do is, if I start to catch a problem with sleep, I like to refer them to sleep doctors. There are some doctors who specialize in sleep function. So my job is to catch something in the very beginning and then refer those patients out to someone who specializes in sleep pathology.
Kevin Pho: Now, let’s say someone comes to you and you identify that the patient doesn’t get the best sleep. How soon after correcting the sleep can the reproductive function resolve itself? Is it over a period of time? Is it relatively quickly? How fast are the effects after correcting someone’s sleep patterns?
Yemi Famuyiwa: I think for most patients, if they correct their sleep pattern, they get almost instantaneous benefit. It’s patients who have really chronic sleep deprivation where just me advising them to develop some good sleep etiquette—like start programming your body by going to bed at the same time, by dimming your lights, by avoiding blue lights—so you can do that, do little things to help yourself establish a routine. But if the problem is ongoing and is severe, then I usually prefer to refer them to someone who is a sleep specialist.
Kevin Pho: And as you mentioned earlier, sleep affects fertility with both men and women as well.
Yemi Famuyiwa: Exactly, yes. In women, there’s a U-shaped curve if you have too much sleep or not enough sleep, both in men and in women. There’s that U-shaped curve so that if they have too little sleep or too much sleep, you have that U-shaped curve in fertility, and that is seen with both sperm and with female fertility.
Kevin Pho: And just to be clear with our definitions, how much sleep is too much and how much sleep is too little?
Yemi Famuyiwa: OK, so I think most of the studies looked at anywhere from seven to eight hours as a very good, nice sandwich time. The studies I looked at said once sleep starts to exceed nine hours, or goes down to six hours and less, that’s when you see that U-shaped curve where fertility and fecundity decrease in both men and women.
Kevin Pho: And how common is it that you unveil a problem with sleep patterns for someone coming to your clinic for a fertility issue?
Yemi Famuyiwa: For most people, it’s not very common. But you can check if they need sleep or so. Most of the studies I’ve looked at say that 24 percent of people with infertility have abnormal sleep patterns. So, I think it’s not very common—I would say 24 percent of patients—but when you do see them, I think most people having minimal intervention would help. But if the sleep deprivation is severe, then I prefer to refer them to someone who can use more medication, or a sleep doctor, if you will, who can help them better.
Kevin Pho: Now, in your article, you specifically call out obstructive sleep apnea as affecting reproductive health. So talk specifically about obstructive sleep apnea.
Yemi Famuyiwa: So obstructive sleep apnea is when you have sleep disruption, right? So you have patients who have a disrupted sleep pattern. The problem with obstructive sleep apnea is that one of its cofounders is that these patients also have obesity with type 2 diabetes and high blood pressure. So if you have patients who have obstructive sleep apnea, you see that they have a higher incidence of infertility. The question is, what is the cause of the infertility? Is it because of the obstructive sleep apnea? Is it because of PCOS that you see in both? Is it because of type 2 diabetes that you see in both? Or is it because of high blood pressure? So there are certainly cofactors in there that could give you a bad outcome with both fertility and sleep disruption, if you will.
Kevin Pho: We’re talking to Yemi Famuyiwa. She’s a fertility specialist, and she’s the founder of the Montgomery Fertility Center. Today’s KevinMD article is “The impact of sleep on fertility: why rest matters for reproductive health.” Yemi, as always, let’s end with some take-home messages that you want to share with the KevinMD audience.
Yemi Famuyiwa: I think the take-home message is pay attention to your sleep hygiene. You might be surprised that the reason your ART treatment is not working or you’re not getting pregnant on your own is that there may be a profound issue with sleep. And most people don’t think of sleep. Until I started writing this, I didn’t even know sleep could be considered a fertility medication, if you will. So I think people need to pay more attention to the emerging field of sleep as a medicine, especially when it comes to fertility.
Kevin Pho: Yemi, as always, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.
Yemi Famuyiwa: Thank you so much, Kevin.
