BIOPSYCHOSOCIAL FACTORS ASSOCIATED WITH MEDICALLY ASSISTED REPRODUCTION: SCREENIVF VALIDATION AND APPLICATION IN CHINA

The general objective of this doctoral research is to validate a psychological instrument in the field of MAR in China and investigate how biopsychosocial factors interact with Chinese MAR women’s experiences (i.e., psychological maladjustment, quality of life, treatment discontinuation, and treatment outcome). Guided by Engel’s biopsychosocial model, this research proposed to (1) synthesise the availability of psychological instruments and factors applied in the field of MAR; (2) validate a Chinese version of a psychological instrument in the context of MAR; and (3) explore how biopsychosocial factors interact with Chinese women MAR treatment experiences.
This research was conducted in three stages. First, a scoping review synthesised international literature on psychological instruments applied and factors investigated in MAR settings, identifying methodological and research gaps. Second, a cross-cultural adaption and psychometric validation study was conducted using a sample of 387 women before IVF treatment in Hospitals in the Guangdong Province to assess the internal consistency and construct validity of the Chinese-SCREENIVF. Third, a cross-sectional study of 312 Chinese infertile women was conducted to investigate the associations between the five psychological factors of SCREENIVF (i.e., anxiety, depression, helplessness, acceptance, and social support), socio-demographic (i.e., marital relationship years, education, job status, family income, etc) and biomedical (i.e., age, duration of pregnancy attempt, previous MAR cycles, previous pregnancy and miscarriage, etc) factors, and MAR experiences (i.e., treatment clinical outcomes, treatment discontinuation, quality of life).
This scoping review systematically synthesised 57 studies published between 2011 and 2025 and identified the common instruments applied in the context of MAR (i.e. FertiQoL, HADS, and FPI) and the most frequently assessed psychosocial domains (i.e. anxiety, depression, and social support). The results also highlight a critical gap in culturally validated instruments in non-Western contexts. In addition, the findings of validation and cross-sectional study showed that the Chinese-SCREENIVF maintained its original five-factor structure and achieved a good level of reliability. Psychological factors, particularly anxiety, helplessness, and acceptance, were significantly associated with treatment outcomes and experiences such as treatment discontinuation, low quality of life, and IVF clinical outcomes. Sociodemographic characteristics, including education, family income, and financial pressure, moderate the effects of psychological maladjustment. Several interaction effects confirmed the dynamic interplay among biomedical, sociodemographic, and psychological factors, providing empirical support for the biopsychosocial model in infertility care. The fertility-related quality of life of the patients was most strongly predicted by psychological risk factors, social support, and financial stability.
The validated Chinese-SCREENIVF is a reliable and valid instrument for identifying psychological maladjustment before MAR treatment in Mainland China. Reproductive centres in China could apply this instrument to the integration of routine healthcare for early psychosocial interventions. This research represented the first comprehensive application and validation of SCREENIVF in Mainland China. This contributed to the psychological adjustment of infertile women in a non-Western setting and advanced the global applicability of the biopsychosocial model.