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Infertility stigma-fertility stress profiles and symptom-level associations among infertile women in Hainan Province: a latent profile and network analysis

Year: 2026

Type: article

Abstract: Infertility stigma and fertility-related stress are common psychosocial burdens among women seeking fertility care. However, their co-occurrence within individuals and conditional associations with depressive symptoms and family function remain insufficiently understood. This study aimed to identify combined stigma-stress profiles and examine node-level associations among women with infertility in Hainan Province, China. A cross-sectional study was conducted among 1,294 treatment-seeking infertile women recruited from two tertiary reproductive care settings in Hainan Province. Infertility stigma, fertility-related stress, depressive symptoms, and family function were assessed using the Infertility Stigma Scale, Fertility Problem Inventory, Patient Health Questionnaire-9, and Family APGAR Questionnaire. Latent profile analysis used four stigma and five stress subscales, with k-means clustering as a sensitivity analysis. A classification-error-adjusted automatic three-step (R3STEP) multinomial logistic regression examined profile correlates. An EBICglasso network was estimated, followed by bootstrap stability assessment, estimator sensitivity analyses, exploratory profile-specific networks, and network comparison tests. Three severity-ordered profiles were retained: low stigma-low stress ( n = 563, 43.5%), moderate stigma-moderate stress ( n = 540, 41.7%), and high stigma-high stress ( n = 191, 14.8%). Rural residence, lower educational attainment, and greater perceived financial stress were associated with higher odds of high-burden profile membership. Male-factor and unknown infertility were associated with lower odds than female-factor infertility, while a longer time since diagnosis was associated with moderate-burden membership. In the full-sample network, public stigma and self-devaluation had the highest expected influence, followed by sad mood, self-harm/suicidal ideation, sexual concern, and psychomotor symptoms. Self-devaluation had the highest bridge expected influence, followed by need for parenthood and social withdrawal. Family function was negatively connected with distress-related nodes. Expected influence showed good stability, and centrality rankings were consistent across estimators. No statistically detectable profile differences in global strength or overall network structure were found after Benjamini-Hochberg correction. Infertility stigma and fertility-related stress were organized primarily along a severity gradient rather than into qualitatively distinct psychosocial subtypes. The full-sample network identified several highly connected stigma, stress, and depressive symptom nodes, whereas profile-specific network differences were not statistically detectable.

Source: BMC Public Health

DOI: 10.1186/s12889-026-29453-z