History of miscarriage and quality of life in couples undergoing medically assisted reproduction: an exploratory couple-based cross-sectional study

Background Miscarriage is associated with psychological distress, but its relationship with quality of life in couples undergoing medically assisted reproduction (MAR) remains insufficiently studied, particularly in male partners. We explored whether a history of miscarriage, previous pregnancy, or live birth was associated with quality of life in women and their partners. Methods In this secondary, exploratory analysis of a cross-sectional study, 100 heterosexual couples undergoing MAR at a university hospital in Zagreb, Croatia, completed the World Health Organization Quality of Life-BREF and the Copenhagen Multi-Centre Psychosocial Infertility (COMPI) Fertility Problem Stress Scale. We used t tests, multivariate analysis of variance, and sex-stratified stepwise regression (19 candidate variables), with adjusted, bootstrap, and dyadic mixed-model sensitivity analyses. Results Of the women, 49% had a previous pregnancy, 8% a live birth, and 26% a miscarriage. Women with a history of miscarriage reported lower overall quality of life than women without (mean 3.77 vs 4.11; p = 0.008; Cohen’s d = 0.61) and than previously pregnant women without a miscarriage (4.18; p = 0.007), whereas never-pregnant women and previously pregnant women without a miscarriage did not differ. Of the four domains, only psychological health differed after Bonferroni adjustment. Miscarriage was the only variable retained in the stepwise model for women (β = −0.268, p = 0.008); in men, personal infertility-related stress (β = −0.284, p = 0.004) and the partner’s history of miscarriage (β = −0.236, p = 0.017) were retained. The association persisted after adjustment for age and personal infertility-related stress and did not differ between partners. Quality of life did not differ by the number of miscarriages or the time since the loss, but these subgroups were small. Conclusions In this exploratory, single-center study, a history of miscarriage, rather than previous pregnancy as such, was associated with lower quality of life in women undergoing MAR and in their partners. These associative, hypothesis-generating findings require confirmation in adequately powered prospective studies that capture the timing, sequence, and cumulative burden of reproductive events.