Quality of Life and Mental Health of Infertile Women Affected by Endometriosis: A Narrative Review

Author(s): Cristina Zarbo*, Agostino Brugnera, Rita Secomandi, Ilario Candeloro, Chiara Malandrino, Enrico Betto, Adriano Bellia, Massimo Rabboni, Emi Bondi, Luigi Frigerio, Angelo Compare

Journal Name: Current Women`s Health Reviews

Volume 15 , Issue 4 , 2019

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Graphical Abstract:


Objective: Infertility has a severe impact on quality of life and mental health. This condition could be exacerbated by the existence of comorbid medical disease, like endometriosis. The aim of this critical narrative review is the examination of the state of the art about the quality of life and mental health in infertile women with endometriosis.

Methods: We performed a rigorous and systematic search for studies on multiple electronic databases. A total of 6 papers were included in the review and were subjected to interpretative and critical narrative synthesis.

Results and Discussion: Major findings are resumed in the following points: (a) infertile women with endometriosis when compared to infertile ones without endometriosis show higher depression, stress perception, and anxiety, and lower general quality of life; (b) quality of life specifically related to infertility is similar among women with and without endometriosis and seems to be related to personality and beliefs factors; (c) giving birth to a child is related to better mental quality of life; (d) during assisted reproductive treatment (ART) stimulation, infertile women with endometriosis have a decrease of dysmenorrhea and dyspareunia; (e) satisfaction of ART is related to the number of attempts, treatment accomplishment and pregnancy test outcomes. Clinical implications of these findings and suggestions for future researches were discussed.

Conclusion: Concluding, it is crucial to assess the psychological factors related to endometriosis and infertility to reduce the impact of these diseases on quality of life and mental health, provide adequate support to these patients, improve their satisfaction and increase the change to get pregnant.

Keywords: Endometriosis, infertility, quality of life, mental health, assisted reproductive treatment, pregnancy.

World Health Organization. Current Practices and Controversies in Assisted Reproduction 2002 Geneva, Switzerland
Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol 2007; 21(2): 293-308.
Maroufizadeh S, Karimi E, Vesali S, Samani RO. Anxiety and depression after failure of assisted reproductive treatment among patients experiencing infertility. Int J Gynaecol Obstet 2015; 130(3): 253-6.
Peterson BD, Newton CR, Feingold T. Anxiety and sexual stress in men and women undergoing infertility treatment. Fertil Steril 2007; 88(4): 911-4.
Chen TH, Chang SP, Tsai CF, Juang KD. Prevalence of depressive and anxiety disorders in an assisted reproductive technique clinic. Hum Reprod 2004; 19(10): 2313-8.
Williams KE, Marsh WK, Rasgon NL. Mood disorders and fertility in women: A critical review of the literature and implications for future research. Hum Reprod Update 2007; 13(6): 607-16.
Smeenk JM, Verhaak CM, Eugster A, van Minnen A, Zielhuis GA, Braat DD. The effect of anxiety and depression on the outcome of in-vitro fertilization. Hum Reprod 2001; 16(7): 1420-3.
Boivin J, Griffiths E, Venetis CA. Emotional distress in infertile women and failure of assisted reproductive technologies: Meta-analysis of prospective psychosocial studies. BMJ 2011; 342: d223.
Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: A committee opinion. Fertil Steril 2012; 98(3): 591-8.
Culley L, Law C, Hudson N, et al. The social and psychological impact of endometriosis on women’s lives: A critical narrative review. Hum Reprod Update 2013; 19(6): 625-39.
Pope CJ, Sharma V, Sharma S, Mazmanian D. A systematic review of the association between psychiatric disturbances and endometriosis. J Obstet Gynaecol Can 2015; 37(11): 1006-15.
Zarbo C, Brugnera A, Frigerio L, et al. Behavioral, cognitive and emotional coping strategies of women with endometriosis: A critical narrative review. Arch Women Ment Health 2018; 21(1): 1-13.
Facchin F, Barbara G, Saita E, et al. Impact of endometriosis on quality of life and mental health: pelvic pain makes the difference. J Psychosom Obstet Gynaecol 2015; 36(4): 135-41.
Lorencatto C, Petta CA, José Navarro M, Bahamondes L, Matos A. Depression in women with endometriosis with and without chronic pelvic pain. Acta Obstet Gynecol Scand 2006; 85(1): 88-92.
Cavaggioni G, Lia C, Resta S, et al. Are mood and anxiety disorders and alexithymia associated with endometriosis? A preliminary study. BioMed Res Int 2014; 2014786830
Moradi M, Parker M, Sneddon A, Lopez V, Ellwood D. Impact of endometriosis on women’s lives: A qualitative study. BMC Womens Health 2014; 14: 123.
Zarbo C, Brugnera A, Compare A, et al. Negative metacognitive beliefs predict sexual distress over and above pain in women with endometriosis. Arch Womens Ment Health 2018. doi: 10.1007/ s00737-018-0928-9. [Epub ahead of print]
Young K, Fisher J, Kirkman M. Women’s experiences of endometriosis: A systematic review and synthesis of qualitative research. J Fam Plann Reprod Health Care 2015; 41(3): 225-34.
Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010; 8(5): 336-41.
Popay J, Roberts H, Sowden A, et al. Guidance on the conduct of narrative synthesis in systematic reviews. A product from the ESRC methods programme. Economic and Social Research Council: Swindon 2006; Version, 1, b92. ISO 690.
Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: What it is and what it isn’t. BMJ 1996; 312(7023): 71-2.
Zarbo C, Bugnera A, Compare A, et al. Perfectionistic traits and importance given to parenthood are associated with infertility-related quality of life in a sample of infertile women with and without endometriosis. Sex Reprod Healthc 2018; 17: 86-90.
Siedentopf F, Tariverdian N, Rücke M, Kentenich H, Arck PC. Immune status, psychosocial distress and reduced quality of life in infertile patients with endometriosis. Am J Reprod Immunol 2008; 60(5): 449-61.
Betto E, Zarbo C, Verrengia A, et al. Long-Term mental and physical quality of life after radical and conservative surgeries and in relation to childbirth in patients with severe endometriosis. J Womens Health Issues Care 2017; 6(6): 1-5.
Garalejic E, Bojovic-Jovic D, Damjanovic A, et al. Hamilton anxiety scale (HAMA) in infertile women with endometriosis and its correlation with magnesium levels in peritoneal fluid. Psychiatr Danub 2010; 22(1): 64-7.
Liang PY, Yin B, Cai J, et al. Increased circulating Th1/Th2 ratios but not other lymphocyte subsets during controlled ovarian stimulation are linked to subsequent implantation failure after transfer of in vitro fertilized embryos. Am J Reprod Immunol 2015; 73(1): 12-21.
van der Houwen LE, Schreurs AM, Schats R, Lambalk CB, Hompes PG, Mijatovic V. Patient satisfaction concerning assisted reproductive technology treatments in moderate to severe endometriosis. Gynecol Endocrinol 2014; 30(11): 798-803.
Santulli P, Bourdon M, Presse M, et al. Endometriosis-related infertility: Assisted reproductive technology has no adverse impact on pain or quality-of-life scores. Fertil Steril 2016; 105(4): 978-87.
Herbert DL, Lucke JC, Dobson AJ. Depression: An emotional obstacle to seeking medical advice for infertility. Fertil Steril 2010; 94(5): 1817-21.
Harlow CR, Fahy UM, Talbot WM, Wardle PG, Hull MG. Stress and stress-related hormones during in-vitro fertilization treatment. Hum Reprod 1996; 11(2): 274-9.
Akande VA, Hunt LP, Cahill DJ, Jenkins JM. Differences in time to natural conception between women with unexplained infertility and infertile women with minor endometriosis. Hum Reprod 2004; 19(1): 96-103.
Macer ML, Taylor HS. Endometriosis and infertility: A review of the pathogenesis and treatment of endometriosis-associated infertility. Obstet Gynecol Clin North Am 2012; 39(4): 535-49.
Bulletti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet 2010; 27(8): 441-7.
Surrey ES. Endometriosis-related infertility: The role of the assisted reproductive technologies. BioMed Res Int 2015; 2015482959
Vitale SG, La Rosa VL, Rapisarda AMC, Laganà AS. Endometriosis and infertility: the impact on quality of life and mental health. J Endometr Pelvic Pain Disord 2017; 9(2): 112-5.
Boivin J. A review of psychosocial interventions in infertility. Soc Sci Med 2003; 57(12): 2325-41.

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Article Details

Year: 2019
Published on: 11 November, 2019
Page: [238 - 244]
Pages: 7
DOI: 10.2174/1573404815666190405112419
Price: $65

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