Infertility and Quality of Life: Findings from a Literature Review

Background: Pelvic inflammatory disease (PID) has been associated with chlamydia and other STDs in women.  PID can have serious sequelae, including tubal-factor infertility.  Quality of life (QoL) measures, such as quality-adjusted life years (QALYs) lost, are typically required for cost-effectiveness analyses and have been estimated for infertility.  These measures have typically only been assessed for women seeking treatment during their fertile lifespan.  Determining the QoL impact of infertility throughout women’s lifespans could improve estimates of the burden of STDs and their sequelae.

Methods: A structured literature search was carried out in PubMed and Web of Science. Articles were identified using the following key words: HRQL, QoL, HALex, EuroQol, OLHQ, HUI, QALY, depression, loneliness, older women, and institutionalization AND/OR infertility and childlessness. Initial identification of articles was based on review of the title and abstract; reference lists were also scanned for additional sources. Relevant articles were retained for detailed evaluation.

Results: The search identified 86 eligible articles.  Of these, 34 articles were excluded and 52 articles were retained. Retained articles revealed decrease in QoL throughout the lifespan in emotional, mental health, and social domains that was associated with infertility.  Limited quantitative studies showed that women with a PID history (0.53 vs. 0.66) and adolescents (0.59 vs. 0.68) assessed significantly lower QoL for infertility compared to fertile women and parents, respectively. Other studies showed that infertile older women were more depressed, lonely and socially isolated; these effects were confounded by marital status.

Conclusions: Literature not specific to STD-caused infertility suggested that infertility was associated with decreased QoL. More research is needed to examine this phenomenon.  Few studies have assessed QoL values to infertility health states and none to older women specifically. Further research will help in understanding the long-term impact of STD infections and the cost-effectiveness of STD prevention programs.