When a clinical pregnancy cannot be established after 12 months of regular, unprotected sexual activity or when a person’s ability to reproduce, either alone or with a partner, is impaired, the condition is referred to as infertility (1). One in six persons worldwide suffer from infertility, which affects 17.8 and 16.5% of people in high- and low- or middle-income nations, respectively (2). It is now a significant global public health issue.

Negative emotional experiences, including as anxiety, depression, and stress, are extremely common among infertile people (3). This is linked to a number of complex elements, including traditional social conceptions and the economic cost of treatment (4). Negative emotions can also exacerbate infertility and negatively impact treatment success (5). Previous research has found that infertility is frequently connected with poor quality of life (QoL) (6). The physiology, psychology, social interactions, and the medical environment all contribute to the quality of life (QoL) of infertile people. There were numerous techniques used to assess QoL, and the Fertility quality of life (FertilQoL) was designed and widely used in infertile populations with poor QoL (7, 8).

Individuals’ resilience is described as their mental ability to withstand and adapt to life-threatening experiences (9). When stressors are removed, a person with resilience adapts to changes flexibly and returns to recovery easily. In contrast, people with weaker resilience are less able to adjust to new circumstances. Couples who have a higher QoL despite infertility are more mentally tolerant of excessive stress (10). We can hypothesize that resilience acts as a protective factor in increasing QoL. Previous research has focused on the relationship between QoL and resilience. However, the findings are inconclusive, and there are disparities in how much emphasis the studies place on men and women. Several studies have reported that levels of QoL are higher in more resilient populations (6, 11), while others have found no significant correlation between QoL and resilience (12). This contradiction in the available literature may be attributable, at least in part, to variations in the scales and subjects utilized in these studies.

Consequently, it is imperative to conduct a comprehensive review of the existing literature on QoL and resilience in infertile patients. This systematic review was carried out to describe QoL and resilience in infertile patients, as well as the relationship between them, and to give a theoretical foundation for clinical practice. The literature incorporated in this article encompasses diverse research designs and data analytical techniques, which are advantageous in elucidating the intricate interplay among biological, cognitive, and social determinants. This understanding could potentially facilitate the development of interventions aimed at assisting infertile patients in leading well-being lives.

Infertility has evolved into a public health issue that requires immediate action. It is inextricably linked to the mental health and quality of life of patients. Previous findings are inconclusive, which may be attributable, at least in part, to variations in the scales and subjects utilized in these studies. Consequently, it is imperative to conduct a comprehensive review of the existing literature on QoL and resilience in infertile patients. This review summarized 21 studies including 7,892 patients, with 2,678 males and 5,214 females. Infertile women always receive more attention than infertile men. Our findings revealed that resilience is not only connected to QoL but also has a significant mediating effect on the association between various psychological markers (such as post-traumatic growth, psychological stress, and so on) and QoL.

The outcomes of this review on levels of QoL and resilience in infertile patients were varied (see Tables 1, 2). QoL was measured using three different tools: FertiQoL, WHOQOL-BREF, and QoLICQ (1998), (7, 16). To test resilience, four different assessment instruments were used: CD-RISC, CD-RISC-10, RS-14, and RS (9, 11, 17, 18). Only 3 studies reported better QoL using the FertiQoL (22, 25, 26), and one study reported better resilience using RS (29). Based on the similarities and differences in domains of each scale, we hypothesize that differences in measurement tools between studies aren’t related to the heterogeneity of findings.

Considerable differences in population among studies may explain the heterogeneity of findings. This finding can be explained by the fact that highly educated patients and patients who live in cities are less likely to be influenced by traditional beliefs due to greater social resources (26). This could also be related to the fact that patients who are further along in the treatment cycle have less doubt and more hope than those who are still in the early stages (22, 25). Cross-cultural differences could potentially explain contradictory conclusions. Asiatic infertile patients showed lower levels of resilience whereas European patients in Germany demonstrated higher levels of resilience (29). These contradictory findings may be explained by the traditional concept of carrying on the family line in Asian. However, the effects of these elements necessitate additional investigation and evidence summarization.

In comparison to infertile women, men have greater QoL and resilience scores (6, 8, 10, 11, 20, 28, 30, 31). This is related to female patients’ higher social and treatment pressures, implying that we should pay more attention to their mental health. Previous research has suggested a correlation between elevated externally oriented thinking in males relative to their partners and their QoL levels. Furthermore, the QoL of both partners appears to be intricately interconnected (35). This finding underscores the significance of implementing interventions aimed at couples as a collective unit. Our review discovered that patients’ treatment tolerability domain and optimistic domain scored low (6, 24–26), indicating that infertility-related treatment has a more profound impact on patients’ lives, and patients’ attitude toward disease treatment is also more pessimistic. As a result, it is critical to pay attention to patients’ psychological status throughout infertility treatment and aim to improve the quality of services provided during treatment, such as the provision of readily available health education, particularly for women.

This review included papers that used correlation analysis, multiple linear regression analysis, and latent class analysis to investigate the relationship between QoL and resilience in infertile couples (4, 6, 10–12, 19–33). This suggests that we should tailor intervention strategies to individual differences in mental resilience in order to improve patients’ quality of life. In two research, the actor-partner interdependence model was applied. One of them discovered that the resilience of an infertile actor affects both his/her own and his/her partner’s QoL (8). However, another study discovered that only the resilience of wives can predict the QoL of both couples (30). Although the results differ, they do present us with a unique perspective on QoL therapies, namely interventions for spouses/interventions for both couples.

Several studies, in contrast to the typical correlation analysis, use the mediation model, which revealed that resilience partially mediated psychological stress (12), fertility-related stress (22), post-traumatic growth (22), and QoL, in that order. One of the studies found that while resilience does not directly affect QoL in patients with polycystic ovary syndrome (PCOS), it does affect QoL indirectly through social support (12). This demonstrates that resilience can mitigate the detrimental impact of stress on QoL while enhancing the good impact of positive stress cognition on QoL. This partially explains the internal mechanism of the positive connection between resilience and QoL and stresses the importance of resilience intervention.

A strength of this review is the adherence to a strict systematic review process and well specified inclusion and exclusion criteria. To find all relevant publications, a comprehensive search approach was used. Another point in favor is the strong inter-rater reliability among reviewers during the screening phase, which reflects transparent selection approach. The current review additionally considered a variety of study approaches and thoroughly synthesizes the literature on QoL and resilience. Finally, this review examined both male and female infertility patients and analyzed the differences between the two, providing future clinical practice with a unique viewpoint to improve the physical and mental health of infertile patients. While this review explored QoL and resilience, it did not look at contributing factors that may have an impact on the balance of outcomes.

This review identified many inherent limitations of related literature. Firstly, the main sampling approach utilized in the included literature is convenience sampling, and there is no guarantee that these patients are a representative sample of all infertile population. Secondly, QoL and resilience were assessed using self-report. As with all self-reports, common methodological variance, social desirability biases, and response distortion due to ego-related defensive tendencies cannot be ignored (36). Not all studies explained any patient exclusions from analysis, and confounding factors were not taken into account. Furthermore, the handling of missing data is ambiguous, and the AHRQ quality assessment revealed poorly reported response rates. Relevant studies are cross-sectional, and the absence of follow-up made investigating cohort effects unfeasible. Finally, this review included only published studies, which will result in an inflated impression of the literature because published studies have more positive results.

Resilience can significantly predict the QoL of infertile patients. It seems plausible that more resilient couples will be less vulnerable to the stress of infertility. Methodological and population differences across studies may explain the variation in literature results. Future research could focus on broader concepts that include not only mental health but also physical and social well-being. Longitudinal analyses may also be utilised to infer causal relationships between the correlates of mental health, and to explore the changes in the psychological perspective of individuals during the reproductive process. A country’s cultural environment may influence QoL and resilience in infertility. A global consortium of infertile population research could make cross-cultural comparisons of QoL and resilience possible. Future research should concentrate on resilience therapies that improve QoL and alleviate psychological burdens in infertile women.

The original contributions presented in the study are included in the article/Supplementary material, further inquiries can be directed to the corresponding authors.

KL: Conceptualization, Methodology, Writing – original draft. SD: Data curation, Writing – original draft. WQ: Formal analysis, Writing – original draft. DZ: Formal analysis, Writing – original draft. WZ: Visualization, Writing – review & editing. DW: Visualization, Writing – review & editing. CZ: Project administration, Writing – review & editing. YG: Supervision, Writing – review & editing. PT: Supervision, Writing – review & editing.