Fertility quality of life and its potential causal mechanisms among recurrent pregnancy loss patients in China:a structural equation model analysis

Fertility quality of life and its potential causal mechanisms among recurrent pregnancy loss patients in China:a structural equation model analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Fertility quality of life and its potential causal mechanisms among recurrent pregnancy loss patients in China:a structural equation model analysis Meng Zhang, Mengtian Zhang, Ying Li, Haiyan Xue, Jingya Gong, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7505131/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Recurrent miscarriages cause significant psychological and physical trauma to patients with recurrent pregnancy loss (RPL), which is severely affects the quality of life of RPL patients. However, there is still a lack of in-depth understanding in the academic community regarding which factors influence fertility quality of life (FertiQoL) and through what mechanisms. By constructing structural equations within the ABC-X theoretical model framework, it is possible to more clearly reveal the intrinsic connections between stressors and stress outcomes. This study identified the status and factors influencing FertiQoL in patients with RPL based on the ABC-X model. In addition, the effects on the FertiQoL in RPL patients with fertility stress, coping style, and intolerance of uncertainty (IU) were clarified. Methods A convenience sampling method was used to study 325 patients with RPL from two reproductive clinics of a tertiary hospital in Suzhou from November 2023 to November 2024 using a self-designed general data questionnaire, the FertiQoL tool, the Fertility Problem Inventory (FPI), the Intolerance of Uncertainty Scale-12 (IUS-12), and the Simple Coping Style Questionnaire (SCSQ). Single factor analysis and multiple linear regression methods were used to analyze the factors influencing FertiQoL in patients with RPL. Results The mean score and standard deviation of FertiQoL score in patients with RPL was 58.06 ± 20.93. Multivariate linear regression analysis showed that employment status, history of late-term abortion, fertility stress, IU, positive coping, and negative coping were the main factors influencing the FertiQoL in patients with RPL ( P < 0.05). The pathway analysis showed that fertility stress, IU, positive coping, and negative coping directly predict FertiQoL ( β = -0.315, β = -0.206, β = 0.256, β = -0.177, P < 0.01). Fertility stress directly predicted positive and negative coping ( β = -0.590, β = 0.459, P < 0.01). IU directly predicted negative coping ( β = 0.247, P < 0.01). Fertility stress indirectly acts on FertiQoL through positive and negative coping ( β = -0.151, β = -0.081, P <0.01). IU indirectly acts on FertiQoL through negative coping, which exerts a mediating effect ( β = -0.044, P < 0.01). Conclusions The FertiQoL level in patients with RPL is low. Healthcare providers should pay attention to the early identification of FertiQoL in patients and enhance the intervention in a timely manner. Fertility Quality of Life Recurrent Pregnancy Loss ABC-X Model Influencing Factors Path Analysis Figures Figure 1 Introduction Recurrent pregnancy loss (RPL) is defined as the loss of two or more pregnancies before the fetus reaches viability, is estimated to affect 1–5% of all couples of reproductive age [ 1 , 2 ] . Due to changes in contemporary lifestyles, increased costs of childbearing, and shifts in reproductive attitudes among individuals of childbearing age, the fertility intentions of this demographic have been steadily declining, the incidence of RPL have a gradual increase. Despite extensive diagnostic investigations, over 40% of cases remain unexplained [ 3 ] . Additionally, there are no specific guidelines regarding the definition, diagnostic workup and treatment of RPL at present, RPL has become a significant reproductive challenge. As pregnancy losses are generally experienced as significant negative life events, RPL is a frustrating and painful experience for most women and seriously affects their psychological status, reproductive health, and quality of life(QoL) [ 4 – 6 ] . A longitudinal study indicates that quality of life is associated with pregnancy outcomes in women with fertility issues [ 7 ] . Consequently, women's quality of life is of paramount importance and warrants significant attention. Assessing quality of life not only helps healthcare professionals gain a comprehensive understanding of an individual's self-perceived health status to determine whether follow-up interventions are needed, but also assists them in identifying issues requiring special attention. Fertility quality of life (FertiQoL) is an important component of quality of life and can comprehensively assess the impact of fertility-related issues on patient emotions, physical and mental health, and marital and social relationships [ 8 ] . FertiQoL is an important indicator for evaluating patients' psychological status, the effect of care and recovery, and also a significant predictor of reproductive outcomes and treatment effects. FertiQoL contains multiple dimensions covering different aspects of health, including specific aspects for women receiving infertility treatments. Therefore, accurately assessing the FertiQoL level in RPL patients and determining the factors influencing FertiQoL can more precisely identify the impact of fertility issues on RPL patients, which is of great significance for promoting psychological well-being and reproductive health and improving their pregnancy outcomes. However, current domestic and international research has only focused on the correlation between FertiQoL in RPL patients and fertility stress and negative psychology [ 9 , 10 ] without any research on the factors influencing FertiQoL in RPL patients. Therefore, this study was based on the ABC-X model [ 11 ] and comprehensively considered the interactive influence of the individual and social environments, accurately assessed the FertiQoL level in RPL patients, and determined the influencing factors and pathway to provide scientific theoretical support for formulating targeted intervention strategies to improve the FertiQoL in RPL patients. Methods Study setting and participants A cross-sectional survey was administered to RPL patients in the reproductive clinics on two campuses of a tertiary general hospital in Suzhou from November 2023 to November 2024. Informed consent was obtained from all participants included in the study. All patients were consecutively recruited by a trained nurse. The inclusion criteria were as follows: (i) 20–50 years of age; (ii) > 2 miscarriages or stillbirths before 28 weeks gestation and (iii) ability to understand and complete the questionnaires. The exclusion criterion was having a history of mental illness or a severe medical condition that could interfere with the baseline measurements. The sample size was determined to be 10—15 times the number of research variables according to the Kendall sample size estimation method and requirements of structural equation models. This study included 26 variables and considering a 15% sample loss rate, the sample size was determined to be 305–458 cases. The final sample size was 325 cases. This study has been approved by the hospital Ethics Committee (JD-LC2024021-I01). Instruments General Information Questionnaire The data were collected using a self-administered, structured questionnaire, which included a study-specific questionnaire on sociodemographic variables and clinically relevant information. To assess psychological adjustment related to RPL, scales measuring perceived stress, dispositional mindfulness, negative emotion, and FertiQoL were administered. The demographic and clinical questionnaire was designed by the authors, which included age, residence, BMI index, Status of medical insurance, marital status, education level, monthly household income, employment status, fertility history, history of late-term abortion, number of abortions, history with assisted reproductive therapy, and duration of infertility. Clinical data were collected from the medical records. FertiQoL tool The FertiQoL tool was designed by Boivin [12] in 2011 to measure the QoL in individuals experiencing infertility; the Cronbach' s α of the Chinese version of the FertiQoL is 0.907 [13] . The FertiQoL tool contains 36 items and 2 modules (a core FertiQoL module and an optional treatment FertiQoL module). The core FertiQoL module is divided into four fields (emotional, mind-body, relationship, and social). The optional treatment FertiQoL module is divided into two fields (medical environment and treatment tolerance). The score for each item is 0–4 points. The total scale and subscale scores can be converted into 0–100-point scales. The standard score was calculated by multiplying the total scale raw score by 25 and dividing by the total number of items in the scale. The higher the score, the higher the FertiQoL. FertiQoL has good reliability and validity and has been widely used in patients with fertility issues. The core FertiQoL module was selected to assess the FertiQoL of RPL patients in this study. Fertility Problem Inventory (FPI) The FPI scale was designed by Newton [14] in 1999 based on the Lazarus stress theory model. This scale has been widely used to measure the perceived stress related to fertility. The Cronbach' s α of the Chinese version of the FPI is 0.81 [15] . The FPI includes 46 items divided into five domains (social concern, relationship concern, sexual concern, the need for parenthood, and rejection of a child-free lifestyle). The score for each item was 1–6 points. The total score ranged from 46–276 points. A higher score indicated higher fertility stress. Intolerance of Uncertainty Scale-12 (IUS-12) The IUS-12 is a 12-item scale assessing negative beliefs about and reactions to uncertainty. Carleton [16] developed the simplified version of the IUS-12 in 2007 based on the IUS-27 to measure patient responses to uncertain situations and events. The Cronbach' s α of the Chinese version of the IUS-12, which was applied to college students, is 0.878 [17] . The scale consists of two parts (prospective anxiety and inhibitory anxiety). Each item is rated on a 5-point Likert scale (1 = not at all characteristic of me; 5 = entirely characteristic of me) and the range of this scale is 12–60. The higher the score, the higher the uncertainty in the patient. Simplified Coping Style Questionnaire (SCSQ) The SCSQ was designed by Xie Yaying in 1998 based on the theory of coping styles and integrating relevant research at home and abroad [18] . The SCSQ is used to measure an individual's coping style when facing stress. The SCSQ has good reliability and validity. The SCSQ consists of 20 items and 2 dimensions (positive coping and negative coping). A 4-point Likert scale is used for scoring with a score range of 0–60. The higher the SCSQ score, the more the individual tends to adopt a positive or negative coping style. Ethical approval Ethical approval was obtained from the Ethics Review Committee of the Second Affiliated Hospital of Soochow University (Approval: JD-LC2024021-I01) and completed registration review (Registration in 29 th April 2024 with the Chinese Clinical Trial Registry: ChiCTR2400083648). The study complies with the World Medical Association's Declaration of Helsinki (revised in 2003) — Ethical Principles for Medical Research Involving Human Subjects. Participants of the study were informed about the purpose, objectives, their right to decline participation or withdraw their participation. A written consent was then obtained. Privacy and confidentiality were maintained throughout the study. Data collection The participants voluntarily provided written informed consent. All data were collected by well-trained collectors using a face-to-face data collection method and remained confidential. Data collection took place at the initial visit of RPL patients. Participants were invited to complete the self-administered questionnaire in a quiet space, with researchers patiently answering any questions about the questionnaire during the filling process; this process took approximately 20–30 min. After the completion of the survey, the contents of the questionnaire were verified by two trained researchers. Any questionnaires with missing or unclear data were revisited and refilled. Data analysis Excel was used for data entry and SPSS 27.0 software was used for data analysis. The measurement data are presented as the mean±standard deviation and enumeration data are expressed as a frequency and constituent ratio (%). The difference in the demographic and disease characteristic variables of the FertiQoL was tested by an independent sample t-test and single-factor variance analysis. FertiQoL, fertility stress, IU, and coping styles underwent Pearson correlation analysis. The factors influencing FertiQoL were analysed by multiple linear regression analysis. A P < 0.05 was considered statistically significant. Results Demographic characteristics of participants and Single-factor analysis of FertiQoL A total of 325 questionnaires were distributed to RPL patients and 305 valid questionnaires were obtained for an effective recovery rate of 93.8%. The average age of the participants was 32.01 years (SD = 3.84) and the average duration of infertility was 1.88 years (SD = 2.36). The results of the single-factor analysis showed that there were statistically significant differences in FertiQoL among RPL patients with respect to monthly household income, residence, status of medical insurance, educational level, history of late miscarriage, number of miscarriages, history of assisted reproductive therapy, and employment status ( P < 0.05). The detailed results are shown in Table 1. Table 1 A one-way analysis of respondent general information and FertiQoL （ n = 305 ） Variables n(%) FertiQoL(M ± SD) t/F P Age(years) 20～29 81 (26.56) 59.88±20.90 0.455 0.635 30～40 215 (70.49) 57.32±21.12 40～50 9 (2.95) 59.38±17.08 Monthly household income(Yuan) ＜3000 11 (3.61) 27.56±7.87 17.629 ＜0.001 3000～6000 178 (58.36) 56.50±21.38 ＞6000 116 (38.03) 63.35±18.11 Residence City 206 (67.54) 61.33±19.55 3.864 ＜0.001 Town 99 (32.46) 51.25±22.14 Status of medical insurance Yes 264 (86.56) 60.61±19.90 5.659 ＜0.001 No 41 (13.44) 41.67±20.17 Marital status First marriage 287 (94.1) 58.27±20.90 0.692 0.489 Remarriage 18 (5.90) 54.75±21.65 Educational level Senior high school or below 39 (12.79) 44.26±20.44 16.031 ＜0.001 Higher vocational education/ University degree 239 (78.36) 58.74±20.84 Master’s degree and above 27 (8.85) 71.99±6.52 BMI index ＜18.5 17 (5.57) 59.19±21.67 0.870 0.457 18.5～23.9 210 (68.85) 59.11±20.49 24～27.9 64 (20.98) 55.66±22.17 ≥28 14 (4.59) 51.93±21.05 Employment status On-the-job 238 (78.03) 61.06±20.35 5.209 0.006 Rest 67 (21.97) 56.29±21.47 Number of abortions 2 171 (56.07) 50.79±20.24 2.274 0.105 3 84(27.54) 60.86±20.34 ≥4 50 (16.39) 55.33±21.90 Duration of infertility (years) ＜1 134 (72.13) 56.99±19.74 1.047 0.296 1～3 116 (19.67) 58.60±20.59 ＞3 55 (8.20) 55.12±22.69 Fertility history No 258 (84.59) 61.29±19.74 5.305 ＜0.001 Yes 47 (15.41) 46.58±21.14 History of late-term abortion No 238 (78.03) 60.24±20.31 2.890 0.004 Yes 67 (21.97) 52.69±21.57 History with assisted reproductive therapy No 217 (71.15) 60.91±19.94 4.625 ＜0.001 Yes 88 (28.85) 47.95±21.37 Scale scores and Correlation analysis between variables The total FertiQoL score was 58.06 (SD = 20.93). The mean physical and mental quality dimension score was the highest (59.33 [SD = 24.55]), while the marital relationship dimension score was the lowest (55.88 [SD = 25.33]). The mean total FPI, IU, and SCSQ scores were 136.39 (SD = 44.22), 35.76 (SD = 11.31), and 32.88 (SD = 8.86), respectively. Pearson correlation analysis was used to analyze the correlations among fertility stress, IU, positive coping, negative coping, and FertiQoL in RPL patients. The results showed that the FertiQoL in RPL patients was negatively correlated with fertility stress (r = -0.517, P < 0.01), negatively correlated with IU (r = -0.372, P < 0.01), positively correlated with positive coping score (r = 0.527, P < 0.01), and negatively correlated with negative coping score (r = -0.492, P < 0.01). The detailed results are shown in Table 2. Table 2 Matrix of correlations coefficients between variables （ n = 305 ） Variables Mean± SD 1 2 3 4 5 1 FertiQoL 58.06±20.93 1 2 FPI 136.39±44.22 -0.517** 1 3 IU 35.76±11.31 -0.372** 0.237** 1 4 positive coping 23.79±9.55 0.527** -0.535** -0.265** 1 5 negative coping 9.09±6.75 -0.492** 0.470** 0.345** -0.452** 1 Note: **indicates P < 0.01 Multivariate linear regression analysis of FertiQoL in patients with RPL Multivariate linear regression analysis showed that employment status, history of late-term abortion, fertility stress, IU, positive coping, and negative coping were the main factors influencing the FertiQoL in patients with RPL ( P < 0.05). The detailed results are shown in Table 3. Table 3 Multiple linear regression analysis of the fertility quality of life in patients with recurrent spontaneous abortion （ n = 305 ） Variant Unstandardized coefficient β t P B SE (Constant) 69.345 11.252 6.163 0.000 Employment status -5.377 2.224 -0.107 -2.418 0.016 History of late-term abortion -4.656 2.263 -0.092 -2.057 0.041 Fertility stress -0.106 0.025 -0.223 -4.152 ＜0.001 IU -0.267 0.085 -0.144 -3.153 0.002 Positive coping 0.501 0.117 0.229 4.291 ＜0.001 Negative coping -0.462 0.162 -0.149 -2.859 0.005 Note: R 2 = 0.499, adjusted R 2 = 0.469, F = 16.824, P ＜ 0.001 Pathway analysis of FertiQoL in patients with RPL Construction and revision of the path analysis model The revised model was evaluated using indicators, c ² / df =1.990 , GFI=0.943, AGFI=0.912, RMSEA=0.057, IFI=0.969, and CFI=0969. The results showed that the revised model fit well. Based on a comprehensive consideration of previous research results in related fields, the initial model for the FertiQoL of RPL patients was revised and adjusted in accordance with model revision principles and the revision prompts of AMOS 26.0 software combined with the P -values of the revised path coefficients and the revised indices to obtain an acceptable revised model of the factors influencing the FertiQoL of RPL patients based on the ABC-X model (Figure 1). Pathways through which influencing factors affect FertiQol The results of the path coefficients in the corrected model are shown in Table 4. The results showed that all path coefficients were significant. Table 4 Path coefficients of the corrected mode l Variables Estimate Standardized Estimate S.E. C.R. P fertility stress → FertiQoL -0.158 -0.315 0.039 -4.058 ＜0.001 IU → FertiQoL -0.238 -0.206 0.070 -3.396 ＜0.001 positive coping → FertiQoL 0.124 0.256 0.030 4.121 ＜0.001 negative coping → FertiQoL -0.121 -0.177 0.042 -2.891 0.004 fertility stress → positive coping -0.607 -0.590 0.059 -10.269 ＜0.001 fertility stress → negative coping 0.334 0.459 0.042 7.886 ＜0.001 IU → negative coping 0.415 0.247 0.098 4.234 ＜0.001 The detailed results of the analysis of the effects of fertility stress, IU, and coping styles on the FertiQoL of RPL patients are shown in Table 5. Table 5 Decomposition of the effects between factors in the corrected model Independent variables Dependent variables Direct effect Indirect effect Total effect fertility stress FertiQoL -0.315 -0.232 -0.548 IU FertiQoL -0.206 -0.044 -0.250 positive coping FertiQoL 0.256 0.000 0.256 negative coping FertiQoL -0.177 0.000 -0.177 fertility stress positive coping -0.590 0.000 -0.590 fertility stress negative coping 0.459 0.000 0.459 IU negative coping 0.247 0.000 0.247 The path analysis results showed that positive coping mediates the relationship between fertility stress and FertiQoL, negative coping mediates the relationship between fertility stress and FertiQoL, and negative coping mediates the relationship between IU and FertiQoL. All path coefficients were significant (Table 6). Table 6 Decomposition of the mediating effect in the modified model Pathway Effectiveness Bootstrap 95%CI P Effect proportion(%) Lower Upper fertility stress→positive coping→ FertiQoL Direct effect -0.315 -0.486 -0.155 ＜0.001 67% Indirect effect -0.151 -0.236 -0.078 ＜0.001 32% Total effect -0.467 -0.617 -0.322 ＜0.001 ／ fertility stress→negative coping→ FertiQoL Direct effect -0.315 -0.486 -0.155 ＜0.001 80% Indirect effect -0.081 -0.154 -0.021 0.008 20% Total effect -0.396 -0.538 -0.251 ＜0.001 ／ IU→negative coping→FertiQoL Direct effect -0.206 -0.331 -0.064 0.005 82% Indirect effect -0.044 -0.097 -0.010 0.006 18% Total effect -0.250 -0.376 -0.111 0.001 ／ Discussion Current status of FertiQoL in RPL patients The FertiQoL score of RPL patients was 58.06 (SD = 20.93). The findings showed that participants experienced comparably poor FertiQoL compared to RPL patients in the Li study [10] . Reproductive failure not only brings physical trauma to RPL patients but also subjects patients to more social pressure and an increased economic burden [19] . In addition, among all the FertiQoL dimensions assessed in this study, the social dimension score was the highest (59.63±24.38), suggesting that the social impact on RPL patients was relatively mild. Of RPL patients, 87.36% have a junior college degree and above, indicating a relatively high level of education. Approximately 86.56% of RPL patients had medical insurance, which contributes to the proactive attitude toward seeking medical care and provides RPL patients with relatively abundant medical resources. Moreover, the relationship dimension scored the lowest (55.88±25.33), which may be attributed to RPL patients failing to meet the need for fertility and pressure from their spouse and family members. The deteriorating emotional communication between couples due to fertility issues and mutual suspicion, which severely affected marital relationships. The study showed that joint treatment and active intervention for couples are necessary conditions to solve couples' psychological problems and improve communication status, which can significantly improve the FertiQoL of both partners [20] . Moreover, the emotional interaction and mutual support between spouses are closely related to successful treatment outcomes [21] . Therefore, healthcare professionals should focus on the treatment needs of RPL patients and systematically assess the psychological status of both partners, fully understand their emotional states, encourage male support and companionship, and implement couple-centered interventions for RPL patients with a lower FertiQoL level, emphasizing that reproduction is a shared responsibility requiring mutual understanding, support, and joint efforts. Influencing factors and pathways for FertiQoL in RPL patients Employed RPL patients have a higher FertiQoL The results of this study showed that employed RPL patients had a higher FertiQoL, which was similar to the findings of Sun [22] . This finding may be because the occurrence of RPL is a complex process involving multiple factors and the proportion of etiological components varies with the number and timing of previous miscarriages [3] . Therefore, multiple screening tests are often required to identify the etiology of RPL, thereby increasing the economic burden on RPL patients. Employed RPL patients have stable economic income sources and lower economic pressure, which alleviates the obstacles patients face during treatment to some extent. Additionally, work distracts patients from reproductive issues, thereby resulting in higher FertiQoL levels. However, clinical observations indicate that RPL patients are highly sensitive to symptoms associated with miscarriage due to anxiety and fear regarding miscarriage, just like lower abdominal discomfort and increased vaginal discharge during early pregnancy. RPL patients tend to take as much time off work as possible or even resign. However, previous studies have shown that bedrest does not decrease the risk of miscarriage [23] . A healthy lifestyle is the key measure for preventing preterm birth [24] . Therefore, it is recommended that physicians should assess the health status of RPL patients, provide personalized activity guidance during pregnancy, help RPL patients improve their health, and enhance confidence in RPL patients by maintaining normal work and daily life. RPL patients with a history of late miscarriage have a lower FertiQoL Previous studies have shown that miscarriage is classified as a traumatic event and women experience high levels of post-traumatic stress, anxiety, and depression after miscarriage with this distress often persisting at high levels for up to 9 months [25] . Pregnant women develop an internal attachment to the fetus by seeing fetal images during ultrasound examinations and feeling fetal movement. Late-term miscarriage damages the symbiotic relationship between mother and fetus, leading to higher levels of grief after late-term miscarriage [26] . Additionally, patients with a history of late-term miscarriage have an increased risk of recurrent late-term miscarriage or preterm birth [27] . A history of late-term miscarriage causes significant physical and psychological trauma for women, resulting in a lower FertiQoL. Studies have shown that women who have experienced a late-term miscarriage need opportunities to communicate with and say goodbye to the fetus [28] . Emotional well-being should be prioritized and a supportive healthcare environment should be provided for women who have experienced a late-term miscarriage. Healthcare satisfaction and information about post-miscarriage physical changes are significantly associated with reduced rates of perinatal grief following a miscarriage [29] . Therefore, hospitals should train healthcare providers involved in miscarriage care to adopt respectful and empathetic communication, enhance information support, provide patient-centered interactive care, prioritize the physical and mental health of both partners, establish post-abortion care rooms, and encourage partner participation to offer medical assistance and emotional support. Fertility stress in RPL patients has direct and indirect effects on FertiQoL The path analysis results of this study showed that the total effect value of fertility stress on FertiQoL for RPL patients was -0.548 (direct effect = -0.315, indirect effect = -0.232). Based on different coping styles, two paths were identified (fertility stress → positive coping → FertiQoL; and fertility stress → negative coping → FertiQoL). The indirect effect values for these paths were -0.151 and -0.081, respectively. This finding indicates that fertility stress not only has a direct negative impact on the FertiQoL of RPL patients (r = -0.517, P < 0.01) but also influences the FertiQoL level by affecting coping style. This finding is in agreement with the report by Zang [30] . The reason for this finding may lie in the fact that RPL patients are subjected to pressure from traditional Chinese reproductive concepts, which result in significant fertility stress due to a history of miscarriage. RPL patients have different capacities to cope with and perceive fertility stress, leading RPL patients to choose different coping styles, which in turn affect the FertiQoL. A study in Jordan [31] showed that miscarriage can influence a woman's decision to attempt pregnancy again. Emotional support from healthcare providers, friends, and family with accurate information about pregnancy and miscarriage provided to couples after a miscarriage are crucial in helping women cope with the loss of a miscarriage. Therefore, healthcare professionals need to closely monitor the fertility stress levels of RPL patients, assess whether their daily lives are negatively impacted during early pregnancy, and provide appropriate guidance and preconception counseling. For RPL patients with higher fertility stress levels, healthcare providers should increase communication with patients, thoroughly understand their obstetric history, and proactively provide information about RPL, including updates on disease progression. Additionally, based on the patient's level of understanding and knowledge about the condition, face-to-face perinatal care knowledge and pregnancy guidance should be provided through prenatal education classes or specialized nursing clinics. Furthermore, research indicates that providing online mental health interventions for RPL patients addresses the time and location constraints of traditional care and enables patients to access information and receive social and emotional support online at any time [32] . Therefore, hospitals should establish online platforms to provide RPL patients with online psychological guidance courses to help them reduce fertility stress, choose positive coping styles, and ensure maternal and infant safety. Direct and indirect effects of IU in RPL patients on FertiQoL The IU score in RPL patients was 35.76 ± 11.31, which was higher than the IU scores reported by Bai [33] , indicating a relatively high IU level. Path analysis results showed that the total effect of IU on FertiQoL was -0.250 (direct effect = -0.206; indirect effect = -0.044) with the indirect effect pathway being IU → negative coping → FertiQoL. The higher the IU level in RPL patients, the lower the FertiQoL (r = -0.372, P < 0.01). The IU can alter FertiQoL in RPL patients by influencing negative coping. This finding may be because the waiting period for re-pregnancy after miscarriage is a traumatic period filled with significant uncertainty and emotional turmoil for RPL patients [34] . In addition, RPL patients have a higher incidence of pregnancy complications during re-pregnancy compared to pregnant women without fertility issues [35] . RPL patients face higher reproductive risks and stress, making RPL patients more sensitive to unknown events, such as treatment and pregnancy outcomes compared to pregnant women without fertility issues [36] . Higher IU levels lead patients to perceive and cope with reproductive issues in a negative manner, exacerbating their sadness and suffering and resulting in a lower FertiQoL. Studies have shown that high levels of IU not only significantly impair patients' daily functioning, negatively impact pregnant women's mental health, but also increase childbirth anxiety in primiparas and complicating pregnancy [37 - 40] . Therefore, it is important to prioritize the IU levels in RPL patients. Rahimi [41] concluded that intervention programs based on IU are more effective than cognitive behavioral therapy and conventional treatment programs in reducing IU levels and improving the FertiQoL. Additionally, studies have shown that patients with high IU levels can reduce IU levels by seeking emotional and practical support as coping styles [42] . Smartphones, as important tools in the internet age, have a significant role in disseminating information and promoting healthy decision-making, thereby alleviating IU levels [43] . Therefore, when faced with younger RPL patients, healthcare providers can assess IU levels during the initial consultation and select IU-based intervention protocols to conduct online interventions, such as live science popularization lectures, establishing online communication channels, providing online consultations, and establishing WeChat groups. Through multi-modal and -channel approaches, the IU levels of RPL patients can be reduced, negative perceptions regarding fertility can be improved, an accurate understanding of the treatment methods applicable to their current RPL status can be facilitated, adherence to treatment and satisfaction can be enhanced, and the FertiQoL can be improved. Direct effects of coping styles on FertiQoL in RPL patients The results of this study showed that RPL patients with lower levels of positive coping and higher levels of negative coping have higher FertiQoL levels ( P < 0.001 and P = 0.004, respectively). Positive and negative coping have direct effects on FertiQoL (direct effect: 0.256 and -0.177, respectively). This finding is consistent with the findings of Rahimi [41] because approximately 78% of RPL patients included in the current study were still employed and their busy work schedules prevented them from attending follow-up appointments promptly, resulting in lower levels of positive coping. However, due to the history of adverse pregnancies, RPL patients have a high demand for medical support, such as self-management and prenatal monitoring [44] . Failure to attend follow-up appointments on time leads to a lack of medical support, resulting in a lower FertiQoL among RPL patients. Additionally, some RPL patients remain unable to identify the underlying etiology for RPL despite repeated screenings. RPL patients may lose trust in the ability of medical institutions to improve pregnancy outcomes and adopt a passive coping strategy, such as discontinuing treatment or abandoning treatment altogether. This approach not only affects treatment outcomes but also fails to alleviate fertility stress, leading to a decline in the FertiQoL. Research indicates that healthcare providers should strengthen the dissemination of perinatal health knowledge among reproductive-age women, enhance health awareness, and encourage RPL patients to transition from passive acceptance to active participation in health protection by proactively addressing pregnancy-related discomfort, and reducing fertility stress [45] . Currently, the UK has established a tiered care system for RPL patients, providing different levels of care and intervention based on the number of miscarriages a woman has experienced, which has significantly improved the post-miscarriage care experience for RPL patients and helped them proactively address their medical condition [46] . Therefore, reproductive clinics can establish a tiered care system based on the China local medical support model and establish clear outpatient and follow-up processes for different types of RPL patients. In addition, nurses can schedule follow-up appointments for RPL patients and provide corresponding nursing measures to ensure patients attend follow-up appointments on time and as needed, thereby improving RPL patients' ability to actively cope with their condition. Furthermore, a multi-support mechanism involving hospitals, communities, and families can be established, implementing dynamic tracking management and one-stop referral systems to facilitate patient visits, meet medical support needs, and improve the FertiQoL. Conclusion The results of this study showed that the FertiQoL of RPL patients is at a relatively low level and influenced by factors, such as employment status, history of late-term abortion, fertility stress, IU, and coping styles. Furthermore, fertility stress, IU, positive coping, and negative coping have multiple pathways of influence on the FertiQoL. Healthcare providers should prioritize and proactively assess the FertiQoL of RPL patients, engage in effective communication to clarify their needs, provide clear disease information, and offer targeted health education and supportive care to help them cope positively and improve the FertiQoL. This study used a cross-sectional survey method. Future research will explore the trajectory of changes in the FertiQoL among RPL patients and the characteristics of each stage, providing theoretical basis for developing targeted intervention strategies. Declarations Ethics approval and consent to participate Ethical approval was obtained from the Ethics Review Committee of the Second Affiliated Hospital of Soochow University (Approval: JD-LC2024021-I01) and completed registration review (Registration in 29 th April 2024 with the Chinese Clinical Trial Registry: ChiCTR2400083648). The study complies with the World Medical Association's Declaration of Helsinki (revised in 2003) — Ethical Principles for Medical Research Involving Human Subjects. Participants of the study were informed about the purpose, objectives, their right to decline participation or withdraw their participation. A written consent was then obtained. Privacy and confidentiality were maintained throughout the study. Consent for publication All authors agree to publication. Availability of data and material The datasets used and/or analysed during the current study available from the corresponding author on reasonable. Competing interests None of the authors have any competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Authors' contributions Survey conception: Ying Li, Meng Zhang; questionnaire implementation: Haiyan Xue, Jingya Gong; data analysis and interpretation: Meng Zhang, Mengtian Zhang, Mingyan Tang; writing; original draft preparation: Meng Zhang, Mengtian Zhang; writing; review and editing: Mengtian Zhang, Mingyan Tang, Liping Tan; project administration: Liping Tan, Mingyan Tang. Acknowledgments The authors acknowledge and thank all participants and experts for their participation and contribution to this study. Authors' information Meng Zhang a,1 , Mengtian Zhang a,1 , Ying Li a,2 , Haiyan Xue a,3 , Jingya Gong a,4 , Mingyan Tang a, *, Liping Tan a, * a Department of Nursing, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China * Correspondence: Liping Tan (Primary corresponding author), Email: [email protected] ; Mingyan Tang, Email: [email protected] . Correspondence: Liping Tan (Primary corresponding author), Master Degree, Telephone: +86-0512-67783325, Email: [email protected] ; The Second Affiliated Hospital of Soochow University; No.999, Sanxiang Road, Gusu District, Suzhou City, Jiangsu Province, China. Mingyan Tang, Bachelor Degree , Telephone: +86-0512-67784924, Email: [email protected] ; The Second Affiliated Hospital of Soochow University; No.999, Sanxiang Road, Gusu District, Suzhou City, Jiangsu Province, China 1 Meng Zhang and Mengtian Zhang share the first authorship. *Liping Tan and Mingyan Tang share the corresponding authorship. 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Analysis of influencing factors of perceived uncertainty in the process of re-pregnancy in patients with recurrent abortion and nursing implications[J]. Chinese Journal of Nursing, 2025, 60(14): 1677-1683. Sahib A, Chen J, Cárdenas D, et al. Intolerance of uncertainty and emotion regulation: A meta-analytic and systematic review[J].Clin Psychol Rev, 2023,101:102270. Çankaya S, İbrahimoğlu T. Stress, anxiety, intolerance of uncertainty, and psychological well-being characteristics of pregnant women with and without threatened miscarriage: a case-control study[J]. J Obstet Gynaecol. 2022;42(8):3577-3583. Ji Kemeng, Li Zhizheng, ZHAO Ying, et al. Effect of Intolerance of Uncertainty on Fear of Childbirth in Primiparas：A Moderated Mediating Model[J]. J Sichuan Univ(Med Sci), 2023,54(4):837-842. Rúger-Navarrete A, Vázquez-Lara JM, Antúnez-Calvente I, et al. Antenatal Fear of Childbirth as a Risk Factor for a Bad Childbirth Experience[J]. Healthcare (Basel). 2023;11(3):297. Rahimi H, Pirmoradi M, Lavasani FF, et al. The effectiveness of group intervention focused on intolerance of uncertainty on psychological distress and quality of life in multiple sclerosis patients[J]. J Educ Health Promot. 2023;12:29. Yao N S, Yang Y, Jiang Y, et al. Intolerance of uncertainty relates to anxiety and depression through negative coping and worry: evidence from a repeated-measures study[J]. Int J Cogn Ther, 2022, 15(1): 42-56. Rozgonjuk D, Elhai J D, Täht K, et al. “Non-social smartphone use mediates the relationship between intolerance of uncertainty and problematic smartphone use: Evidence from a repeated-measures study” [J]. Comput Hum Behav, 2019, 96: 56-62. Koert E, Hartwig TS, Hviid Malling GM, et al. 'You're never pregnant in the same way again': prior early pregnancy loss influences need for health care and support in subsequent pregnancy[J]. Hum Reprod Open. 2023;2023(3):hoad032. LI Jingling, XU Xiaoyan, LI Jing, et al. Correlation study of pregnancy stress, pre-pregnancy health care behavior and coping style of pregnant women [J]. Journal of Shanghai Jiaotong University (Medical Science), 2024,44(8):968-974. Coomarasamy A, Dhillon-Smith RK, Papadopoulou A, et al. Recurrent miscarriage: evidence to accelerate action[J]. Lancet. 2021;397(10285):1675-1682. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 14 Oct, 2025 Reviewers invited by journal 08 Oct, 2025 Editor invited by journal 05 Sep, 2025 Editor assigned by journal 04 Sep, 2025 Submission checks completed at journal 04 Sep, 2025 First submitted to journal 01 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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23:18:48","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":156345,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7505131/v1/1f591326ca82dbaa7acadc16.html"},{"id":94047888,"identity":"3e50bcf8-5919-4a5e-8a2d-74730c5489e7","added_by":"auto","created_at":"2025-10-21 23:18:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":210414,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePath model diagram of factors affecting the FertiQoLof patients with RPL\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7505131/v1/e445016b06f9819cbb769478.png"},{"id":94049386,"identity":"7e104ed5-e3e8-4996-984c-0aa5143c1dec","added_by":"auto","created_at":"2025-10-21 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Due to changes in contemporary lifestyles, increased costs of childbearing, and shifts in reproductive attitudes among individuals of childbearing age, the fertility intentions of this demographic have been steadily declining, the incidence of RPL have a gradual increase. Despite extensive diagnostic investigations, over 40% of cases remain unexplained\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Additionally, there are no specific guidelines regarding the definition, diagnostic workup and treatment of RPL at present, RPL has become a significant reproductive challenge.\u003c/p\u003e\u003cp\u003eAs pregnancy losses are generally experienced as significant negative life events, RPL is a frustrating and painful experience for most women and seriously affects their psychological status, reproductive health, and quality of life(QoL)\u003csup\u003e[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. A longitudinal study indicates that quality of life is associated with pregnancy outcomes in women with fertility issues\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Consequently, women's quality of life is of paramount importance and warrants significant attention. Assessing quality of life not only helps healthcare professionals gain a comprehensive understanding of an individual's self-perceived health status to determine whether follow-up interventions are needed, but also assists them in identifying issues requiring special attention.\u003c/p\u003e\u003cp\u003eFertility quality of life (FertiQoL) is an important component of quality of life and can comprehensively assess the impact of fertility-related issues on patient emotions, physical and mental health, and marital and social relationships\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. FertiQoL is an important indicator for evaluating patients' psychological status, the effect of care and recovery, and also a significant predictor of reproductive outcomes and treatment effects. FertiQoL contains multiple dimensions covering different aspects of health, including specific aspects for women receiving infertility treatments. Therefore, accurately assessing the FertiQoL level in RPL patients and determining the factors influencing FertiQoL can more precisely identify the impact of fertility issues on RPL patients, which is of great significance for promoting psychological well-being and reproductive health and improving their pregnancy outcomes. However, current domestic and international research has only focused on the correlation between FertiQoL in RPL patients and fertility stress and negative psychology\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e without any research on the factors influencing FertiQoL in RPL patients. Therefore, this study was based on the ABC-X model\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e and comprehensively considered the interactive influence of the individual and social environments, accurately assessed the FertiQoL level in RPL patients, and determined the influencing factors and pathway to provide scientific theoretical support for formulating targeted intervention strategies to improve the FertiQoL in RPL patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy setting and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional survey was administered to RPL patients in the reproductive clinics on two campuses of a tertiary general hospital in Suzhou from November 2023 to November 2024. Informed consent was obtained from all participants included in the study. All patients were consecutively recruited by a trained nurse. The inclusion criteria were as follows: (i) 20\u0026ndash;50 years of age; (ii) \u003cu\u003e\u0026gt;\u003c/u\u003e 2 miscarriages or stillbirths before 28 weeks gestation and (iii) ability to understand and complete the questionnaires. The exclusion criterion was having a history of mental illness or a severe medical condition that could interfere with the baseline measurements. The sample size was determined to be 10\u0026mdash;15 times the number of research variables according to the Kendall sample size estimation method and requirements of structural equation models. This study included 26 variables and considering a 15% sample loss rate, the sample size was determined to be 305\u0026ndash;458 cases. The final sample size was 325 cases. This study has been approved by the hospital Ethics Committee (JD-LC2024021-I01).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstruments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral Information Questionnaire\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data were collected using a self-administered, structured questionnaire, which included a study-specific questionnaire on sociodemographic variables and clinically relevant information. To assess psychological adjustment related to RPL, scales measuring perceived stress, dispositional mindfulness, negative emotion, and FertiQoL were administered.\u003c/p\u003e\n\u003cp\u003eThe demographic and clinical questionnaire was designed by the authors, which included age, residence,\u0026nbsp;BMI index, Status of medical insurance, marital status, education level, monthly household income, employment status, fertility history, history of late-term abortion, number of abortions, history with assisted reproductive therapy, and duration of infertility. Clinical data were collected from the medical records.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFertiQoL tool\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe FertiQoL tool was designed by Boivin\u003csup\u003e[12]\u003c/sup\u003e in 2011 to measure the QoL in individuals experiencing infertility; the Cronbach\u0026apos; s \u0026alpha;\u0026nbsp;of the Chinese version of the FertiQoL is 0.907\u003csup\u003e[13]\u003c/sup\u003e. The FertiQoL tool contains 36 items and 2 modules (a core FertiQoL module and an optional treatment FertiQoL module). The core FertiQoL module is divided into four fields (emotional, mind-body, relationship, and social). The optional treatment FertiQoL module is divided into two fields (medical environment and treatment tolerance). The score for each item is 0\u0026ndash;4 points. The total scale and subscale scores can be converted into 0\u0026ndash;100-point scales. The standard score was calculated by multiplying the total scale raw score by 25 and dividing by the total number of items in the scale. The higher the score, the higher the FertiQoL. FertiQoL has good reliability and validity and has been widely used in patients with fertility issues. The core FertiQoL module was selected to assess the FertiQoL of RPL patients in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFertility Problem Inventory (FPI)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe FPI scale was designed by Newton\u003csup\u003e[14]\u003c/sup\u003e in 1999 based on the Lazarus stress theory model. This scale has been widely used to measure the perceived stress related to fertility. The Cronbach\u0026apos; s \u0026alpha;\u0026nbsp;of the Chinese version of the FPI is 0.81\u003csup\u003e[15]\u003c/sup\u003e. The FPI includes 46 items divided into five domains (social concern, relationship concern, sexual concern, the need for parenthood, and rejection of a child-free lifestyle). The score for each item was 1\u0026ndash;6 points. The total score ranged from 46\u0026ndash;276 points. A higher score indicated higher\u0026nbsp;fertility stress.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntolerance of Uncertainty Scale-12 (IUS-12)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe IUS-12 is a 12-item scale assessing negative beliefs about and reactions to uncertainty. Carleton\u003csup\u003e[16]\u003c/sup\u003e developed the simplified version of the IUS-12 in 2007 based on the IUS-27 to measure patient responses to uncertain situations and events. The Cronbach\u0026apos; s \u0026alpha;\u0026nbsp;of the Chinese version of the IUS-12, which was applied to college students, is 0.878\u003csup\u003e[17]\u003c/sup\u003e. The scale consists of two parts (prospective anxiety and inhibitory anxiety). Each item is rated on a 5-point Likert scale (1 = not at all characteristic of me; 5 = entirely characteristic of me) and the range of this scale is 12\u0026ndash;60. The higher the score, the higher the uncertainty in the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSimplified Coping Style Questionnaire (SCSQ)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe SCSQ was designed by Xie Yaying in 1998 based on the theory of coping styles and integrating relevant research at home and abroad\u003csup\u003e[18]\u003c/sup\u003e. The SCSQ is used to measure an individual\u0026apos;s coping style when facing stress. The SCSQ has good reliability and validity. The SCSQ consists of 20 items and 2 dimensions (positive coping and negative coping). A 4-point Likert scale is used for scoring with a score range of 0\u0026ndash;60. The higher the SCSQ score, the more the individual tends to adopt a positive or negative coping style.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Ethics Review Committee of the Second Affiliated Hospital of Soochow University (Approval: JD-LC2024021-I01) and completed registration review (Registration in 29\u003csup\u003eth\u003c/sup\u003e April 2024 with the Chinese Clinical Trial Registry: ChiCTR2400083648). The study complies with the World Medical Association\u0026apos;s Declaration of Helsinki (revised in 2003)\u0026nbsp;\u0026mdash;\u0026nbsp;Ethical Principles for Medical Research Involving Human Subjects. Participants of the study were informed about the purpose, objectives, their right to decline participation or withdraw their participation. A written consent was then obtained. Privacy and confidentiality were maintained throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants voluntarily provided written informed consent. All data were collected by well-trained collectors using a face-to-face data collection method and remained confidential. Data collection took place at the initial visit of RPL patients. Participants were invited to complete the self-administered questionnaire in a quiet space, with researchers patiently answering any questions about the questionnaire during the filling process; this process took approximately 20\u0026ndash;30 \u0026nbsp;min. After the completion of the survey, the contents of the questionnaire were verified by two trained researchers. Any questionnaires with missing or unclear data were revisited and refilled.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExcel was used for data entry and SPSS 27.0 software was used for data analysis. The measurement data are presented as the mean\u0026plusmn;standard deviation and enumeration data are expressed as a frequency and constituent ratio (%). The difference in the demographic and disease characteristic variables of the FertiQoL was tested by an independent sample t-test and single-factor variance analysis. FertiQoL, fertility stress, IU, and coping styles underwent Pearson correlation analysis. The factors influencing FertiQoL were analysed by multiple linear regression analysis. A \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic characteristics of participants and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSingle-factor analysis of FertiQoL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 325 questionnaires were distributed to RPL patients and 305 valid questionnaires were obtained for an effective recovery rate of 93.8%. The average age of the participants was 32.01 years (SD = 3.84) and the average duration of infertility was 1.88 years (SD = 2.36). The results of the single-factor analysis showed that there were statistically significant differences in FertiQoL among RPL patients with respect to monthly household income, residence, status of medical insurance, educational level, history of late miscarriage, number of miscarriages, history of assisted reproductive therapy, and employment status (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). The detailed results are shown in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 A one-way analysis of respondent general information and FertiQoL\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en = 305\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"106%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFertiQoL(M\u003c/strong\u003e\u003cstrong\u003e\u0026plusmn;\u003c/strong\u003e\u003cstrong\u003eSD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003et/F\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge(years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e20～29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e81\u0026nbsp;(26.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e59.88\u0026plusmn;20.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.635\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e30～40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e215\u0026nbsp;(70.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e57.32\u0026plusmn;21.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e40～50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e9\u0026nbsp;(2.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e59.38\u0026plusmn;17.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonthly household income(Yuan)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e＜3000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e11\u0026nbsp;(3.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e27.56\u0026plusmn;7.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e17.629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e3000～6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e178\u0026nbsp;(58.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e56.50\u0026plusmn;21.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e＞6000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e116\u0026nbsp;(38.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e63.35\u0026plusmn;18.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eCity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e206 (67.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e61.33\u0026plusmn;19.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e3.864\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eTown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e99 (32.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e51.25\u0026plusmn;22.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatus of medical insurance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e264 (86.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e60.61\u0026plusmn;19.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e5.659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e41 (13.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e41.67\u0026plusmn;20.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eFirst marriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e287 (94.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e58.27\u0026plusmn;20.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.692\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.489\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eRemarriage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e18 (5.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e54.75\u0026plusmn;21.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eSenior high school or below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e39\u0026nbsp;(12.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e44.26\u0026plusmn;20.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e16.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eHigher vocational education/ University degree\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e239\u0026nbsp;(78.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e58.74\u0026plusmn;20.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s degree and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e27\u0026nbsp;(8.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e71.99\u0026plusmn;6.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e＜18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e17\u0026nbsp;(5.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e59.19\u0026plusmn;21.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.870\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.457\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e18.5～23.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e210\u0026nbsp;(68.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e59.11\u0026plusmn;20.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e24～27.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e64\u0026nbsp;(20.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e55.66\u0026plusmn;22.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u0026ge;28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e14\u0026nbsp;(4.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e51.93\u0026plusmn;21.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eOn-the-job\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e238\u0026nbsp;(78.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e61.06\u0026plusmn;20.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e5.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eRest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e67\u0026nbsp;(21.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e56.29\u0026plusmn;21.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of abortions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e171\u0026nbsp;(56.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e50.79\u0026plusmn;20.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e2.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e84(27.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e60.86\u0026plusmn;20.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e\u0026ge;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e50\u0026nbsp;(16.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e55.33\u0026plusmn;21.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of infertility (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e＜1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e134 (72.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e56.99\u0026plusmn;19.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e1.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e1～3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e116 (19.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e58.60\u0026plusmn;20.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003e＞3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e55 (8.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e55.12\u0026plusmn;22.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFertility history\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e258 (84.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e61.29\u0026plusmn;19.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e5.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e47 (15.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e46.58\u0026plusmn;21.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of late-term abortion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e238\u0026nbsp;(78.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e60.24\u0026plusmn;20.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e2.890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e67\u0026nbsp;(21.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e52.69\u0026plusmn;21.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory with assisted reproductive therapy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e217\u0026nbsp;(71.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e60.91\u0026plusmn;19.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e4.625\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003e88\u0026nbsp;(28.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e47.95\u0026plusmn;21.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eScale scores and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCorrelation analysis between variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe total FertiQoL score was 58.06 (SD = 20.93). The mean physical and mental quality dimension score was the highest (59.33 [SD = 24.55]), while the marital relationship dimension score was the lowest (55.88 [SD = 25.33]). The mean total FPI, IU, and SCSQ scores were 136.39 (SD = 44.22), 35.76 (SD = 11.31), and 32.88 (SD = 8.86), respectively. Pearson correlation analysis was used to analyze the correlations among fertility stress, IU, positive coping, negative coping, and FertiQoL in RPL patients. The results showed that the FertiQoL in RPL patients was negatively correlated with fertility stress (r = -0.517, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01), negatively correlated with IU (r = -0.372, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01), positively correlated with positive coping score (r = 0.527, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01), and negatively correlated with negative coping score (r = -0.492, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01). The detailed results are shown in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Matrix of correlations coefficients between variables\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en = 305\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"101%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1 FertiQoL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e58.06\u0026plusmn;20.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2 FPI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e136.39\u0026plusmn;44.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.517**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 IU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e35.76\u0026plusmn;11.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.372**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.237**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003epositive coping\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e23.79\u0026plusmn;9.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.527**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.535**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.265**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5 negative coping\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e9.09\u0026plusmn;6.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.492**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.470**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e0.345**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.452**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNote:\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;**indicates \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.01\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariate linear regression analysis of FertiQoL in patients with RPL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultivariate linear regression analysis showed that employment status, history of late-term abortion, fertility stress, IU, positive coping, and negative coping were the main factors influencing the FertiQoL in patients with RPL (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05). The detailed results are shown in Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Multiple linear regression analysis of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ethe fertility quality of life\u0026nbsp;in patients with recurrent spontaneous abortion\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en = 305\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"101%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnstandardized coefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026beta;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003et\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eB\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(Constant)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e69.345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e11.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e6.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-5.377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-2.418\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of late-term abortion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-4.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e2.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-2.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFertility stress\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-4.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-3.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive coping\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e4.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNegative coping\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.462\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e-0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-2.859\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eNote: R\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e= 0.499, adjusted \u003cem\u003eR\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e= 0.469, \u003cem\u003eF\u0026nbsp;\u003c/em\u003e= 16.824, \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e＜\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;0.001\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePathway analysis of FertiQoL in patients with RPL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConstruction and revision of the path analysis model\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe revised model was evaluated using indicators, \u003cem\u003ec\u003c/em\u003e\u003cem\u003e\u0026sup2;\u003c/em\u003e/\u003cem\u003edf\u003c/em\u003e=1.990\u003cem\u003e,\u003c/em\u003e GFI=0.943, AGFI=0.912, RMSEA=0.057, IFI=0.969, and CFI=0969. The results showed that the revised model fit well. Based on a comprehensive consideration of previous research results in related fields, the initial model for the FertiQoL of RPL patients was revised and adjusted in accordance with model revision principles and the revision prompts of AMOS 26.0 software combined with the \u003cem\u003eP\u003c/em\u003e-values of the revised path coefficients and the revised indices to obtain an acceptable revised model of the factors influencing the FertiQoL of RPL patients based on the ABC-X model (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePathways through which influencing factors affect FertiQol\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of the path coefficients in the corrected model are shown in Table 4. The results showed that all path coefficients were significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Path coefficients of the corrected mode\u003c/strong\u003e\u003cstrong\u003el\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"635\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 249px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEstimate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandardized\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEstimate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eS.E.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eC.R.\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003efertility stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026rarr;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003eFertiQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e-0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e-4.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eIU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026rarr;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003eFertiQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e-0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e-3.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003epositive coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026rarr;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003eFertiQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e4.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003enegative coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026rarr;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003eFertiQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e-0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e-2.891\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003efertility stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026rarr;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003epositive coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e-0.607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e-0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e-10.269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003efertility stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026rarr;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003enegative coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e7.886\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eIU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026rarr;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003enegative coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e0.415\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e4.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe detailed results of the analysis of the effects of fertility stress, IU, and coping styles on the FertiQoL of RPL patients are shown in Table 5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5 Decomposition of the effects between factors in the corrected model\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"114%\" class=\"fr-table-selection-hover\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndependent variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDependent variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirect effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndirect effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003efertility stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eFertiQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.548\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eIU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eFertiQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.250\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003epositive coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eFertiQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003enegative coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eFertiQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.177\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003efertility stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003epositive coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e-0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003efertility stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003enegative coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25px;\"\u003e\n \u003cp\u003eIU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003enegative coping\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe path analysis results showed that positive coping mediates the relationship between fertility stress and FertiQoL, negative coping mediates the relationship between fertility stress and FertiQoL, and negative coping mediates the relationship between IU and FertiQoL. All path coefficients were significant (Table 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6 Decomposition of the mediating effect in the modified model\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"125%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePathway\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffectiveness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBootstrap 95%CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect proportion(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 25px;\"\u003e\n \u003cp\u003efertility stress\u0026rarr;positive coping\u0026rarr; FertiQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eDirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e67%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eIndirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e32%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eTotal effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-0.322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e／\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 25px;\"\u003e\n \u003cp\u003efertility stress\u0026rarr;negative coping\u0026rarr; FertiQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eDirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e80%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eIndirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eTotal effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.396\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e／\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 25px;\"\u003e\n \u003cp\u003eIU\u0026rarr;negative coping\u0026rarr;FertiQoL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eDirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.331\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e82%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eIndirect effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e18%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003eTotal effect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 13px;\"\u003e\n \u003cp\u003e-0.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e-0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e／\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cstrong\u003eCurrent status of\u0026nbsp;FertiQoL in\u0026nbsp;RPL patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe FertiQoL score of RPL patients was 58.06 (SD = 20.93). The findings showed that participants experienced comparably poor FertiQoL compared to RPL patients in the Li study\u003csup\u003e[10]\u003c/sup\u003e. Reproductive failure not only brings physical trauma to RPL patients but also subjects patients to more social pressure and an increased economic burden\u003csup\u003e[19]\u003c/sup\u003e. In addition, among all the FertiQoL dimensions assessed in this study, the social dimension score was the highest (59.63\u0026plusmn;24.38), suggesting that the social impact on RPL patients was relatively mild. Of RPL patients, 87.36% have\u0026nbsp;a junior college degree\u0026nbsp;and above, indicating a relatively high level of education. Approximately 86.56% of RPL patients had medical insurance, which contributes to the proactive attitude toward seeking medical care and provides RPL patients with relatively abundant medical resources. Moreover, the relationship dimension scored the lowest (55.88\u0026plusmn;25.33), which may be attributed to RPL patients failing to meet the need for fertility and pressure from their spouse and family members. The deteriorating emotional communication between couples due to fertility issues and mutual suspicion, which severely affected marital relationships. The study showed that joint treatment and active intervention for couples are necessary conditions to solve couples\u0026apos; psychological problems and improve communication status, which can significantly improve the FertiQoL of both partners\u003csup\u003e[20]\u003c/sup\u003e. Moreover, the emotional interaction and mutual support between spouses are closely related to successful treatment outcomes\u003csup\u003e[21]\u003c/sup\u003e. Therefore, healthcare professionals should focus on the treatment needs of RPL patients and systematically assess the psychological status of both partners, fully understand their emotional states, encourage male support and companionship, and implement couple-centered interventions for RPL patients with a lower FertiQoL level, emphasizing that reproduction is a shared responsibility requiring mutual understanding, support, and joint efforts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInfluencing factors and pathways for FertiQoL in RPL patients\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEmployed RPL patients have a higher FertiQoL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study showed that employed RPL patients had a higher FertiQoL, which was similar to the findings of Sun\u003csup\u003e[22]\u003c/sup\u003e. This finding may be because the occurrence of RPL is a complex process involving multiple factors and the proportion of etiological components varies with the number and timing of previous miscarriages\u003csup\u003e[3]\u003c/sup\u003e. Therefore, multiple screening tests are often required to identify the etiology of RPL, thereby increasing the economic burden on RPL patients. Employed RPL patients have stable economic income sources and lower economic pressure, which alleviates the obstacles patients face during treatment to some extent. Additionally, work distracts patients from reproductive issues, thereby resulting in higher FertiQoL levels. However, clinical observations indicate that RPL patients are highly sensitive to symptoms associated with miscarriage due to anxiety and fear regarding miscarriage, just like lower abdominal discomfort and increased vaginal discharge during early pregnancy. RPL patients tend to take as much time off work as possible or even resign. However, previous studies have shown that bedrest does not decrease the risk of miscarriage\u003csup\u003e[23]\u003c/sup\u003e. A healthy lifestyle is the key measure for preventing preterm birth\u003csup\u003e[24]\u003c/sup\u003e. Therefore, it is recommended that physicians should assess the health status of RPL patients, provide personalized activity guidance during pregnancy, help RPL patients improve their health, and enhance confidence in RPL patients by maintaining normal work and daily life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRPL patients with a history of late miscarriage have a lower FertiQoL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrevious studies have shown that miscarriage is classified as a traumatic event and women experience high levels of post-traumatic stress, anxiety, and depression after miscarriage with this distress often persisting at high levels for up to 9 months\u003csup\u003e[25]\u003c/sup\u003e. Pregnant women develop an internal attachment to the fetus by seeing fetal images during ultrasound examinations and feeling fetal movement. Late-term miscarriage damages the symbiotic relationship between mother and fetus, leading to higher levels of grief after late-term miscarriage\u003csup\u003e[26]\u003c/sup\u003e. Additionally, patients with a history of late-term miscarriage have an increased risk of recurrent late-term miscarriage or preterm birth\u003csup\u003e[27]\u003c/sup\u003e. A history of late-term miscarriage causes significant physical and psychological trauma for women, resulting in a lower FertiQoL. Studies have shown that women who have experienced a late-term miscarriage need opportunities to communicate with and say goodbye to the fetus\u003csup\u003e[28]\u003c/sup\u003e. Emotional well-being should be prioritized and a supportive healthcare environment should be provided for women who have experienced a late-term miscarriage. Healthcare satisfaction and information about post-miscarriage physical changes are significantly associated with reduced rates of perinatal grief following a miscarriage\u003csup\u003e[29]\u003c/sup\u003e. Therefore, hospitals should train healthcare providers involved in miscarriage care to adopt respectful and empathetic communication, enhance information support, provide patient-centered interactive care, prioritize the physical and mental health of both partners, establish post-abortion care rooms, and encourage partner participation to offer medical assistance and emotional support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFertility stress in RPL patients has direct and indirect effects on FertiQoL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe path analysis results of this study showed that the total effect value of fertility stress on FertiQoL for RPL patients was -0.548 (direct effect = -0.315, indirect effect = -0.232). Based on different coping styles, two paths were identified (fertility stress\u0026nbsp;\u0026rarr;\u0026nbsp;positive coping\u0026nbsp;\u0026rarr;\u0026nbsp;FertiQoL; and fertility stress\u0026nbsp;\u0026rarr;\u0026nbsp;negative coping\u0026nbsp;\u0026rarr;\u0026nbsp;FertiQoL). The indirect effect values for these paths were -0.151 and -0.081, respectively. This finding indicates that fertility stress not only has a direct negative impact on the FertiQoL of RPL patients (r = -0.517, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01) but also influences the FertiQoL level by affecting coping style. This finding is in agreement with the report by Zang\u003csup\u003e[30]\u003c/sup\u003e. The reason for this finding may lie in the fact that RPL patients are subjected to pressure from traditional Chinese reproductive concepts, which result in significant fertility stress due to a history of miscarriage. RPL patients have different capacities to cope with and perceive fertility stress, leading RPL patients to choose different coping styles, which in turn affect the FertiQoL. A study in Jordan\u003csup\u003e[31]\u003c/sup\u003e showed that miscarriage can influence a woman\u0026apos;s decision to attempt pregnancy again. Emotional support from healthcare providers, friends, and family with accurate information about pregnancy and miscarriage provided to couples after a miscarriage are crucial in helping women cope with the loss of a miscarriage. Therefore, healthcare professionals need to closely monitor the fertility stress levels of RPL patients, assess whether their daily lives are negatively impacted during early pregnancy, and provide appropriate guidance and preconception counseling. For RPL patients with higher fertility stress levels, healthcare providers should increase communication with patients, thoroughly understand their obstetric history, and proactively provide information about RPL, including updates on disease progression. Additionally, based on the patient\u0026apos;s level of understanding and knowledge about the condition, face-to-face perinatal care knowledge and pregnancy guidance should be provided through prenatal education classes or specialized nursing clinics. Furthermore, research indicates that providing online mental health interventions for RPL patients addresses the time and location constraints of traditional care and enables patients to access information and receive social and emotional support online at any time\u003csup\u003e[32]\u003c/sup\u003e. Therefore, hospitals should establish online platforms to provide RPL patients with online psychological guidance courses to help them reduce fertility stress, choose positive coping styles, and ensure maternal and infant safety.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDirect and indirect effects of IU in RPL patients on FertiQoL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe IU score in RPL patients was 35.76\u0026nbsp;\u0026plusmn;\u0026nbsp;11.31, which was higher than the IU scores reported by Bai\u003csup\u003e[33]\u003c/sup\u003e, indicating a relatively high IU level. Path analysis results showed that the total effect of IU on FertiQoL was -0.250 (direct effect = -0.206; indirect effect = -0.044) with the indirect effect pathway being IU\u0026nbsp;\u0026rarr;\u0026nbsp;negative coping\u0026nbsp;\u0026rarr;\u0026nbsp;FertiQoL. The higher the IU level in RPL patients, the lower the FertiQoL (r = -0.372, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01). The IU can alter FertiQoL in RPL patients by influencing negative coping. This finding may be because the waiting period for re-pregnancy after miscarriage is a traumatic period filled with significant uncertainty and emotional turmoil for RPL patients\u003csup\u003e[34]\u003c/sup\u003e. In addition, RPL patients have a higher incidence of pregnancy complications during re-pregnancy compared to pregnant women without fertility issues\u003csup\u003e[35]\u003c/sup\u003e. RPL patients face higher reproductive risks and stress, making RPL patients more sensitive to unknown events, such as treatment and pregnancy outcomes compared to pregnant women without fertility issues\u003csup\u003e[36]\u003c/sup\u003e. Higher IU levels lead patients to perceive and cope with reproductive issues in a negative manner, exacerbating their sadness and suffering and resulting in a lower FertiQoL.\u003c/p\u003e\n\u003cp\u003eStudies have shown that high levels of IU not only significantly impair patients\u0026apos; daily functioning, negatively impact pregnant women\u0026apos;s mental health, but also increase childbirth anxiety in primiparas and complicating pregnancy\u003csup\u003e[37\u003c/sup\u003e\u003csup\u003e-\u003c/sup\u003e\u003csup\u003e40]\u003c/sup\u003e. Therefore, it is important to prioritize the IU levels in RPL patients. Rahimi\u003csup\u003e[41]\u003c/sup\u003e concluded that intervention programs based on IU are more effective than cognitive behavioral therapy and conventional treatment programs in reducing IU levels and improving the FertiQoL. Additionally, studies have shown that patients with high IU levels can reduce IU levels by seeking emotional and practical support as coping styles\u003csup\u003e[42]\u003c/sup\u003e. Smartphones, as important tools in the internet age, have a significant role in disseminating information and promoting healthy decision-making, thereby alleviating IU levels\u003csup\u003e[43]\u003c/sup\u003e. Therefore, when faced with younger RPL patients, healthcare providers can assess IU levels during the initial consultation and select IU-based intervention protocols to conduct online interventions, such as live science popularization lectures, establishing online communication channels, providing online consultations, and establishing WeChat groups. Through multi-modal and -channel approaches, the IU levels of RPL patients can be reduced, negative perceptions regarding fertility can be improved, an accurate understanding of the treatment methods applicable to their current RPL status can be facilitated, adherence to treatment and satisfaction can be enhanced, and the FertiQoL can be improved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDirect effects of coping styles on FertiQoL in RPL patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results of this study showed that RPL patients with lower levels of positive coping and higher levels of negative coping have higher FertiQoL levels (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001 and \u003cem\u003eP\u003c/em\u003e = 0.004, respectively). Positive and negative coping have direct effects on FertiQoL (direct effect: 0.256 and -0.177, respectively). This finding is consistent with the findings of Rahimi\u003csup\u003e[41]\u003c/sup\u003e because approximately 78% of RPL patients included in the current study were still employed and their busy work schedules prevented them from attending follow-up appointments promptly, resulting in lower levels of positive coping. However, due to the history of adverse pregnancies, RPL patients have a high demand for medical support, such as self-management and prenatal monitoring\u003csup\u003e[44]\u003c/sup\u003e. Failure to attend follow-up appointments on time leads to a lack of medical support, resulting in a lower FertiQoL among RPL patients. Additionally, some RPL patients remain unable to identify the underlying etiology for RPL despite repeated screenings. RPL patients may lose trust in the ability of medical institutions to improve pregnancy outcomes and adopt a passive coping strategy, such as discontinuing treatment or abandoning treatment altogether. This approach not only affects treatment outcomes but also fails to alleviate fertility stress, leading to a decline in the FertiQoL. Research indicates that healthcare providers should strengthen the dissemination of perinatal health knowledge among reproductive-age women, enhance health awareness, and encourage RPL patients to transition from passive acceptance to active participation in health protection by proactively addressing pregnancy-related discomfort, and reducing fertility stress\u003csup\u003e[45]\u003c/sup\u003e. Currently, the UK has established a tiered care system for RPL patients, providing different levels of care and intervention based on the number of miscarriages a woman has experienced, which has significantly improved the post-miscarriage care experience for RPL patients and helped them proactively address their medical condition\u003csup\u003e[46]\u003c/sup\u003e. Therefore, reproductive clinics can establish a tiered care system based on the China local medical support model and establish clear outpatient and follow-up processes for different types of RPL patients. In addition, nurses can schedule follow-up appointments for RPL patients and provide corresponding nursing measures to ensure patients attend follow-up appointments on time and as needed, thereby improving RPL patients\u0026apos; ability to actively cope with their condition. Furthermore, a multi-support mechanism involving hospitals, communities, and families can be established, implementing dynamic tracking management and one-stop referral systems to facilitate patient visits, meet medical support needs, and improve the FertiQoL.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study showed that the FertiQoL of RPL patients is at a relatively low level and influenced by factors, such as employment status, history of late-term abortion, fertility stress, IU, and coping styles. Furthermore, fertility stress, IU, positive coping, and negative coping have multiple pathways of influence on the FertiQoL. Healthcare providers should prioritize and proactively assess the FertiQoL of RPL patients, engage in effective communication to clarify their needs, provide clear disease information, and offer targeted health education and supportive care to help them cope positively and improve the FertiQoL. This study used a cross-sectional survey method. Future research will explore the trajectory of changes in the FertiQoL among RPL patients and the characteristics of each stage, providing theoretical basis for developing targeted intervention strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Ethics Review Committee of the Second Affiliated Hospital of Soochow University (Approval: JD-LC2024021-I01) and completed registration review (Registration in 29\u003csup\u003eth\u003c/sup\u003e April 2024 with the Chinese Clinical Trial Registry: ChiCTR2400083648). The study complies with the World Medical Association\u0026apos;s Declaration of Helsinki (revised in 2003)\u0026nbsp;\u0026mdash;\u0026nbsp;Ethical Principles for Medical Research Involving Human Subjects. Participants of the study were informed about the purpose, objectives, their right to decline participation or withdraw their participation. A written consent was then obtained. Privacy and confidentiality were maintained throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors agree to publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the authors have any competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSurvey conception: Ying Li, Meng Zhang; questionnaire implementation: Haiyan Xue, Jingya Gong; data analysis and interpretation: Meng Zhang, Mengtian Zhang, Mingyan Tang; writing; original draft preparation: Meng Zhang, Mengtian Zhang; writing; review and editing: Mengtian Zhang, Mingyan Tang, Liping Tan; project administration: Liping Tan, Mingyan Tang.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge and thank all participants and experts for their participation and contribution to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMeng Zhang\u003csup\u003ea,1\u003c/sup\u003e, Mengtian Zhang\u003csup\u003ea,1\u003c/sup\u003e, Ying Li\u003csup\u003ea,2\u003c/sup\u003e, Haiyan Xue\u003csup\u003ea,3\u003c/sup\u003e, Jingya Gong\u003csup\u003ea,4\u003c/sup\u003e, Mingyan Tang\u003csup\u003ea,\u003c/sup\u003e*, Liping Tan\u003csup\u003ea,\u003c/sup\u003e*\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eDepartment of Nursing, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e* Correspondence: Liping Tan (Primary corresponding author), Email: [email protected]; Mingyan Tang, Email: [email protected].\u003c/p\u003e\n\u003cp\u003eCorrespondence: Liping Tan (Primary corresponding author), Master Degree, Telephone: +86-0512-67783325, Email: [email protected]; The Second Affiliated Hospital of Soochow University; No.999, Sanxiang Road, Gusu District, Suzhou City, Jiangsu Province, China.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMingyan Tang, Bachelor Degree , Telephone: +86-0512-67784924, Email: [email protected]; The Second Affiliated Hospital of Soochow University; No.999, Sanxiang Road, Gusu District, Suzhou City, Jiangsu Province, China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Meng Zhang and Mengtian Zhang share the first authorship.\u003c/p\u003e\n\u003cp\u003e*Liping Tan and Mingyan Tang share the corresponding authorship.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBender Atik R, Christiansen O B, Elson J, et al. 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Recurrent miscarriage: evidence to accelerate action[J]. Lancet. 2021;397(10285):1675-1682. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Fertility Quality of Life, Recurrent Pregnancy Loss, ABC-X Model, Influencing Factors, Path Analysis","lastPublishedDoi":"10.21203/rs.3.rs-7505131/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7505131/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eRecurrent miscarriages cause significant psychological and physical trauma to patients with recurrent pregnancy loss (RPL), which is severely affects the quality of life of RPL patients. However, there is still a lack of in-depth understanding in the academic community regarding which factors influence fertility quality of life (FertiQoL) and through what mechanisms. By constructing structural equations within the ABC-X theoretical model framework, it is possible to more clearly reveal the intrinsic connections between stressors and stress outcomes. This study identified the status and factors influencing FertiQoL in patients with RPL based on the ABC-X model. In addition, the effects on the FertiQoL in RPL patients with fertility stress, coping style, and intolerance of uncertainty (IU) were clarified.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA convenience sampling method was used to study 325 patients with RPL from two reproductive clinics of a tertiary hospital in Suzhou from November 2023 to November 2024 using a self-designed general data questionnaire, the FertiQoL tool, the Fertility Problem Inventory (FPI), the Intolerance of Uncertainty Scale-12 (IUS-12), and the Simple Coping Style Questionnaire (SCSQ). Single factor analysis and multiple linear regression methods were used to analyze the factors influencing FertiQoL in patients with RPL.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe mean score and standard deviation of FertiQoL score in patients with RPL was 58.06\u0026thinsp;\u0026plusmn;\u0026thinsp;20.93. Multivariate linear regression analysis showed that employment status, history of late-term abortion, fertility stress, IU, positive coping, and negative coping were the main factors influencing the FertiQoL in patients with RPL (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The pathway analysis showed that fertility stress, IU, positive coping, and negative coping directly predict FertiQoL (\u003cem\u003eβ\u003c/em\u003e = -0.315, \u003cem\u003eβ\u003c/em\u003e = -0.206, \u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.256, \u003cem\u003eβ\u003c/em\u003e = -0.177, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01). Fertility stress directly predicted positive and negative coping (\u003cem\u003eβ\u003c/em\u003e = -0.590, \u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.459, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01). IU directly predicted negative coping (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.247, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01). Fertility stress indirectly acts on FertiQoL through positive and negative coping (\u003cem\u003eβ\u003c/em\u003e = -0.151, \u003cem\u003eβ\u003c/em\u003e = -0.081, \u003cem\u003eP\u003c/em\u003e \u0026lt;0.01). IU indirectly acts on FertiQoL through negative coping, which exerts a mediating effect (\u003cem\u003eβ\u003c/em\u003e = -0.044, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.01).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eThe FertiQoL level in patients with RPL is low. Healthcare providers should pay attention to the early identification of FertiQoL in patients and enhance the intervention in a timely manner.\u003c/p\u003e","manuscriptTitle":"Fertility quality of life and its potential causal mechanisms among recurrent pregnancy loss patients in China:a structural equation model analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-21 23:18:43","doi":"10.21203/rs.3.rs-7505131/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"162364843973862900347200783943083538405","date":"2025-10-14T09:14:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-08T12:04:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-05T07:01:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-04T11:57:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-04T11:55:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2025-09-01T06:49:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b61abbd8-2fe9-4fb1-9c06-5a84fc22aac3","owner":[],"postedDate":"October 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-21T23:18:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-21 23:18:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7505131","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7505131","identity":"rs-7505131","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}