الفهرس 
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Abstract
Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Medical professionals classify women as having either primary or secondary infertility. Health care providers use the term “primary infertility” to describe those who have never had a pregnancy and “secondary infertility” to describe those who have previously been pregnant.
Infertility represents a major life crisis that threatens significant life goals and can be accompanied by a variety of psychological disorders. It may be caused by a number of different factors, in either the male or female reproductive systems. However, it is sometimes not possible to explain the causes of infertility.
Assisted reproductive technology (ART) is perceived as a more successful treatment for infertility. Two of the most common fertility treatments are In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI).
There is growing evidence that sleep plays an important role in several medical diseases, impaired sleep has been associated with various deleterious mental and physical health outcomes, including cardiovascular disease and glucose dysregulation, psychiatric and neurodegenerative disease, dysregulated immune function, and it has been argued that sleep loss may affect fertility through compromised immunity in women.
In addition, some studies have found correlations between sleep disturbances or disrupted circadian rhythm and diminished ovarian reserve, irregular menstrual cycle, and fertility. Correspondingly, several hormones are thought to present possible endocrine pathways by which sleep disturbance could affect fertility.
Furthermore, it has been suggested that infertility could also affect sleep, and the two may be reciprocally determined. Sleep could thus be affected by externally administered reproductive hormones as part of advanced infertility treatment with in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Women receiving the long gonadotropin-releasing hormone (GnRH) agonist protocol have been found to report more significant impairment of sleep quality and more depressive symptoms than women receiving the short GnRH antagonist protocol, possibly due to the longer duration of treatment and pituitary down regulation.
Recent studies also suggest a bi-directional link between sleep and mental health due to overlapping neural and endogenous regulatory pathways. Research directly exploring associations between fertility and sleep duration in specific is also lacking. Two recent studies observed a weak association between shorter sleep duration and reduced fecundability among women and men attempting pregnancy. In addition, a growing body of research has confirmed non-linear associations between sleep duration and other health outcomes, with higher prevalence’s of psychological and physical symptoms.
In men, self-reported sleep disturbance, short or very long sleep duration, and late bedtimes have all been associated with poor semen quality, However, only limited evidence is available on the prevalence of poor sleep quality among men undergoing fertility treatment , with only one study reporting that 46.3% of men experienced sleep disturbances during the early stages of fertility treatment.
Taken together, the available evidence on sleep quality during fertility treatment is limited, and our objective was therefore, to explore self-reported sleep duration and sleep quality in couples undergoing IVF or ICSI fertility treatment. In addition, we wished to explore possible associations with hormonal stimulation protocol type, sleep disorders, psychological distress, and ultimately pregnancy outcome.
The objective of our study was to correlate between sleep quality index and psychological stress manifestation on the clinical pregnancy.
This prospective observational study was conducted in Obstetrics and Gynecology department at Faculty of Medicine, Minia University in Minia Infertility Special Centers after being approved by local hospital ethical committee.
The main results of the study revealed that:
There is no significant difference between types of ovarian stimulation protocols regarding pregnancy rate.
However, there is no significant in sleep quality categories from T1 to T2.
There is a no significant difference between the ovarian stimulation protocols groups regarding PSQI score among T2.
There is no significant difference between the ovarian stimulation protocol groups regarding number of retrieved oocytes, number of mature oocytes, number of fertilized oocytes, and fertilization rate.
There is a no significant difference between the PSQI groups regarding pregnancy rate.
There is no significant difference between the PSQI groups regarding number of retrieved oocytes, number of mature oocytes, number of fertilized oocytes, and fertilization rate.
There is a significant difference between the PSQI groups regarding E2 level on trigger day.
There is no significant difference between pregnant and non-pregnant regarding anxiety, depression, and psychological stress.
However, anxiety incidence was higher among pregnant, while depression was lower among pregnant.
There is no significant difference between rural and urban regarding anxiety, depression, and psychological stress.
There is no significant difference between the anxiety and non-anxiety regarding number of retrieved oocytes, number of mature oocytes, number of fertilized oocytes, and fertilization rate.
There is no significant difference between depressed women and non-depressed women regarding number of retrieved oocytes, number of mature oocytes, number of fertilized oocytes, and fertilization rate.
There is a significant difference between women with psychological stress and women without regarding number of retrieved oocytes and number of fertilized oocytes.