Maladaptive emotion regulation and psychologic outcomes in infertility: a systematic review and meta-analysis

Objective: Infertility is a chronic and potentially traumatic condition that frequently requires assisted reproductive technologies (ART), posing significant psychologic challenges. This review aimed to synthesize systematically evidence on the associations between maladaptive emotion regulation strategies and psychologic outcomes in individuals experiencing infertility or undergoing ART, to inform clinical interventions. Evidence Review: We conducted a systematic review following PRISMA guidelines, searching PsycINFO, PsycArticles, PubMed, Web of Science, Scopus, and Google Scholar databases (2004–2025). Studies were included if they assessed maladaptive emotion regulation strategies (e.g., self-blame, rumination, avoidance, low acceptance), examined associations with psychologic correlates, involved clinical participants experiencing infertility or undergoing ART, and reported original quantitative data. Two independent reviewers performed study selection, data extraction, and quality assessment using a modified Newcastle– Ottawa Scale, resolving discrepancies by consensus. Meta-analyses used random-effects models for associations between maladaptive emotion regulation and anxiety, depression, infertility-stress, and infertility-related quality of life as primary outcomes. Results: A total of 46 studies were included, comprising 25 studies suitable for meta-analysis. Meta-analytic results showed significant positive associations of maladaptive emotion regulation with anxiety (r = 0.31; 95% confidence interval [CI], 0.23–0.39), depression (r = 0.31; 95% CI, 0.24–0.37), and infertility-related stress (r = 0.24; 95% CI, 0.18–0.30), and a negative association with infertility-related quality of life (r = − 0.27; 95% CI, − 0.36– − 0.18). Avoidance and emotional coping moderated some outcomes. Systematic review findings highlighted consistent links between dysfunctional strategies and reduced well-being, distress, maladjustment to infertility, psychopathological symptoms, and poorer relational and social aspects. Conclusion: Maladaptive emotion regulation represents a key mechanism affecting psychologic and relational outcomes in individuals facing infertility. Interventions targeting maladaptive strategies, fostering emotional awareness, acceptance, and regulatory flexibility, may reduce distress, support couple functioning, and enhance ART adherence, offering a clinically relevant approach to improving patient well-being.