Levels and correlates of alexithymia among individuals experiencing infertility: a systematic review and meta-analysis

Infertility is accompanied by considerable psychological demands, yet emotional processing difficulties such as alexithymia have received comparatively limited attention. Although alexithymia has been examined among individuals experiencing infertility, its overall level, differences from comparison populations, and associations with psychological distress remain unclear. This systematic review and meta-analysis aimed to comprehensively assess alexithymia levels among individuals experiencing infertility and to synthesize the available evidence on between-group differences and psychological correlates. Six databases were searched from inception to October 30, 2024, for English- or Chinese-language studies assessing alexithymia using the 20-item Toronto Alexithymia Scale (TAS-20) among individuals experiencing infertility. Study selection, data extraction, and methodological quality appraisal were conducted independently by two reviewers. Random-effects models were used to pool mean TAS-20 scores, between-group differences using Hedges’ g, and correlation coefficients. Exploratory subgroup analyses, meta-regression, and leave-one-out sensitivity analysis were also conducted. Ten studies involving 1,705 individuals experiencing infertility contributed to the primary meta-analysis. The pooled mean TAS-20 score was 50.52 (95% CI 47.47–53.57), with substantial between-study heterogeneity (I² = 97.64%). Across three case-control studies involving 315 individuals experiencing infertility and 216 healthy or fertile comparison participants, TAS-20 scores were higher among individuals experiencing infertility (Hedges’ g = 0.36, 95% CI 0.18–0.54). Alexithymia was moderately correlated with depressive symptoms across three studies involving 683 participants ( r = 0.51, 95% CI 0.44–0.58) and with state anxiety across two studies involving 330 participants ( r = 0.40, 95% CI 0.30–0.49). Alexithymia appears to be a relevant psychological characteristic among individuals experiencing infertility and is closely associated with concurrent psychological distress. Difficulties in identifying and describing emotions may represent an important aspect of psychological need that warrants attention during infertility care and may inform individualized communication and psychosocial support. However, the current evidence is insufficient to support routine TAS-20 screening or any specific alexithymia-focused intervention. Further longitudinal and more representative research is needed to clarify how alexithymia manifests across infertility populations and how it relates to psychological distress over the course of infertility and its treatment. CRD42024607972.