Mental health outcomes in infertility and fertility treatment: a systematic review of prevalence, correlates, and psychosocial interventions

ABSTRACT

Background. Infertility and fertility treatments are associated with substantial mental health burdens, yet systematic evidence on prevalence, correlates, and interventions across global contexts remains fragmented.

Objectives. To systematically review mental health outcomes, including prevalence of depression, anxiety, stress, and quality of life impairments, alongside correlates and effects of psychosocial interventions in individuals undergoing infertility evaluation and fertility treatments.

Methods. Systematic extraction from 38 diverse studies (cross-sectional n = 17, prospective cohorts n = 6, RCTs n = 4, others), spanning low/middle-income (e.g., Iran n = 6, India n = 3) and high-income countries, assessing standardized outcomes via DASS, FertiQoL, GHQ-28, MINI, and others in clinic-based samples (N = total > 30,000).

Results. Clinically significant depression (40-60%) and anxiety (40-75%) prevailed, with infertility-specific stress in 80-92%; women exceeded men (39% vs 15% MDD). Emotional/relational QoL domains scored lowest. Correlates included female gender, childlessness, low SES, stigma, and poor sleep (OR = 9-16). RCTs showed hope therapy reduced depression (AMD = -3.1, p < 0.001) and ACT improved FertiQoL (AMD = 14.8, p < 0.001). Pre-treatment depression lowered treatment initiation (OR = 0.55) and live birth odds (AOR = 0.83); emotional QoL predicted pregnancy (+2.4%/unit).

Conclusions. High mental health morbidity underscores need for routine screening and scalable interventions like ACT/hope therapy to enhance both psychological well-being and reproductive success, particularly in high-burden LMIC settings.

Key words

Infertility; mental health; depression; anxiety; fertility treatment; psychosocial interventions; quality of life.