Is stress different in infertile women and men? A systematic review and meta-analysis

Stress is gender-specific and differs between in infertile women and men Therefore, according to the importance of this issue, this systematic review and meta-analysis was conducted to investigate the difference in stress in infertile women and men.

This a systematic review and meta-analysis in accordance with PRISMA guidelines was conducted without time limit until August 20, 2024 through searching in the international database (PubMed, Web of sciences, Scopus), and the Google Scholar search engine using the keywords of infertility and stress. The words were combined using AND and OR, and the specific search strategy for each database was used. All articles retrieved from the databases were imported into EndNote 7 software. Duplicate records were removed, and studies were then screened according to the predefined inclusion and exclusion criteria. The quality of the articles was assessed by two reviewers independently using the Joanna Briggs Institute (JBI). The analysis was performed using STATA 18.0. Cohen's d index was used to examine the effect size.

The systematic part of the study included 53 studies with a total sample size of 21,355 infertile people, 12,913 men and 8,442 women. Nine questionnaires including the Fertility Problem Inventory (FPI), the Perceived Stress Scale (PPS), the Perceived Stress Questionnaire (PSQ), Booklet contains several questions related to reproductive health, stress, social relations, coping, and well-being (The COMPI questionnaire), Depression Anxiety and Stress Scale (DASS), the Psychological State of Stress, Specific stress symptom scale, Treatment related Stress Scale (TTS), and the Infertility-Related Stress Scale (IRSS) were used in this study. Given the fact that at least 3 studies are needed to perform a meta-analysis, it was only possible to compare the stress of infertile men and women on the FPI questionnaire and its dimensions. The difference in the total stress score of infertile men and women was 0.33 (95%CI: 0.23-0.44, P˂0.001), and in the dimensions of the FPI questionnaire, it was 0.35 (95%CI: 0.12-0.59, P < 0.001) for social concern, 0.35 (95%CI: 0.08-0.61, P = 0.005) for sexual concern, and 0.31 (95%CI: 0.19-0.43, P < 0.001) for need for parenthood. The difference between women and men was significant, and women's stress score was higher than men's.

The stress in infertile women and men is an important issue that requires attention and planning and affects both sexes. It is suggested that couples' stress be assessed in infertility evaluations using standard tools, and that appropriate planning for screening and counseling in this area be designed, implemented, and evaluated in accordance with the culture of each country.