Infertility, traumatic stress and trauma-informed fertility care: a mixed-methods systematic review and modified Delphi study

Addyman, Grace 2026. Infertility, traumatic stress and trauma-informed fertility care: a mixed-methods systematic review and modified Delphi study. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

Abstract Background: Infertility has a lifetime prevalence of 17.5% globally. Negative psychological impacts of infertility, including depression and anxiety, are well documented. Common events in fertility care (e.g. recurrent miscarriage) are recognised to engender trauma responses. Objective and rationale: Recognition that infertility may involve traumatic responses is increasing, with calls for fertility care to be trauma-informed emerging in response. This review aims to determine the association between infertility and/or its treatment and post-traumatic responses. Search methods: Original empirical studies examining infertility or fertility treatment in relation to traumatic stress responses were identified through searches of PsychInfo, Medline, SCOPUS, EMBASE, The Cochrane Library, and Proquest (June 2025). All papers were screened and included studies critically appraised, using the Quality Assessment of Diverse Studies tool, by two reviewers. Reference lists of included papers were screened. Quantitative and qualitative data were extracted using standardised protocols (including study aims, sample characteristics, outcomes, and analytic approach). Data were synthesised using a convergent integrated approach following Joanna Briggs Institute guidance. Quantitative data was ‘qualitised’ through textual description of results. Data were narratively synthesised. Outcomes: Eighteen studies met inclusion criteria, including qualitative (n = 4), quantitative (n = 11), and mixed-methods (n = 3) designs. The infertility-related index event was frequently unspecified. Most studies conceptualised trauma symptomatically; intrusion and avoidance were the most assessed symptom domains. Of the three studies comparing infertility samples with fertile comparators, two reported significantly higher trauma symptoms among individuals experiencing infertility, although differences were limited to specific symptom domains or timepoints. Theoretical mechanisms were not tested and designs were predominantly cross sectional, precluding causal inference. Evidence for clinical and demographic risk factors was limited and inconsistent. Preliminary trends suggested several potential correlates, including female sex, primary infertility, and greater fertility-related stress. Other factors—including infertility aetiology and treatment type—were rarely examined, while characteristics such as race, sexual orientation, and socioeconomic status were not examined. Integrated synthesis identified themes including identity disruption, diminished self-worth, symbolic loss, relational and emotional strain, and social isolation, with several themes aligning with complex post traumatic stress disorder (C-PTSD) domains. No studies evaluated interventions for infertility related trauma. Wider implications: Prospective, longitudinal, and theory-driven research is needed to clarify the relationship between infertility and trauma, with studies specifying infertility-related index events, extending measurement beyond core PTSD symptoms, and including appropriate comparators. Greater inclusion of diverse populations is required. Fertility services should recognise emerging evidence linking infertility and trauma-related responses and consider trauma-informed care. Funding: This work was completed in partial fulfilment of a doctorate in clinical psychology funded by Health Education and Improvement Wales (HEIW). Registration number: PROSPERO: CRD420250633591

Item Type:	Thesis (DClinPsy)
Status:	Unpublished
Schools:	Schools > Psychology
Uncontrolled Keywords:	Trauma, Infertility, PTSD, Trauma-informed Care, Reproductive Health, Fertility
Date of First Compliant Deposit:	16 September 2026
Last Modified:	28 Sep 2026 10:15
URI:	https://orca.cardiff.ac.uk/id/eprint/189647

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