Socio-ecological determinants of infertility psychological distress trajectories in women undergoing ART: a...

Infertility psychological distress (IPD) is a prevalent condition influenced by a complex interplay of demographic, clinical, and psychosocial factors. However, the longitudinal progression of IPD remains poorly understood, and existing research has largely failed to capture the potential heterogeneity in its developmental trajectories over time. Furthermore, the multi-level determinants of these trajectories require clearer identification to inform targeted supportive care.

This study aimed to identify the distinct developmental trajectories of IPD among women undergoing assisted reproductive treatments throughout a complete clinical cycle, and to delineate the key multi-level determinants predicting trajectory membership.

Utilizing a prospective longitudinal design, we tracked IPD in a cohort of 377 women undergoing assisted reproduction treatment. Guided by the health ecology model, comprehensive data on potential predictors across individual, interpersonal, occupational, and clinical domains were collected. Latent Class Growth Modeling (LCGM) was performed to characterize the heterogeneous trajectories of IPD, and logistic regression analysis was subsequently employed to identify the significant predictors of trajectory class membership.

Three distinct IPD trajectory classes were identified: a stable-low distress class, a moderate-increasing distress class, and a high-acute distress class. Multinomial logistic regression indicated that high-risk trajectory membership (the moderate-increasing and high-acute classes) was significantly predicted by clinical parameters (less embryos in the current cycle), psychological/behavioral factors (insomnia severity index), interpersonal challenges (unfriendly social attitudes toward infertile populations), and environmental barriers (presences of work-treatment conflict).

These findings underscore the clinical necessity of integrating routine, longitudinal screening for psychological distress into standard ART care protocols to facilitate the early identification of high-risk individuals. Furthermore, to effectively mitigate distress, supportive intervention strategies should expand beyond individual- and family-centric approaches to incorporate public advocacy and institutional policy reforms, thereby cultivating a supportive, health-promoting ecosystem.