Detecting anxiety and depression among infertile patients undergoing IVF-ET using the fertility quality of life and the patient health questionnaire-4 tools

Infertility is associated with considerable psychosocial distress, yet many affected individuals lack formal diagnosis or treatment. The Fertility Quality of Life (FertiQoL) tool is widely used to assess quality of life in infertile populations, while the Patient Health Questionnaire-4 (PHQ-4) is a validated screening tool for anxiety and depression. This study investigated whether FertiQoL could be applied as a screening measure to identify high-risk individuals during in vitro fertilization–embryo transfer (IVF-ET). This study enrolled participants (320 patients with 444 valid responses) between February and July 2023 across 11 assisted reproductive technology institutions in Taiwan. FertiQoL was used to evaluate quality of life, and PHQ-4 was used to screen for anxiety and depression. Associations between the two measures were analyzed, and a decision tree model was applied to identify an optimal FertiQoL cutoff score for risk classification. FertiQoL total scores were significantly and negatively correlated with PHQ-4 outcomes (–0.531 for PHQ-2; − 0.525 for GAD-2). A cutoff FertiQoL score of 63.6 provided satisfactory performance in identifying high-risk individuals, demonstrating sensitivities and specificities of 72% and 76% for anxiety (GAD-2), and 81% and 73% for depression (PHQ-2). The findings support the clinical utility of FertiQoL as a standardized tool not only for quality of life assessment but also for identifying mental health risks in infertile patients.