Male- and Female-Factor Infertility and Partners' Quality of Life During ART

Female-factor infertility lowered male partners' wellbeing scores; male-factor infertility had no detectable effect on female partners

Journal: Journal of the Chinese Medical Association | Published: 2026-04-21 | Type: Cross-sectional, retrospective | PMID: 42010733 Authors: Pan Po-Hung et al. (National Cheng Kung University Hospital, Tainan, Taiwan) Funding/COI: Funding not listed. Authors declare no conflicts of interest.

Summary

Using the actor-partner interdependence model (APIM) on 105 couples undergoing ART at a Taiwanese tertiary center, this study found an asymmetric pattern: female-factor infertility was associated with meaningfully lower quality of life in male partners, while male-factor infertility had no detectable effect on female partners' QoL. Women reported lower QoL than men across all domains regardless of diagnosis. The authors frame the male QoL decline as a "bystander effect" — men witnessing invasive treatment they cannot share or resolve.

Claims

• Women reported lower QoL than men across all domains (p < 0.01)
• Female-factor infertility was associated with lower Mind-Body scores in male partners (β = −17.54, p = 0.017)
• Female-factor infertility was associated with lower Core scores in male partners (β = −10.15, p = 0.045)
• No significant partner effect of male-factor infertility on female QoL was detected
• Actor effects (one's own diagnosis on one's own QoL) were not significant for either partner
• Results held after adjusting for age, BMI, infertility duration, and prior embryo transfer attempts
• 67 of 105 couples proceeded to embryo transfer during the study window; 25 clinical pregnancies (37.3% per transfer), 22 live births (32.8% per transfer)

Study Quality

This is a retrospective cross-sectional study of 105 couples at a single Taiwanese tertiary center, using a validated dyadic statistical model (APIM with distinguishable dyads) that is appropriate for coupled data — a genuine methodological step up from treating partners as independent individuals. The FertiQoL tool used is validated, including a Mandarin version verified in prior work from the same group. Sample size is modest: 105 couples is acceptable for detecting large effects but underpowered for anything subtle, and the confidence intervals on the betas are not reported in the abstract.

The cross-sectional design cannot establish temporality — it is unknown whether male QoL was already lower before female-factor diagnosis was made, or whether QoL changed as a result of it. The questionnaire was completed at a single treatment visit (before oocyte retrieval or embryo transfer), meaning it captures a snapshot under procedural stress rather than a stable baseline. Additionally, Taiwan's Assisted Reproduction Act restricts ART to married heterosexual couples, so the sample is legally defined and not generalizable to other relationship structures or legal contexts.

Red Flags

• High exclusion rate: 393 records initially identified; only 105 couples enrolled after excluding incomplete dyads — the 73% attrition rate is a substantial selection bias risk that the authors acknowledge but cannot fully correct for
• Single-center tertiary sample: a center with mean female age 38.2 years and low ovarian reserve represents a high-stress ceiling; the null finding on clinical history variables (duration, prior failures) may reflect this, not genuine absence of effect
• Cross-sectional design: no causal inference possible; directionality is assumed, not demonstrated
• No confidence intervals on partner-effect betas in the abstract or reported sections available here — statistical significance alone is insufficient without effect size precision
• Funding not disclosed: common for institutional studies but worth noting
• Actor effects null: neither partner's diagnosis predicted their own QoL — an unexpected finding that could reflect the ceiling effect the authors describe, or could indicate that the FertiQoL tool lacks sensitivity at this end of the clinical spectrum

Strengths

• APIM is the correct statistical framework for dyadic data and is rarely used in infertility research
• Both partners completed the instrument, not just the index patient
• Sensitivity analyses adjusted for clinically relevant confounders and yielded consistent results
• Mandarin-validated FertiQoL instrument, not an ad hoc translation
• Prospective enrollment during a defined treatment window with IRB approval and complete clinical records

Verdict

A methodologically credible small study whose main value is demonstrating that male partners' wellbeing is not insulated from their partner's diagnosis — specifically when the partner's body is what requires treatment. The asymmetry finding is plausible and the statistical model is appropriate, but 105 couples from one Taiwanese hospital cannot carry much generalizability, and the cross-sectional design means this is hypothesis-generating, not confirmatory. The high exclusion rate is a real concern. Worth reading if you work in ART counseling or dyadic psychosocial research; not worth citing as evidence that male partners need intervention programs.