Background <p>Sleep quality has been shown to be strongly associated with a variety of health outcomes, but its role in assisted reproductive technology (ART) treatment outcomes has not been clarified. The study aims to systematically evaluate the relationship between sleep quality and the outcomes of assisted reproductive technology.</p> Methods <p>This study systematically searched databases such as PubMed, Embase, Web of Science, and the Cochrane Library from its inception to 1 April 2025 to screen observational studies assessing the relationship between sleep quality and ART outcomes. The quality of the included studies was evaluated using the Newcastle–Ottawa Scale (NOS), and meta-analysis was performed using Stata 15.0 software.</p> Results <p>A total of 8 studies (<i>N</i> = 6754) were included to assess the relationship between good sleep quality and clinical pregnancy, and the combined analysis showed that good sleep significantly increased the clinical pregnancy rate [OR = 1.53, 95% CI (1.16, 2.03)]; sensitivity analysis suggested that Liu (2023) was the main source of heterogeneity, and heterogeneity declined to 33.2% after exclusion, which resulted in a stable outcome [OR = 1.59, 95% CI (1.28, 1.96)]. 3 studies evaluated the relationship between good sleep and embryo implantation rate, and the results showed that good sleep significantly increased the implantation rate [OR = 1.41, 95% CI (1.04, 1.92)]. 2 studies investigated the relationship between good sleep and live birth rate, and the results did not show any statistical difference [OR = 0.84, 95% CI (0.44, 1.61)].</p> Conclusions <p>Good sleep quality is associated with higher clinical pregnancy and implantation rates in couples undergoing ART. Its effect on live birth remains inconclusive and warrants further investigation.</p>