There is a growing trend among women to postpone motherhood for several reasons, although fertility decreases with age.1, 2 Women over 35 years old, considered as advanced maternal age, can benefit from assisted reproductive treatment (ART), which is making an increasing contribution to birthrates worldwide.2 According to recent data (REDLARA), 72.2% of women who underwent ART in 2017 were over 35 years.2 Despite successful rates of ART, pregnancies in women of advanced age have higher risks of failure, maternal and foetal complications,1, 2 requiring even more caution in their care. This includes paying attention to the sleep quality, as sleep is important to the regulation of the organism. Women undergoing ART may have poor sleep quality3 that may impair fertilization and hormonal management. Simultaneously, they may have greater concerns about their self-image due to ageing and deprived sleep,4, 5 which could increase their demand for skin procedures. The risks of these procedures to ART are still not clear, requiring further investigation. We raise possible effects of dermatological treatments during ART and the role of sleep in this interaction. Sleep could be a link between skin ageing, the necessity of skin treatment, and ART, as sleep acts in both hormonal and oxidative stress (OS) regulation (References S1 and S2). Poor sleep quality, especially due to increased OS, can accelerate skin ageing (References S1 and S2). Parallelly, it could influence fertilization and ART outcomes. Sleep disturbance can result from the continuous psychological stress and anxiety of many women undergoing ART.3 Satisfactory sleep quality may be an important factor to ART success,3 given that reproductive endocrinological regulation could be affected by sleep distress.3 Chronic sleep dysregulation and harmful environmental exposure can increase OS,1 (Reference S1) which may also be greater across ageing and impair skin (References S1 and S2). Oxidative stress may impact skin appearance and fertility, with sleep being the main axis of this triad. Free radicals and OS may accelerate skin ageing due to cutaneous cell injury and affect fertility processes impacting ART,1 (Reference S1). Oxidative stress has been reported to produce abnormalities in the ovaries, impair embryo implantation and pregnancy success due to endothelial dysfunction.1 Oxidative stress (enhanced by poor sleep) can affect skin integrity (Reference S1 and S2), while satisfactory sleep is associated with healthy skin and hormonal balance (Reference S1). Adrenergic systems are boosted by prolonged stress, enhanced by poor sleep; this may accelerate skin ageing through immune and endocrinological impairment, higher OS and DNA injury (References S1 and S2), and may affect fertility.1 This three-way relationship may be significant in advanced age women. As an increasing number of women seeking ART are of advanced maternal age,2 part of these women could be using treatments to delay skin ageing and improve self-image (References S3 and S4), including periodic skin cosmetics and dermatological procedures (injectables and laser; References S3 and S4). Some products, such as chemical sunscreens, contain xenoestrogens, reported as possible factors that can influence fertility due to endocrine disruption (Reference S5). They may influence the hormonal regulation required for fertility success, especially in those suffering from poor sleep. Evidence has shown that good sleep quality is associated with a better perception of self-image,4, 5 (Reference S1). Better sleep, provided by sleep therapy, may help to delay skin damage through improved OS regulation, and minimize deleterious effects of OS on ART. Sleep therapy should be considered as important adjuvant care to women undergoing ART,3 as poor sleep can increase OS and hormonal imbalance (Reference S1). Retrospective studies examining ART outcomes in patients, skin treatment routines and sleep may provide initial base to this research line. Physicians should be encouraged to take a thorough clinical interview covering reproductive and dermatological areas, and sleep patterns. The possible risks and benefits of skin procedures must be considered. These measures could help to provide better assistance to these women by improving their life and sleep quality, and promoting successful ART outcomes. Our studies are supported by the Associação Fundo de Incentivo à Pesquisa (AFIP). MLA receives a CNPq fellowship. EMSX receives a CAPES Post-Graduate grant. No sponsorship was received for the publication of this manuscript. All authors declare no conflicts of interest. *AS and EMSX have contributed equally as first authors to the drafting, planning and writing of the manuscript. MS and MLA have contributed to conception and planning, major review and intellectual content of the work. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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Aug 7, 2021
Lisa T Goberdhan + 5
Open Access