I’ve long been fascinated by how symptoms provide insight into underlying hormonal disturbances. A great example is the emerging research on sleep. Your body has a circadian rhythm or a daily cycle of when specific physiologic events are to occur. This process organizes everything from growth, digestion and repair to consolidation of memories and production of chemicals to regulate your mood. It also coordinates the growth and development of sperm and eggs. The hormone that regulates your circadian rhythm is called melatonin.
Melatonin is a hormone produced by an area of the brain called the pineal gland. Blood levels typically between midnight and about 4 am. Maybe more interesting is the fact that exposing your eyes to light can abruptly interrupt the production and release of this hormone that helps you sleep through the second half of the night. That’s also the time of night when various physiologic functions peak including testosterone production and ovulation.
This is just one of the many facts linking your sleep pattern with your fertility.
Most fertility clinics may not inquire about what role your circadian rhythm may be playing your chance of conception, a recent publication in Fertility & Sterility summarized over 200 studies on how melatonin may be influencing your reproductive function. Here are just a few key points:
- Melatonin is a potent anti-oxidant. Studies show that the process of ovulation produces free radicals which can damage an egg. This hormone is concentrated in the fluid that surrounds mature eggs and likely serves to protect them from harm.
- Melatonin influences the production of estradiol, progesterone and testosterone differently during varying stages of the menstrual cycle.
- Melatonin regulates the maturation capacity of an egg. One study demonstrated that women with a history of failed IVF cycles experienced improved fertilization rates after melatonin supplementation.
- Melatonin modulates the immune system. It is estimated that 30% of women with premature ovarian failure have an autoimmune component. Additionally, many women with recurrent early pregnancy loss also have an immunologic disorder. These situations offer potential intervention to improve outcome through normalization of the circadian rhythm.
- Various fertility problems may be influenced by a melatonin deficiency. For instance, women with PCOS tend to have lower than normal levels of melatonin in their follicular fluid and melatonin may influence endometriosis growth.
The best way to optimize melatonin production is to establish and maintain a normal sleep pattern. In some situations melatonin supplements or the use of long acting melatonin-like medications may be of benefit. If you haven’t considered the role that a good night sleep can play in your successful conception check out this sleep assessment tool.
Enhancing Fertility 
Dear Dr Greene
Thankyou for such a helpful website . As a mother of two IVF children as well as now working as a fertility coach i think your site is incredibly useful . Both Informative and compassionate , and so good to be hearing a male perspective .
My husband and i went through six years and odds of 1 in 125,000 of ever conceiving to finally achieve our amazing family .IVF though incredibly tough is also a hugely important resource that is a blessing to many thousands of people .
I will be recomending you to clients and hope to be in touch in the future
all best wishes
Anya Sizer
http://www.thefertilitycoach.co.uk
Thank you for your comments and your support. I will look forward to more of your feedback in the future.
Best thoughts,
~Robert
Hi Dr Greene
This is fascinating. I have premature ovarian failure and am also a pretty awful sleeper. Before I went on HRT I would often wake at 2am and be unable to get back to sleep until about 5.30am.
Thankfully that doesn’t happen as often now although I sometimes wake at 4am before drifting off again an hour later.
I never have problems going to sleep when I first go to bed though and I was a good sleeper before my mid 30s when diagnosed with POF.
Do you think melatonin could help me with my sleeping and fertility??
Thanks for your kind comments regarding the information posted here. I’m so glad that you’ve found it to be useful.
Unfortunately, melatonin treatment is not nearly as effective as theory would predict. It is believed that the natural release pattern simply isn’t replicated with simple replacement strategies. I try to explain this more fully in my book PERFECT HORMONE BALANCE FOR FERTILITY but I can summarize by stating that recreating a physiologic release of your own melatonin can be helpful but there is no evidence that taking a supplement will do so. That’s why I try to explain to patients the various factors that can impact your brain’s ability to make this “rest & digest” hormone and hopefully restore hormone balance.
Best thoughts,
~Robert
Robert Greene, MD, FACOG
Medical Director
SIRM–Northern California
Dr Greene,
Thanks for the great information. I am 37 years old. I’ve been TTC for almost 4 years, had three failed IVF, poor responder, do you think I will benifit from taking Melatonin supplement? I’ve had sleeping problems since my 20’s. I also have night sweat. There are two skylight windows in my bedroom, so the room is not that dark, I started using eye mask a couple of months ago, it helps a lot. So I am pretty sure that I am low in Melatonin.
Thanks!
Jasmine
Dear Jasmine,
Thank you for your kind comments. I’m so pleased that you’ve found this information to be useful. Unfortunately, I have not seen any data suggesting that melatonin can improve ovarian responsiveness. It is possible that correcting any hormone imbalance may improve egg quality but there is no evidence that I could increase the number of eggs. In fact, it is very rare that melatonin deficiency is a primary cause of sleep problems. Instead, there are typically other factors that may be reducing melatonin production or release. Identifying and treating those factors may be even more beneficial than simply trying to boost melatonin levels through taking a supplement. Does that make sense?
Best thoughts,
~Robert
Robert Greene, MD, FACOG
Medical Director
SIRM–Northern California
I have been trying to get pregnant for 8 months, I recently (a month ago) started taking melatonin 1.5mg at bedtime for insomnia. I have read that this can cause infertility? What is your take on melatonin supplements and fertility/infertility?
Dear Carly,
Outdated advice doesn’t die easily. I’ve heard the same thing about melatonin for years without any data supporting the concern that it could contribute to infertility. Ironically, there have been several very well designed research studies over the last few years that demonstrated that exact opposite; melatonin may actually improve fertility by boosting egg quality in women that are deficient. In fact, I’ve written a blog on it which you may wish to check out. If you do, you’ll find links to some of the specific studies that support this hormone balancing strategy. Hope this helps.
Best thoughts,
~Robert
Dr. Greene,
How long are you supposed to take melatonin. I read to start taking 3 mgs the same day you start gonal injections which I did. However, I don’t know how long to stay on it now that my eggs have been retrieved?
Dear Tracy,
That’s a good question that doesn’t have a clear answer. IF you are sleeping well, you may not even be benefitting from the melatonin. We know it can be beneficial in people that are deficient but it cannot be measure during the day so we use sleep length/quality as surrogate markers for estimating whether or not yet may benefit from melatonin. So if you’re sleeping well, you may wish to discontinue. IF however you’re not sleeping well, then it might be best to continue it for it may even help reduce your risk of developing gestational diabetes.
Pleasant dreams,
~Robert
Robert Greene, MD, FACOG
Board Certified, Reproductive Endocrinology & Infertility