Measurement and evaluation of quality of life and well-being in individuals having or having had fertility problems: a systematic review

Figures & data

Figure 1. Flow diagram.

Table 1. Summary of identified studies’ designs and outcomes.

Study and country	Aims	Sample	Assessment	Results	Association between infertility and QoL/well-being^a
Aduloju et al. [7] Nigeria	To examine QoL in women of reproductive age by comparing QoL scores between infertile and fertile women attending gynaecology or postnatal clinics	361 infertile women and 722 fertile women	Generic QoL: WHOQOL-BREF	QoL was significantly lower among infertile women compared with fertile women	Negative
Ahmadi et al. [8] Iran	To assess QoL of women who conceived by ART and had successful childbirth for the first time and compare it with QoL in women who become pregnant naturally and similarly had successful childbirth for the first time	86 women with successful ART and 76 women with natural conception	Generic QoL: SF-36	During pregnancy, women who naturally conceived scored better on physical functioning, role limitation due to physical problems, bodily pain and social functioning, while the ART group scored better on general health, vitality, role limitation due to emotional problems, and mental health; after childbirth, the ART group scored higher than the naturally conceived group on all but one dimension	Unclear
Amiri et al. [9] Iran	To compare QoL among fertile and infertile women and the factors affecting it	511 infertile women and 1017 fertile women	Generic QoL: SF-36	Fertile women’s QoL score was not significantly different from that of infertile women	No association
Ashraf et al. [10] Iran	To compare QoL in fertile and infertile women	111 infertile women and 339 fertile women	Generic QoL: SF-36	Infertile women scored significantly lower than fertile women in 7/8 domains of the SF-36	Negative
Callan [11] Australia	To examine the psychological well-being and marital happiness of three groups of women: mothers of younger children, voluntarily childless wives, and a group of long-term infertile women currently attempting to have a child on an IVF programme	53 infertile women, 32 voluntarily childless women and 50 mothers	Generic well-being: self-constructed rating scale	Infertile women were less satisfied with their lives compared with voluntarily childless women; no difference was found between mothers and either of the two other groups	Negative
De Pascalis et al. [12] Italy	To compare levels of and changes in QoL during pregnancy between couples who conceived spontaneously and couples who underwent successful ART treatment	57 couples with successful ART and 58 couples who spontaneously conceived	Generic QoL: SF-36	ART couples reported a lower QoL compared with non-ART couples in the physical summary score; little difference was found in the mental summary score	Mixed results
Direkvand-Moghadam et al. [13] Iran	To compare QoL in fertile and infertile women	339 fertile women and 111 infertile women	Generic QoL: SF-36	The major dimension QoL of infertile women was lower than that of fertile women	Negative
Drosdzol and Skrzypulec [14] Poland	To evaluate the influence of infertility on QoL and sexual functioning of infertile couples	206 infertile couples and 190 fertile couples	Generic QoL: SF-36	Infertile women had significantly lower QoL compared with controls in 5/9 domains of the SF-36; infertile males were not found to have significantly different QoL from that of the fertile control group	Negative for women, no association in men
El Kissi et al. [15] Tunisia	To compare QoL gender differences in infertile couples and between infertile couples and controls	100 infertile couples and 100 control couples	Generic QoL: SF-36	Infertile men scored lower in the mental dimension of the SF-36 compared with men in the control group, and they had lower social functioning and role-emotion; infertile women compared with controls scored lower on both summary scores of the mental and physical dimensions, vitality, social functioning, role-emotion, and mental health	Negative
Graham [16] Australia	To examine the association between motherhood status and general physical and mental health and well-being over a 10 year period	4139 mothers and 1939 childless women	Generic QoL: SF-36	Childless women experienced significantly better scores on the mental and physical component summary measures compared with mothers	Positive
Hassanin et al. [17] Egypt	To assess the effect of infertility on health-related QoL and sexual function of infertile women	116 women with primary infertility and 116 fertile controls	Disease-specific QoL: QLQ-C30	Infertile women had significantly lower QoL compared with fertile women; women with infertility duration of 4–6 years had even lower mean QoL	Negative
Jeffries and Konnert [18] Canada	To compare voluntarily childless women, involuntarily childless women and mothers on measures of regret and present-ideal self-evaluations	23 voluntarily childless women, 24 involuntarily childless women and 25 mothers	Generic well-being: SPWB-SF	No significant differences were found in overall psychological well-being between involuntarily childless women, voluntarily childless women and mothers	No association
Johansson et al. [19] Sweden	To describe QoL in men and women who had terminated IVF in the public health system 4.0–5.5 years previously, and for whom treatment did not result in childbirth	149 women with unsuccessful IVF, 121 men with unsuccessful IVF, 126 female controls and 99 male controls	Generic well-being: PGWB	Compared with the control group, men with unsuccessful IVF scored lower in the PGWB domains of depression and positive well-being; men with successful IVF had better vitality; women with unsuccessful IVF scored lower on depression; and women with successful IVF showed no differences in total or domain scores	Unclear
Johansson et al. [20] Sweden	To describe and compare QoL in men and women who had IVF in the Swedish public health system 4.0–5.5 years previously, either unsuccessfully and subsequently living without children or successfully and having children aged 4.0–5.5 years	26 men with unsuccessful IVF, 135 men with successful IVF, 37 women with unsuccessful IVF, 154 women with successful IVF, 93 male controls and 118 female controls	Generic well-being: PGWB	Total PGWB scores and domain scores except anxiety were lower among men with unsuccessful IVF compared with men with successful IVF; men with unsuccessful IVF showed lower scores on depression and positive well-being than men in the control group; no difference in total PGWB scores was found when comparing either successful IVF men or women with the control group	Unclear
Klemetti et al. [21] Finland	To examine mental disorders, depression, psychological distress, perceived health and QoL among women and men who had experienced infertility	239 infertile women, 99 infertile men and 1953 fertile men and women	Generic QoL: self-constructed rating scale	QoL was only significantly lower among infertile childless men compared with men without infertility	Negative for men; no association in women
Kowalcek et al. [22] Germany	To investigate the following about subjective well-being: do involuntarily childless women and men differ in the extent of their subjective well-being from healthy individuals and other women? Do women and men in infertile couples differ in their subjective impairment according to the cause of infertility?	110 infertile couples	Generic well-being: Von Zerssen symptom checklist	No difference between infertile couples and healthy comparators	No association
Masoumi et al. [23] Iran	To compare the QoL and marital and sexual satisfaction between fertile and infertile couples	125 infertile couples and 125 fertile couples	Generic QoL: WHOQOL-BREF	Fertile couples had significantly higher QoL compared with infertile couples	Negative
Monga et al. [24] USA	To evaluate the hypothesis that infertility may result in a decrease in QoL and an increase in marital discord and sexual dysfunction	18 infertile couples and 12 control couples	Generic well-being: QWB	Women in couples seeking infertility treatment showed lower health-related QoL compared with women in couples seeking elective sterilisation; there was no difference in men from the same couples	Negative for women; no association in men
Onat and Beji [25] Turkey	To investigate the effects of infertility on marital relations and QoL	58 infertile couples and 51 fertile couples	Generic QoL: WHOQOL-BREF	Infertile couples had significantly higher scores in all subdomains of the WHOQOL-BREF compared with fertile controls	Positive
Pinar and Zeyneloglu [26] Turkey	To evaluate QoL and anxiety/depression levels of women prior to receiving ART	80 infertile men, 80 infertile women, 160 controls	Generic QoL: WHOQOL-BREF	The infertile group scored significantly lower in all subdomains of QoL compared with fertile controls	Negative
Sani et al. [27] Iran	To evaluate and compare QoL, self-efficacy and resiliency in infertile and fertile women	60 infertile women and 60 fertile women	Generic QoL: WHOQOL-BREF	QoL in infertile women was lower than that in fertile women	Negative
Schanz et al. [28] Germany	To measure QoL of infertile men at baseline and after 5 years with a specific QoL instrument for involuntarily childless men	101 involuntarily childless men	Fertility-specific QoL: TLMK	Scores over 5 years in the domains of desire for a child and gender identity improved; no differences were found in QoL between those who had become fathers and those who remained childless	No association
Sezgin et al. [29] Turkey	To compare the level of psychiatric symptoms, disability and QoL in fertile and infertile urban women	100 infertile women and 100 fertile women	Generic QoL: SF-36	Urban married women seeking treatment for infertility had poorer QoL compared with fertile married controls	Negative
Valsangkar et al. [30] India	To measure and compare the impact of infertility on marital adjustment, sexual functioning, QoL and acceptability of various infertility treatment modalities	106 infertile women and 212 fertile women	Fertility-specific QoL: FertiQoL	Infertile women had decreased QoL compared with reference data	Negative
Wischmann et al. [31] Germany	To find out in a large sample whether, in comparison with parents, involuntarily childless couples had a different subjective perception of overall and specific QoL over a period of >10 years	148 couples with previous infertility treatment	Fertility-specific QoL: self-constructed rating scale	Childless couples and parents had increased QoL, but it was not significantly different between groups	Unclear
Xiaoli et al. [32] China	To assess QoL of infertile Chinese women and determine the specific factors adversely affecting QoL for improving care and treatment compliance of infertile women	81 infertile women and 81 fertile women	Generic QoL: WHOQOL-100	Married infertile Chinese women had significantly lower overall and comprehensive QoL scores compared with fertile controls	Negative

^a Positive: infertility is associated with higher QoL/well-being; negative: infertility is associated with lower QoL/well-being.

QoL, quality of life.

Table 2. Applied quality-of-life and well-being instruments.

Instrument	Description	Availability of preference-based utility weights	Study
Generic QoL instruments
SF-36	The SF-36 is a generic instrument used to measure health status in 8 dimensions: physical function, role limitations due to physical problems, bodily pain, general health, vitality, social functioning, role limitations due to emotional problems and mental health; these domains can be used to compose the Physical Component Summary and the Mental Component Summary [33]	Yes (convert to SF-6D)	Ahmadi et al. [8]
			Amiri et al. [9]
			Ashraf et al. [10]
			De Pascalis et al. [12]
			Direkvand-Moghadam et al. [13]
			Drosdzol and Skrzypulec [14]
			El Kissi et al. [15]
			Graham [16]
			Sezgin et al. [29]
WHOQOL-100	The WHOQOL-100 is a QoL instrument developed by the WHO; it contains 100 items scored on a 5 point Likert scale [32]	No	Xiaoli et al. [32]
WHOQOL-BREF	The WHOQOL-BREF is a QoL instrument developed by the WHO; it is an abbreviated version of the WHOQOL-100 and contains 27 items divided over four subdomains: physical, emotional, environmental and social [26]	No	Aduloju et al. [7]
			Masoumi et al. [23]
			Onat and Beji [25]
			Pinar and Zeyneloglu [26]
			Sani et al. [27]
Generic well-being instruments
QWB	The QWB is a preference-based instrument designed to classify health status from which health-state values can be calculated; outcomes are presented on a scale between 0 and 1, where higher values indicate better health-related QoL [24]	Yes	Monga et al. [24]
PGWB	The PGWB is a generic instrument used to measure psychological general well-being, indicating subjective well-being and distress in six domains: anxiety, depressed mood, positive well-being, self-control, general health, and vitality; a higher score indicates better well-being [19]	No	Johansson et al. [19]
			Johansson et al. [20]
SPWB-SF	The SPWB-SF is used to assess overall psychological well-being and has subscales on well-being of autonomy, environmental mastery, personal growth, positive relations with others, purpose in life and self-acceptance [18]	No	Jeffries and Konnert [18]
Von Zerssen symptom checklist	The Von Zerssen symptom checklist is applied to determine subjective well-being, consisting of 24 items including somatic, general and psychological symptoms; the total score indicates the extent of subjective impairment [22]	No	Kowalcek et al. [22]
Disease-specific QoL and well-being instruments
FertiQoL	FertiQoL is a fertility-specific self-report questionnaire designed to assess QoL of infertile individuals [34]	No	Valsangkar et al. [30]
TLMK	The TLMK is a fertility-specific instrument originally used to assess QoL in men with a desire for a child; it consists of items covering four areas: desire for a child and associated stress, gender identity, marital relationship and psychological well-being [35]	No	Schanz et al. [28]
QLQ-C30	The QLQ-C30 is designed to collect information on function, global health, QoL and symptoms in cancer patients; a higher global score indicates better QoL [17]	Yes	Hassanin et al. [17]

QoL: quality of life.

Aduloju OP, Olaogun OD, Aduloju T. Quality of life in women of reproductive age: a comparative study of infertile and fertile women in a Nigerian tertiary centre. J Obstet Gynaecol. 2018;38:247–251.

 PubMedGoogle Scholar

Ahmadi SE, Montazeri A, Mozafari R, et al. Health-related quality of life and primi-gravid: a comparative study of natural conception and conception by assisted reproduction technologies (ARTs). Int J Fertil Steril. 2014;8:167–174.

 PubMedGoogle Scholar

Amiri M, Chaman R, Sadeghi Z, et al. Quality of life among fertile and infertile women. Iran J Psychiatry Behav Sci. 2017;11:e5641.

 Web of Science ®Google Scholar

Ashraf DM, Ali D, Azadeh DM. Effect of infertility on the quality of life, a cross- sectional study. J Clin Diagn Res. 2014;8:OC13–OC15.

 PubMedGoogle Scholar

Callan VJ. The personal and marital adjustment of mothers and of voluntarily and involuntarily childless wives. J Marriage Fam. 1987;49:847–856.

 Web of Science ®Google Scholar

De Pascalis L, Agostini F, Monti F, et al. A comparison of quality of life following spontaneous conception and assisted reproduction. Int J Gynaecol Obstet. 2012;118:216–219.

 PubMed Web of Science ®Google Scholar

Direkvand-Moghadam A, Delpisheh A, Montazeri A, et al. Quality of life among Iranian infertile women in postmenopausal period: a cross-sectional study. J Menopausal Med. 2016;22:108–113.

 PubMedGoogle Scholar

Drosdzol A, Skrzypulec V. Quality of life and sexual functioning of Polish infertile couples. Eur J Contracept Reprod Health Care. 2008;13:271–281.

 PubMed Web of Science ®Google Scholar

El Kissi Y, Amamou B, Hidar S, et al. Quality of life of infertile Tunisian couples and differences according to gender. Int J Gynaecol Obstet. 2014;125:134–137.

 PubMed Web of Science ®Google Scholar

Graham M. Is being childless detrimental to a woman’s health and well-being across her life course? Women’s. Womens Health Issues. 2015;25:176–184.

 PubMed Web of Science ®Google Scholar

Hassanin IMA, Abd-El-Raheem T, Shahin AY. Primary infertility and health-related quality of life in Upper Egypt. Int J Gynaecol Obstet. 2010;110:118–121.

 PubMed Web of Science ®Google Scholar

Jeffries S, Konnert C. Regret and psychological well-being among voluntarily and involuntarily childless women and mothers. Int J Aging Hum Dev. 2002;54:89–106.

 PubMed Web of Science ®Google Scholar

Johansson M, Adolfsson A, Berg M, et al. Quality of life for couples 4-5.5 years after unsuccessful IVF treatment. Acta Obstet Gynecol Scand. 2009;88:291–300.

 PubMed Web of Science ®Google Scholar

Johansson M, Adolfsson A, Berg M, et al. Gender perspective on quality of life, comparisons between groups 4-5.5 years after unsuccessful or successful IVF treatment. Acta Obstet Gynecol Scand. 2010;89:683–691.

 PubMed Web of Science ®Google Scholar

Klemetti R, Raitanen J, Sihvo S, et al. Infertility, mental disorders and well-being-a nationwide survey. Acta Obstet Gynecol Scand. 2010;89:677–682.

 PubMed Web of Science ®Google Scholar

Kowalcek I, Wihstutz N, Buhrow G, et al. Subjective well-being in infertile couples. J Psychosom Obstet Gynaecol. 2001;22:143–148.

 PubMed Web of Science ®Google Scholar

Masoumi SZ, Garousian M, Khani S, et al. Comparison of quality of life, sexual satisfaction and marital satisfaction between fertile and infertile couples. Int J Fertil Steril. 2016;10:290–296.

 PubMed Web of Science ®Google Scholar

Monga M, Alexandrescu B, Katz SE, et al. Impact of infertility on quality of life, marital adjustment, and sexual function. Urology. 2004;63:126–130.

 PubMed Web of Science ®Google Scholar

Onat G, Kizilkaya Beji N. Effects of infertility on gender differences in marital relationship and quality of life: a case-control study of Turkish couples. Eur J Obstet Gynecol Reprod Biol. 2012;165:243–248.

 PubMed Web of Science ®Google Scholar

Pinar G, Zeyneloglu HB. Quality of life, anxiety and depression in Turkish women prior to receiving assisted reproductive techniques. Int J Fertil Steril. 2012;6:1–12.

 PubMed Web of Science ®Google Scholar

Sani MS, Tamannaeifar M. The comparison of quality of life, self-efficacy and resiliency in infertile and fertile women. Middle East J Fam Med. 2017;15:111–118.

 Google Scholar

Schanz S, Hafner HM, Ulmer A, et al. Quality of life in men with involuntary childlessness: long-term follow-up. Andrologia. 2014;46:731–737.

 PubMed Web of Science ®Google Scholar

Sezgin H, Hocaoglu C, Guvendag-Guven ES. Disability, psychiatric symptoms, and quality of life in infertile women: a cross-sectional study in Turkey. Shanghai Arch Psychiatry. 2016;28:86–94.

 PubMedGoogle Scholar

Valsangkar S, Bodhare T, Bele S, et al. An evaluation of the effect of infertility on marital, sexual satisfaction indices and health-related quality of life in women. J Hum Reprod Sci. 2011;4:80–85.

 PubMedGoogle Scholar

Wischmann T, Korge K, Scherg H, et al. A 10-year follow-up study of psychosocial factors affecting couples after infertility treatment. Hum Reprod. 2012;27:3226–3232.

 PubMed Web of Science ®Google Scholar

Xiaoli S, Mei L, Junjun B, et al. Assessing the quality of life of infertile Chinese women: a cross-sectional study. Taiwan J Obstet Gynecol. 2016;55:244–250.

 PubMed Web of Science ®Google Scholar

Ware JE, Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30:473–483.

 Google Scholar

Hsu PY, Lin MW, Hwang JL, et al. The fertility quality of life (FertiQoL) questionnaire in Taiwanese infertile couples. Taiwan. J Obstet Gynecol. 2013;52:204–209.

 Google Scholar

Ried K, Alfred A. Quality of life, coping strategies and support needs of women seeking Traditional Chinese Medicine for infertility and viable pregnancy in Australia: a mixed methods approach. BMC Women’s Health. 2013;13:17.

 PubMed Web of Science ®Google Scholar