#3488 A prospective observational cohort study analysing how infertility affects quality of life of patients with and without chronic kidney disease (CKD) using the FertiQOL questionnaire

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Abstract Background and Aims Infertility is known to affect quality of life (QoL) and mental health in otherwise healthy couples. Parenthood and pregnancy are key life events for many people, including those with CKD. However, neither are typically integrated into QoL assessments for women with CKD, who often have complex emotional needs when considering pregnancy. Despite the increasing prevalence of CKD for women of childbearing age, there is very limited research investigating the impact of infertility on quality of life. FertiQOL is a validated instrument to measure QoL in individuals experiencing fertility problems. The aim of the study was to investigate how infertility affects the quality of life in people with chronic kidney disease (CKD) compared to the general population using the FertiQOL questionnaire. Method A prospective observational multi-centre cohort study of women with CKD and controls (healthy volunteers). The study was conducted over a 12-month period from October 2022–23 and recruited 107 women. Women with CKD were recruited from four tertiary hospital sites. Controls were healthy women undergoing treatment for male factor infertility. All controls had no fertility issues, determined by detailed history, hormonal blood profile and ultrasound scan. Ethical approval was provided by the Health Research Authority and written informed consent was obtained. Prior fertility treatment, active attempts to conceive, age, body mass index, ethnicity and medical history were recorded. All participants completed the FertiQOL survey; a validated instrument measuring QoL in individuals experiencing fertility problems divided into 6 domains (emotional, mind-body, relational, social, environment and tolerability) with raw and scaled (out of 100) scores. Difference between groups was assessed using Mann Whitney-U test. Linear regression models were performed on significant associations adjusting for age, BMI and parity. Results A total of 73 (68.2%) women with CKD and 34 (31.8%) controls were recruited. Women with CKD were older than controls (35.1 ± 6.7 vs. 31.2 ± 4.6 years) and were less likely to be nulliparous (46.1% vs. 73.5%) or desire pregnancy (73.5% vs. 100%). Both groups were comparable for BMI, ethnicity, attempts to conceive, and prior fertility treatment. FertiQoL raw and scaled total scores were similar between groups. The CKD total median raw score of 66.2 (IQR 54.8–77.8) compared to the control group score of 60.4 (IQR 55.4–72.2). This suggests infertility affects the QoL in women with CKD as much as in the general population. However, women with CKD had significantly lower scores in the raw environmental domain (CKD = 12.0; Controls = 16.0, P = 0.02). This assesses external factors that affect access to and experience of fertility treatment such as treatment availability, quality of care and financial burden of fertility services. Among participants who had undergone fertility treatment (n = 20), those with CKD had lower total scaled FertiQoL scores (51.0 vs. 63.5, P = 0.047) and significantly lower emotional (37.5 vs. 54.2, P = 0.04) and social (54.2 vs. 79.2, P = 0.007) scaled scores. The emotional domain reflects feelings like sadness, jealousy and resentment; the social domain evaluates social inclusion, stigma and impact of infertility on relationships. Conclusion Scores were similar between CKD and control groups. However, women with CKD and prior fertility treatment had significantly higher emotional burden and greater negative social impact than controls. Limitations include the two groups were not matched for age or parity. However linear regression modelling adjusting for age, BMI and parity did not impact significant differences. This is the first study evaluating the impact of infertility on QoL in women with CKD. Although infertility impacts this group's QoL as much as the general population's, we identified fertility treatment may have a more pronounced emotional and social effect emphasizing the importance of tailored, holistic support in treating this growing population.

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