Association between quality of life and pregnancy outcomes among infertility patients undergoing assisted reproduction technologies: a prospective cohort study

Background Infertility and its treatment impose significant psychosocial burdens that impair quality of life (QoL). Its impact on pregnancy outcomes after embryo transfer (ET) in assisted reproduction technologies (ART) remains underexplored.Objective This study prospectively examined the association between QoL—measured by the FertiQoL instrument—and cumulative live birth rates (CLBRs) in women undergoing ART.Methods In this prospective cohort study, 1,233 women initiating IVF/ICSI completed the FertiQoL questionnaire pretreatment. Latent profile analysis (LPA) identified distinct QoL subgroups based on domain scores. Multivariable regression models, adjusted for confounders, assessed associations between QoL profiles/scores and pregnancy outcomes, with CLBRs as the primary endpoint. Smoothed curve fitting and threshold analyses explored nonlinear relationships.Results LPA delineated three FertiQoL subgroups: Low (n = 278), Medium (n = 676), and High (n = 279). Multivariate regression revealed that, relative to the Low-QoL group, the Medium-QoL group had significantly higher CLBRs (adjusted odds ratio [OR]: 1.704; 95% CI: 1.217–2.380) and reduced miscarriage risk (adjusted OR: 0.513; 95% CI: 0.304–0.875). Smoothed curve fitting indicated a nonlinear association between total FertiQoL score and CLBRs. Threshold analysis identified a cutoff of 74.306 (log-likelihood ratio test p = 0.054); below this value, each one-unit increase in score corresponded to a 2.1% higher CLBR (adjusted OR: 1.021; 95% CI: 1.006–1.036). Bootstrap internal validation confirmed the stability of this cutoff.Conclusion QoL was significantly associated with CLBRs following ET. A threshold effect was evident: improvements in QoL below a score of 74.306 were associated with higher live birth rates. These findings underscore the importance of integrating QoL assessment and intervention into infertility care.