Sleep Quality, Psychological Resilience, and Attachment Dimensions in Women with Unexplained and Male Factor Infertility: A Cross-Sectional Study.

Objective

To compare sleep quality, psychological resilience, and attachment dimensions between women with unexplained infertility and those with male factor infertility undergoing in vitro fertilization (IVF). Materials and

Methods

In this single-center, cross-sectional study, 201 women undergoing IVF (101 with unexplained and 100 with male factor infertility) completed the Pittsburgh Sleep Quality Index (PSQI), the Brief Resilience Scale (BRS), and the Experiences in Close Relationships-Relationship Structures (ECR-RS) questionnaire. Poor sleep quality was defined as a global PSQI score greater than 5. The primary outcome was the global PSQI score. Between-group comparisons were supplemented by multivariable analyses adjusted for age, economic status, chronic disease, infertility duration, and number of previous IVF attempts.

Results

No statistically significant differences were observed in most baseline characteristics, although low economic status was more frequent in the male factor group (34.0% vs. 15.8%; p = 0.008). The median global PSQI score did not differ significantly between the unexplained and male factor groups (6.0 vs. 5.0; p = 0.143). Poor sleep quality was observed in 51.5% and 42.0% of women, respectively (p = 0.178), with an overall prevalence of 46.8% (95% CI, 40.0-53.7%). Psychological resilience (3.33 vs. 3.17; p = 0.474), attachment avoidance (9.0 vs. 9.5; p = 0.336), and attachment anxiety (3.0 vs. 3.0; p = 0.648) did not differ significantly between the groups. After adjustment, unexplained infertility was not significantly associated with global PSQI score (β = 0.76, 95% CI -0.17 to 1.69; p = 0.110) or poor sleep quality (adjusted prevalence ratio = 1.24, 95% CI 0.92-1.67; p = 0.162).

Conclusions

Women with unexplained and male factor infertility undergoing IVF showed similar patterns of sleep quality, psychological resilience, and attachment dimensions, with no statistically significant between-group differences detected. Poor sleep quality affected nearly half of the study population. These findings should not be interpreted as evidence of equivalence between infertility etiologies but highlight the potential relevance of sleep assessment in women undergoing IVF.