Table 1.

The association between stress, sleep dysregulation, and circadian dysrhythmia and reproductive hormones.

HORMONES
	TSH	LH	FSH	PRL	Androgens	Estradiol	AMH	Progesterone
Role in Fertility	↑levels:: anovulation, miscarriages	↑LH:: Infertility	↑FSH:: poor ovarian reserve; reproductive aging; ↓luteal phase dysfunction	↑ PRL indicates anovulation, PCOS, endometriosis	↑androgens: PCOS	Irregular estradiol secretion::ano vulation	AMH::DOR	Progesterone:: Implantation; ↓levels linked to infertility
Sleep/Wake Changes	TSH ↑ around sleep onset; ↑ throughout night; ↓during daytime	Sleep:: ↓ LH pulses; Awakenings:: ↑ LH pulses in early follicular phase	Short sleep:: ↓ FSH	Sleep onset:: PRL ↑ Awakenings:: PRL ↓	Sleep onset:: ↑testosterone following sleep onset; Sleep duration in men:: ↑testosterone	?	?	Second half of night: ↑ progesterone
PATHWAYS
1. Stress	?	Stress:: ↓ LH	Stress:: ↓FSH	?	?	?	?	Stress:: ↓ progesterone
2. Sleep Dysregulation	Acute SD:: ↑ TSH; Chronic SD: ↓ TSH lnsomnia::↓ TSH	PSD and TSD:: ↑ LH amplitude	PSD :: no change in FSH	Narcolepsy:: ↓PRL; Night eating syndrome:: ↑ PRL	PCOS:: testosterone ; ↑ OSA risk; TSD in men and women with depression:: ↓ testosterone	PSD:: ↑ estradiol Variable sleep schedules:: ↓ estradiol	↑ sleep disturbance :: DOR	SDB, PCOS :: ↓ Progesterone
3. Circadian Rhythmicity	+	−/+ ultradian pulsatility	−	+	+ in men	−	+ subtle	?
Dysrhythmia	− ?	Shift work:: ↑ LH during daytime and nighttime sleep	Shift workers:: ↑ FSH during daytime sleep and nighttime sleep	Shift work::↑ PRL in shift workers	?	Shift workers: ↑ estradiol in those who did not nap; E1C unchanged	?	?

+ There is evidence to support that this hormone has a circadian rhythm

− There is evidence to support that this hormone does not have a circadian rhythm

:: associated with/is related to

SD Sleep Deprivation

PSD Partial Sleep Deprivation

TSD Total Sleep Deprivation

SDB Sleep Disordered Breathing

OSA Obstructive Sleep Apnea

DOR Diminished Ovarian Reserve