The effect of job stress on fertility, its intention, and infertility treatment among the workers: a systematic review.

This systematic review study was registered on PROSPERO (CRD42023434146) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 31 ]. The Medical Ethics Committee of Shahrekord University of Medical Sciences approved the methods used in this study (IR.SKUMS.REC.1402.080). The PECO framework, for Population, Exposure, Comparator, and Outcome, clearly describes the relationship between the studied variables [ 32 ]. Table  1 summarizes the details of this framework. Table 1 PECO (population, exposure, comparator, and outcome) description PECO Evidence Population All people under job stress Exposure Job stress Comparator Variability in fertility, its intention, and infertility treatment process due to job stress Outcome Relationship between job stress and fertility, its intention, and infertility treatment process PECO (population, exposure, comparator, and outcome) description It was aimed to include articles with proper quality from four valid databases. Therefore, the systematic search was carried out in four electronic bibliographic databases, including Scopus, PubMed, Web of Science, and Embase, up to 25 November 2023. The combinations of three groups of keywords were used for the search. The first group of keywords included “job”, “occup*, work, and indust* and the second group consisted of stress, distress, and strain. The third group of keywords comprised pregnancy rate, fertility, infertility, fecundability, and childlessness. Table  2 describes the search strategy used in the databases. Various types of studies, including cohort, case-control, and cross-sectional research, were entered into the systematic review in English. The review and meta-analysis studies, editorial letters, case reports, and conference papers were omitted from the study. Moreover, animal research was extracted from the review. All searched papers were imported into Endnote and then, duplicated papers were removed. Eligible studies were identified by two independent researchers (S.M. and S.Y.) who evaluated the titles and abstracts of the articles. The papers with irrelated titles and abstracts were excluded, and the full text of the remaining papers was studied by two researchers to confirm the criteria (S.M. and S.Y.). Then, relevant papers were included in the review. In cases of disagreement between two researchers, a third researcher (A.M.) investigated the problem. To evaluate the quality of the case-control, cross-sectional, and cohort studies, critical appraisal tools of the Joanna Briggs Institute (JBI) were applied. The JBI checklist is a helpful tool to survey the quality of various studies [ 33 ]. After completion of these checklists, the number of positive answers was summed, and the total score was computed. Then, the papers were grouped into three categories of low quality, moderate quality, and high quality. The criteria of the checklist related to cohort study include similarity between two groups and populations, measurement of exposures in two groups similarly, validity and reliability of measured exposure, identification of confounding factors, determination of strategies to deal with confounding factors, freedom of participants of the outcome at the start of the study, validity and reliability of measured outcomes, sufficiency of follow up time, description of reasons for incomplete follow up, consideration of strategies to address incomplete follow up, and appropriateness of the used statistical analysis. The criteria of the checklist related to cross-sectional study consist of the definition of inclusion criteria, description of study subjects and the setting, validity and reliability of measured exposure, use of objective and standard criteria for measurement of the condition, identification of confounding factors, determination of strategies to deal with confounding factors, validity and reliability of measured outcomes, and appropriateness of the used statistical analysis. The criteria of the checklist related to the case-control study are comparability of case and control groups, matching of case and control groups, similarity of criteria used for identification of cases and controls, validity and reliability of measured exposure, similarity of method used for measurement of exposure in two groups, identification of confounding factors, determination of strategies to deal with confounding factors, validity and reliability of measured outcomes, sufficiency of exposure period, and appropriateness of the used statistical analysis. Table 2 The search strategy used in the databases Database Search strategy PubMed (((Fertility[Title/Abstract] OR Fecundability[Title/Abstract] OR Fecundity[Title/Abstract] OR Fertility Incentives[Title/Abstract] OR Fertility Incentive[Title/Abstract] OR Marital Fertility[Title/Abstract] OR “Fertility, Marital“[Title/Abstract] OR Natural Fertility[Title/Abstract] OR “Fertility, Natural“[Title/Abstract] OR World Fertility Survey[Title/Abstract] OR “Fertility Surveys, World“[Title/Abstract] OR “Fertility Survey, World“[Title/Abstract] OR “Surveys, World Fertility“[Title/Abstract] OR “Survey, World Fertility“[Title/Abstract] OR World Fertility Surveys[Title/Abstract] OR “Fertility, Below Replacement“[Title/Abstract] OR Below Replacement Fertility[Title/Abstract] OR Fertility Determinants[Title/Abstract] OR Determinant, Fertility[Title/Abstract] OR “Determinants, Fertility“[Title/Abstract] OR Fertility Determinant[Title/Abstract] OR Subfecundity[Title/Abstract] OR Differential Fertility[Title/Abstract] OR “Fertility, Differential“[Title/Abstract] OR Fertility Preferences[Title/Abstract] OR Fertility Preference[Title/Abstract] OR “Preference, Fertility “OR “Preferences, Fertility“[Title/Abstract]) OR ((Fertility[Title/Abstract] OR Fecundability[Title/Abstract] OR Fecundity[Title/Abstract] OR Fertility Incentives[Title/Abstract] OR Fertility Incentive[Title/Abstract] OR Marital Fertility[Title/Abstract] OR “Fertility, Marital“[Title/Abstract] OR Natural Fertility[Title/Abstract] OR “Fertility, Natural“[Title/Abstract] OR World Fertility Survey[Title/Abstract] OR “Fertility Surveys, World“[Title/Abstract] OR “Fertility Survey, World“[Title/Abstract] OR “Surveys, World Fertility“[Title/Abstract] OR “Survey, World Fertility“[Title/Abstract] OR World Fertility Surveys[Title/Abstract] OR “Fertility, Below Replacement“[Title/Abstract] OR Below Replacement Fertility[Title/Abstract] OR Fertility Determinants[Title/Abstract] OR Determinant, Fertility[Title/Abstract] OR “Determinants, Fertility“[Title/Abstract] OR Fertility Determinant[Title/Abstract] OR Subfecundity[Title/Abstract] OR Differential Fertility[Title/Abstract] OR “Fertility, Differential“[Title/Abstract] OR Fertility Preferences[Title/Abstract] OR Fertility Preference[Title/Abstract] OR “Preference, Fertility “OR “Preferences, Fertility“[Title/Abstract]) AND (Intention[Title/Abstract] OR Intentions[Title/Abstract])) OR ((“Sterility, Reproductive“[Title/Abstract] OR Reproductive Sterility[Title/Abstract] OR Sterility[Title/Abstract] OR Subfertility[Title/Abstract] OR Sub-Fertility[Title/Abstract] OR Infertility[Title/Abstract]) AND (Therapeutic[Title/Abstract] OR Therapy[Title/Abstract] OR Therapies[Title/Abstract] OR Treatment[Title/Abstract] OR Treatments[Title/Abstract]))) AND (Occupational Stresses[Title/Abstract] OR “Stress, Occupational“[Title/Abstract] OR Professional Stress[Title/Abstract] OR Professional Stresses[Title/Abstract] OR Stress, Professional“[Title/Abstract] OR Job Stress[Title/Abstract] OR Job Stresses[Title/Abstract] OR “Stress, Job“[Title/Abstract] OR Job-related Stress[Title/Abstract] OR Job related Stress[Title/Abstract] OR Job-related Stresses[Title/Abstract] OR “Stress, Job-related“[Title/Abstract] OR Workplace Stress[Title/Abstract] OR “Stresses, Workplace“[Title/Abstract] OR “Stress, Workplace“[Title/Abstract] OR Workplace Stresses[Title/Abstract] OR Work Place Stress[Title/Abstract] OR “Stress, Work Place“[Title/Abstract] OR Work Place Stresses[Title/Abstract] OR Work Stress[Title/Abstract] OR “Stress, Work“[Title/Abstract] OR Work Stresses[Title/Abstract] OR Work-related Stress[Title/Abstract] OR “Stress, Work-related“[Title/Abstract] OR Work related Stress[Title/Abstract] OR Work-related Stresses[Title/Abstract] OR Workplace Bullying[Title/Abstract] OR Bullying, Workplace[Title/Abstract] OR Workplace Abuse[Title/Abstract] OR Abuse, Workplace[Title/Abstract] OR Workplace Abuses[Title/Abstract] OR Job Demands[Title/Abstract] OR “Demand, Job“[Title/Abstract] OR Job Demand[Title/Abstract] OR Job Control[Title/Abstract]) AND (Occupational Stresses OR “Stress, Occupational” OR Professional Stress OR Professional Stresses OR Stress, Professional” OR Job Stress OR Job Stresses OR “Stress, Job” OR Job-related Stress OR Job related Stress OR Job-related Stresses OR “Stress, Job-related” OR Workplace Stress OR “Stresses, Workplace” OR “Stress, Workplace” OR Workplace Stresses OR Work Place Stress OR “Stress, Work Place” OR Work Place Stresses OR Work Stress OR “Stress, Work” OR Work Stresses OR Work-related Stress OR “Stress, Work-related” OR Work related Stress OR Work-related Stresses OR Workplace Bullying OR Bullying, Workplace OR Workplace Abuse OR Abuse, Workplace OR Workplace Abuses OR Job Demands OR “Demand, Job” OR Job Demand OR Job Control)) OR ((((“Therapeutics“[Mesh]) AND (“Infertility“[Mesh])) OR ((“Fertility“[Mesh]) AND (“Intention“[Mesh])) OR (“Fertility“[Mesh])) AND (“Occupational Stress“[Mesh]) AND (“Occupational Groups“[Mesh])) ISI #1; TS=(Fertility OR Fecundability OR Fecundity OR Fertility Incentives OR Fertility Incentive OR Marital Fertility OR “Fertility, Marital” OR Natural Fertility OR “Fertility, Natural” OR World Fertility Survey OR “Fertility Surveys, World” OR “Fertility Survey, World” OR “Surveys, World Fertility” OR “Survey, World Fertility” OR World Fertility Surveys OR “Fertility, Below Replacement” OR Below Replacement Fertility OR Fertility Determinants OR Determinant, Fertility OR “Determinants, Fertility” OR Fertility Determinant OR Subfecundity OR Differential Fertility OR “Fertility, Differential” OR Fertility Preferences OR Fertility Preference OR “Preference, Fertility ”OR “Preferences, Fertility” (Topic) And Intention OR Intentions (Topic) #2; TS=(“Sterility, Reproductive” OR Reproductive Sterility OR Sterility OR Subfertility OR Sub-Fertility OR Infertility)) AND TS=(Therapeutic OR Therapy OR Therapies OR Treatment OR Treatments) #3; TS=(Fertility OR Fecundability OR Fecundity OR Fertility Incentives OR Fertility Incentive OR Marital Fertility OR “Fertility, Marital” OR Natural Fertility OR “Fertility, Natural” OR World Fertility Survey OR “Fertility Surveys, World” OR “Fertility Survey, World” OR “Surveys, World Fertility” OR “Survey, World Fertility” OR World Fertility Surveys OR “Fertility, Below Replacement” OR Below Replacement Fertility OR Fertility Determinants OR Determinant, Fertility OR “Determinants, Fertility” OR Fertility Determinant OR Subfecundity OR Differential Fertility OR “Fertility, Differential” OR Fertility Preferences OR Fertility Preference OR “Preference, Fertility ”OR “Preferences, Fertility”) #4; #1 OR #2 OR #3 #5; TS=(Occupational Stresses OR Stress, Occupational OR Professional Stress OR Professional Stresses OR Stress, Professional OR Job Stress OR Job Stresses OR Stress, Job OR Job-related Stress OR Job related Stress OR Job-related Stresses OR Stress, Job-related OR Workplace Stress OR Stresses, Workplace OR Stress, Workplace OR Workplace Stresses OR Work Place Stress OR Stress, Work Place OR Work Place Stresses OR Work Stress OR Stress, Work OR Work Stresses OR Work-related Stress OR Stress, Work-related OR Work related Stress OR Work-related Stresses OR Workplace Bullying OR Bullying, Workplace OR Workplace Abuse OR Abuse, Workplace OR Workplace Abuses OR Job Demands OR Demand, Job OR Job Demand OR Job Control) #6; TS=(Employees OR Personnel OR Workers OR Employee OR Group, Occupational OR Groups, Occupational OR Occupational Group OR Worker) #7; #4 AND #5 AND #6 SCOPUS #1; TITLE-ABS-KEY (Fertility OR Fecundability OR Fecundity OR Fertility Incentives OR Fertility Incentive OR Marital Fertility OR “Fertility, Marital” OR Natural Fertility OR “Fertility, Natural” OR World Fertility Survey OR “Fertility Surveys, World” OR “Fertility Survey, World” OR “Surveys, World Fertility” OR “Survey, World Fertility” OR World Fertility Surveys OR “Fertility, Below Replacement” OR Below Replacement Fertility OR Fertility Determinants OR Determinant, Fertility OR “Determinants, Fertility” OR Fertility Determinant OR Subfecundity OR Differential Fertility OR “Fertility, Differential” OR Fertility Preferences OR Fertility Preference OR “Preference, Fertility ”OR “Preferences, Fertility” (Topic) And Intention OR Intentions (Topic) #2; TITLE-ABS-KEY (“Sterility, Reproductive” OR Reproductive Sterility OR Sterility OR Subfertility OR Sub-Fertility OR Infertility)) AND TS=(Therapeutic OR Therapy OR Therapies OR Treatment OR Treatments) #3; TITLE-ABS-KEY (Fertility OR Fecundability OR Fecundity OR Fertility Incentives OR Fertility Incentive OR Marital Fertility OR “Fertility, Marital” OR Natural Fertility OR “Fertility, Natural” OR World Fertility Survey OR “Fertility Surveys, World” OR “Fertility Survey, World” OR “Surveys, World Fertility” OR “Survey, World Fertility” OR World Fertility Surveys OR “Fertility, Below Replacement” OR Below Replacement Fertility OR Fertility Determinants OR Determinant, Fertility OR “Determinants, Fertility” OR Fertility Determinant OR Subfecundity OR Differential Fertility OR “Fertility, Differential” OR Fertility Preferences OR Fertility Preference OR “Preference, Fertility ”OR “Preferences, Fertility”) #4; #1 OR #2 OR #3 #5; TITLE-ABS-KEY (Occupational Stresses OR Stress, Occupational OR Professional Stress OR Professional Stresses OR Stress, Professional OR Job Stress OR Job Stresses OR Stress, Job OR Job-related Stress OR Job related Stress OR Job-related Stresses OR Stress, Job-related OR Workplace Stress OR Stresses, Workplace OR Stress, Workplace OR Workplace Stresses OR Work Place Stress OR Stress, Work Place OR Work Place Stresses OR Work Stress OR Stress, Work OR Work Stresses OR Work-related Stress OR Stress, Work-related OR Work related Stress OR Work-related Stresses OR Workplace Bullying OR Bullying, Workplace OR Workplace Abuse OR Abuse, Workplace OR Workplace Abuses OR Job Demands OR Demand, Job OR Job Demand OR Job Control) #6; TITLE-ABS-KEY (Employees OR Personnel OR Workers OR Employee OR Group, Occupational OR Groups, Occupational OR Occupational Group OR Worker) #7; #4 AND #5 AND #6 EMBASE (‘occupational stresses’:ti, ab, kw OR ‘stress, occupational’:ti, ab, kw OR ‘professional stress’:ti, ab, kw OR ‘professional stresses’:ti, ab, kw OR ‘stress, professional’:ti, ab, kw OR ‘job stress’:ti, ab, kw OR ‘job stresses’:ti, ab, kw OR ‘stress, job’:ti, ab, kw OR ‘job-related stress’:ti, ab, kw OR ‘job related stress’:ti, ab, kw OR ‘job-related stresses’:ti, ab, kw OR ‘stress, job-related’:ti, ab, kw OR ‘workplace stress’:ti, ab, kw OR ‘stresses, workplace’:ti, ab, kw OR ‘stress, workplace’:ti, ab, kw OR ‘workplace stresses’:ti, ab, kw OR ‘work place stress’:ti, ab, kw OR ‘stress, work place’:ti, ab, kw OR ‘work place stresses’:ti, ab, kw OR ‘work stress’:ti, ab, kw OR ‘stress, work’:ti, ab, kw OR ‘work stresses’:ti, ab, kw OR ‘work-related stress’:ti, ab, kw OR ‘stress, work-related’:ti, ab, kw OR ‘work related stress’:ti, ab, kw OR ‘work-related stresses’:ti, ab, kw OR ‘workplace bullying’:ti, ab, kw OR ‘bullying, workplace’:ti, ab, kw OR ‘workplace abuse’:ti, ab, kw OR ‘abuse, workplace’:ti, ab, kw OR ‘workplace abuses’:ti, ab, kw OR ‘job demands’:ti, ab, kw OR ‘demand, job’:ti, ab, kw OR ‘job demand’:ti, ab, kw OR ‘job control’:ti, ab, kw) AND (‘infertility’/exp OR infertility OR ‘fertility’/exp OR fertility OR ‘fecundability’/exp OR fecundability OR ‘fecundity’/exp OR fecundity OR ‘fertility incentives’/exp OR ‘fertility incentives’ OR ((‘fertility’/exp OR fertility) AND (‘incentives’/exp OR incentives)) OR ‘fertility incentive’ OR ((‘fertility’/exp OR fertility) AND (‘incentive’/exp OR incentive)) OR ‘marital fertility’/exp OR ‘marital fertility’ OR (marital AND (‘fertility’/exp OR fertility)) OR ‘fertility, marital’ OR ((‘fertility,‘/exp OR fertility, ) AND marital) OR ‘natural fertility’/exp OR ‘natural fertility’ OR ((‘natural’/exp OR natural) AND (‘fertility’/exp OR fertility)) OR ‘fertility, natural’ OR ((‘fertility,‘/exp OR fertility, ) AND (‘natural’/exp OR natural)) OR ‘world fertility survey’ OR ((‘world’/exp OR world) AND (‘fertility’/exp OR fertility) AND (‘survey’/exp OR survey)) OR ‘fertility surveys, world’ OR ((‘fertility’/exp OR fertility) AND surveys, AND (‘world’/exp OR world)) OR ‘fertility survey, world’ OR ((‘fertility’/exp OR fertility) AND survey, AND (‘world’/exp OR world)) OR ‘surveys, world fertility’ OR (surveys, AND (‘world’/exp OR world) AND (‘fertility’/exp OR fertility)) OR ‘survey, world fertility’ OR (survey, AND (‘world’/exp OR world) AND (‘fertility’/exp OR fertility)) OR ‘world fertility surveys’/exp OR ‘world fertility surveys’ OR ((‘world’/exp OR world) AND (‘fertility’/exp OR fertility) AND (‘surveys’/exp OR surveys)) OR ‘fertility, below replacement’ OR ((‘fertility,‘/exp OR fertility, ) AND below AND (‘replacement’/exp OR replacement)) OR ‘below replacement fertility’/exp OR ‘below replacement fertility’ OR (below AND (‘replacement’/exp OR replacement) AND (‘fertility’/exp OR fertility)) OR ‘fertility determinants’/exp OR ‘fertility determinants’ OR ((‘fertility’/exp OR fertility) AND (‘determinants’/exp OR determinants)) OR ‘determinant, fertility’ OR (determinant, AND (‘fertility’/exp OR fertility)) OR ‘determinants, fertility’ OR (determinants, AND (‘fertility’/exp OR fertility)) OR ‘fertility determinant’ OR ((‘fertility’/exp OR fertility) AND (‘determinant’/exp OR determinant)) OR subfecundity OR ‘differential fertility’/exp OR ‘differential fertility’ OR (differential AND (‘fertility’/exp OR fertility)) OR ‘fertility, differential’ OR ((‘fertility,‘/exp OR fertility, ) AND differential) OR ‘fertility preferences’/exp OR ‘fertility preferences’ OR ((‘fertility’/exp OR fertility) AND preferences) OR ‘fertility preference’ OR ((‘fertility’/exp OR fertility) AND (‘preference’/exp OR preference)) OR ‘preference, fertility’ OR (preference, AND (‘fertility’/exp OR fertility)) OR ‘preferences, fertility’ OR (preferences, AND (‘fertility’/exp OR fertility))) The search strategy used in the databases #1; TS=(Fertility OR Fecundability OR Fecundity OR Fertility Incentives OR Fertility Incentive OR Marital Fertility OR “Fertility, Marital” OR Natural Fertility OR “Fertility, Natural” OR World Fertility Survey OR “Fertility Surveys, World” OR “Fertility Survey, World” OR “Surveys, World Fertility” OR “Survey, World Fertility” OR World Fertility Surveys OR “Fertility, Below Replacement” OR Below Replacement Fertility OR Fertility Determinants OR Determinant, Fertility OR “Determinants, Fertility” OR Fertility Determinant OR Subfecundity OR Differential Fertility OR “Fertility, Differential” OR Fertility Preferences OR Fertility Preference OR “Preference, Fertility ”OR “Preferences, Fertility” (Topic) And Intention OR Intentions (Topic) #2; TS=(“Sterility, Reproductive” OR Reproductive Sterility OR Sterility OR Subfertility OR Sub-Fertility OR Infertility)) AND TS=(Therapeutic OR Therapy OR Therapies OR Treatment OR Treatments) #3; TS=(Fertility OR Fecundability OR Fecundity OR Fertility Incentives OR Fertility Incentive OR Marital Fertility OR “Fertility, Marital” OR Natural Fertility OR “Fertility, Natural” OR World Fertility Survey OR “Fertility Surveys, World” OR “Fertility Survey, World” OR “Surveys, World Fertility” OR “Survey, World Fertility” OR World Fertility Surveys OR “Fertility, Below Replacement” OR Below Replacement Fertility OR Fertility Determinants OR Determinant, Fertility OR “Determinants, Fertility” OR Fertility Determinant OR Subfecundity OR Differential Fertility OR “Fertility, Differential” OR Fertility Preferences OR Fertility Preference OR “Preference, Fertility ”OR “Preferences, Fertility”) #4; #1 OR #2 OR #3 #5; TS=(Occupational Stresses OR Stress, Occupational OR Professional Stress OR Professional Stresses OR Stress, Professional OR Job Stress OR Job Stresses OR Stress, Job OR Job-related Stress OR Job related Stress OR Job-related Stresses OR Stress, Job-related OR Workplace Stress OR Stresses, Workplace OR Stress, Workplace OR Workplace Stresses OR Work Place Stress OR Stress, Work Place OR Work Place Stresses OR Work Stress OR Stress, Work OR Work Stresses OR Work-related Stress OR Stress, Work-related OR Work related Stress OR Work-related Stresses OR Workplace Bullying OR Bullying, Workplace OR Workplace Abuse OR Abuse, Workplace OR Workplace Abuses OR Job Demands OR Demand, Job OR Job Demand OR Job Control) #6; TS=(Employees OR Personnel OR Workers OR Employee OR Group, Occupational OR Groups, Occupational OR Occupational Group OR Worker) #7; #4 AND #5 AND #6 #1; TITLE-ABS-KEY (Fertility OR Fecundability OR Fecundity OR Fertility Incentives OR Fertility Incentive OR Marital Fertility OR “Fertility, Marital” OR Natural Fertility OR “Fertility, Natural” OR World Fertility Survey OR “Fertility Surveys, World” OR “Fertility Survey, World” OR “Surveys, World Fertility” OR “Survey, World Fertility” OR World Fertility Surveys OR “Fertility, Below Replacement” OR Below Replacement Fertility OR Fertility Determinants OR Determinant, Fertility OR “Determinants, Fertility” OR Fertility Determinant OR Subfecundity OR Differential Fertility OR “Fertility, Differential” OR Fertility Preferences OR Fertility Preference OR “Preference, Fertility ”OR “Preferences, Fertility” (Topic) And Intention OR Intentions (Topic) #2; TITLE-ABS-KEY (“Sterility, Reproductive” OR Reproductive Sterility OR Sterility OR Subfertility OR Sub-Fertility OR Infertility)) AND TS=(Therapeutic OR Therapy OR Therapies OR Treatment OR Treatments) #3; TITLE-ABS-KEY (Fertility OR Fecundability OR Fecundity OR Fertility Incentives OR Fertility Incentive OR Marital Fertility OR “Fertility, Marital” OR Natural Fertility OR “Fertility, Natural” OR World Fertility Survey OR “Fertility Surveys, World” OR “Fertility Survey, World” OR “Surveys, World Fertility” OR “Survey, World Fertility” OR World Fertility Surveys OR “Fertility, Below Replacement” OR Below Replacement Fertility OR Fertility Determinants OR Determinant, Fertility OR “Determinants, Fertility” OR Fertility Determinant OR Subfecundity OR Differential Fertility OR “Fertility, Differential” OR Fertility Preferences OR Fertility Preference OR “Preference, Fertility ”OR “Preferences, Fertility”) #4; #1 OR #2 OR #3 #5; TITLE-ABS-KEY (Occupational Stresses OR Stress, Occupational OR Professional Stress OR Professional Stresses OR Stress, Professional OR Job Stress OR Job Stresses OR Stress, Job OR Job-related Stress OR Job related Stress OR Job-related Stresses OR Stress, Job-related OR Workplace Stress OR Stresses, Workplace OR Stress, Workplace OR Workplace Stresses OR Work Place Stress OR Stress, Work Place OR Work Place Stresses OR Work Stress OR Stress, Work OR Work Stresses OR Work-related Stress OR Stress, Work-related OR Work related Stress OR Work-related Stresses OR Workplace Bullying OR Bullying, Workplace OR Workplace Abuse OR Abuse, Workplace OR Workplace Abuses OR Job Demands OR Demand, Job OR Job Demand OR Job Control) #6; TITLE-ABS-KEY (Employees OR Personnel OR Workers OR Employee OR Group, Occupational OR Groups, Occupational OR Occupational Group OR Worker) #7; #4 AND #5 AND #6 In this step, two reviewers extracted the required information from the selected articles. This data included the author’s name, publication year, country, study type, sample size, gender, job type, age, job stress risk factors, stress tool, effect type, and outcomes. The agreement between the reviewers was examined by calculating Cohen’s kappa coefficient [ 34 ]. The obtained kappa coefficients for the different steps were computed by 0.92 and 0.95 respectively.

In this study, 640 papers were collected from the databases. Among these, 97 repeated papers were removed. Two researchers reviewed the title and abstracts of 543 remaining papers. After that, 512 papers without inclusion criteria or with exclusion criteria were omitted. Finally, the researchers evaluated the full texts of 31 papers, and 16 articles were entered into the study. The flow diagram of PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) is depicted in Fig.  1 . Fig. 1 The flow diagram of PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) The flow diagram of PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Table  3 displays the details of the articles encompassed in this review. Of the 16 eligible papers, 6 papers have been performed as cohort [ 26 , 28 , 35 – 38 ], 5 papers as cross-sectional [ 21 , 24 , 25 , 39 , 40 ], and 5 papers as case-control [ 29 , 30 , 41 – 43 ]. 3 studies have been conducted in Israel [ 26 , 30 , 43 ], 3 studies in Japan [ 21 , 25 , 28 ], 3 studies in the United States [ 29 , 37 , 39 ], and 1 study in each of the countries of Netherlands [ 24 ], Canada [ 41 ], Egypt [ 42 ], Denmark [ 35 ], South Korea [ 36 ], Malaysia [ 40 ], and Thailand [ 38 ]. Among these studies, 6 papers were conducted on females [ 21 , 24 , 25 , 30 , 35 , 38 ], 5 papers on males [ 29 , 39 – 42 ], and 5 papers on both males and females [ 26 , 28 , 36 , 37 , 43 ]. In total, these studies were carried out on 11,041 subjects. Eight studies investigated the effect of job stress on fertility [ 29 , 30 , 35 – 38 , 42 , 43 ], three studies evaluated its effect on fertility intention [ 21 , 24 , 28 ], and five studies examined its effect on infertility treatment process [ 25 , 26 , 39 – 41 ]. 10 papers were with high quality [ 21 , 24 , 29 , 35 – 39 , 41 , 42 ], 5 papers with moderate quality [ 25 , 26 , 28 , 30 , 43 ], and 1 paper [ 40 ] with low quality. Table  4 represents the details related to the quality assessment of the reviewed studies. In the reviewed studies, the job stress risk factors included job difficulty, workload, and shift work, time pressure, job demand, job control, workplace social support, environmental and psychological hazards in the workplace, low family income, effort-reward imbalance, individual factors, working hours per week, access to leave, employment status, working hours, physical, environmental, socio-economical and behavioral components at work, burnout, job satisfaction. Table 3 The details of the articles encompassed in the review Author and year Country Type of study Sample size Age (year) gender Job Job stress risk factors Stress tool Effect type Outcome Quality Eri Maeda et al. (2022) [ 21 ] Japan Cross-sectional 271 persons 33 females - Job demand, control, support, Individual factors, working hours per week, and access to leave Brief Occupational Stress Questionnaire Fertility intention The quality of life-related to fertility showed a significant association with various occupational factors, such as self-employment status (β = 0.11), job demands (β= −0.18), colleague support (β = 0.14), working hours (β= −0.11), and the availability of leave (β = 0.22). Q1 Craig James McKinnon et al. (2022) [ 37 ] United States Cohort 1818 couples 33 Males and females Engineer, teacher, and military Employment status, working hours per week, working time per day, and shift work Self-report Questionnaire and the Perceived Stress Scale (PSS-10) Fertility Employment status and non-day shift work could slightly reduce fecundability ( P  < 0.05). Q1 Yuko Ikemoto et al. (2021) [ 25 ]  Japan  Cross-sectional  1335 persons  37.4Females - Low family income and perceived difficulty in working conditions or cessation from work Kessler Six-question Psychological Distress Scale (K6) Infertility treatment process Increased stress levels were significantly linked to prolonged infertility exceeding two years [OR = 1.87 (95%CI: 1.08 − 3.25)] and reported difficulties in working during fertility treatments [OR = 2.94 (95%CI:1.15 − 7.50)]. Q2 Khairul Osman et al. (2018) [ 40 ] Malaysia Cross-sectional 210 persons 40 Males - Physical, environmental, socio-economical, and behavioral components at work Union of Shops, Distribution and Allied Worker Questionnaire (USDAW) Infertility treatment process Increased smoking due to job stress can be associated with a higher incidence of abnormal sperm histone-to-protamine ratios ( P  < 0.001). Q3 Hisashi Eguchi et al. (2016) [ 28 ] Japan Cohort 103 couples - Males and females Managerial and non-managerial jobs Job demand, job control, and workplace social support Brief Job Stress Questionnaire (BJSQ) Fertility intention Males occupied in jobs with high demands and high control (active job group) showed a greater likelihood of having more children [OR = 9.07 (95%CI: 1.27–64.85)]. Q2 Teresa Janevic et al. (2014) [ 39 ] United States Cross-sectional 193 persons 43.5 Males - Job demands, job control, and other psychosocial factors Job Content Questionnaire (JCQ) Infertility treatment process Men with the experience of two or more stressful life events indicated a decrease in the percentage of motile sperm [b= − 8.22 (95%CI: − 14.31– − 2.13)] and morphologically normal sperm [b = − 1.66 (95%CI: − 3.35 − 0.03)]. Q1 Katia Begall and Melinda Mills (2011) [ 24 ] Netherlands Cross-sectional 1533 persons - Females Dependent workers Workload and Job strain (time pressure) - Fertility intention Women with high job control and low job strain are considerably more likely to plan for a second child ( P  < 0.05). Q1 Mohamed El-Helaly et al. (2010) [ 42 ] Egypt Case-control 522 persons 60.02 Males - Shift work and environmental and psychological hazards in the workplace Self-report questionnaire on socioeconomic, medical, and occupational factors Fertility Shift work [OR = 3.60 (95%CI: 1.12–11.57) and job-related stress [OR = 3.76 (95%CI: 1.96–7.52)] could substantially elevate the risk of infertility among men. Q1 Mi-Sun Lee et al. (2009) [ 36 ] South Korea Cohort 322 couples 35.5 Males and females Petrochemical workers Effort-reward imbalance Effort – reward questionnaire Fertility Work-related paternal stress, quantified by the effort-reward imbalance model, can lead to a decrease in the number of conceptions during the initial menstrual cycle [OR = 0.47 (95%CI:0.22–0.99)]. Q1 Vered Barzilai-Pesach et al. (2006) [ 26 ] Israel Cohort 75 persons 31.3 Females Clerical jobs, service providers, and manual workers Job difficulty, workload, and shift work - Infertility treatment process Women employed in jobs with high demands showed a decrease in fertility rates [RR = 0.6 (95%CI: 0.42–0.96)]. Q2 Clarisa R. Gracia et al. (2005) [ 29 ] United States Case-control 1348 persons 37.5 Males Blue-collar jobs self-report questionnaires on socioeconomic, medical, and environmental factors Fertility There were no significant correlations between infertility and factors such as shift work or occupational stress ( P  > 0.05). Q1 E.Sheiner et al. (2003) [ 30 ] Israel Case-control 170 persons 31.05 Females Clerical jobs and teachers burnout, job strain (job demands and decision latitude), and job satisfaction Karasek’s job content questionnaires Fertility A notable relationship was observed between levels of burnout, job stress, and job satisfaction and the fertility status of women ( P  > 0.05). Q2 Einat K. Sheiner et al. (2002) [ 43 ] Israel Case-control 202 persons - Males and females Industrial and construction workers burnout, job strain (job demands and decision latitude), and job satisfaction Karasek’s job content questionnaires Fertility Industrial and construction jobs [OR = 2.2 (95%CI:1.2–2.7)] and cognitive weariness [OR = 1.8 (95%CI: 1.03–4.6)] have been identified as separate risk factors for male infertility issues. Q2 Pitchaya Tuntiseranee et al. (1999) [ 38 ] Thailand Cohort 1797 persons - Females Executive jobs, clerical jobs, and skilled and unskilled workers Job demand Karasek’s job content questionnaires Fertility Karasek’s model of psychological job demands showed a slight correlation with the incidence of small infants for gestational age ( P  < 0.05). Q1 Philip L. Bigelow et al. (1998) [ 41 ] Canada Case-control 845 semen samples 33.9 Males Clerical jobs - - Infertility treatment process With the increase in stress levels, a decline in five seminal parameters, including progressive sperm movement, total motile count, sperm morphology, abnormal heads, and coiled tails, was observed ( P  < 0.039). Q1 Niels Henrik I Hjollund et al. (1998) [ 35 ] Denmark Cohort 297 couples 27.5 Males and females Metal workers, office and commercial workers, nurses and day-care workers Shift work, Job demand, and job control Karasek’s job content questionnaires Fertility Occupational stress may influence the likelihood of conception in each menstrual cycle among women [OR = 0.9 (95% CI: 0.5–1.5)]. Q1 The details of the articles encompassed in the review Job demand, control, support, Individual factors, working hours per week, and access to leave - Males and females - Females - Males and females - Females Table 4 The details related to the quality assessment of the reviewed studies Author and year Type of study Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Quality Eri Maeda et al. (2022) [ 21 ] Cross-sectional ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ - - - Q1 Craig James McKinnon et al. (2022) [ 37 ] Cohort ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ × ✓ Q1 Yuko Ikemoto et al. (2021) [ 25 ] Cross-sectional × ✓ ✓ ✓ × × × ✓ - - - Q2 Khairul Osman et al. (2018) [ 40 ] Cross-sectional × × × × × × ✓ × - - - Q3 Hisashi Eguchi et al. (2016) [ 28 ] Cohort ✓ ✓ ✓ × × ? ✓ × ? × ✓ Q2 Teresa Janevic et al. (2014) [ 39 ] Cross-sectional ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ - - - Q1 Katia Begall, Melinda Mills (2011) [ 24 ] Cross-sectional ✓ ✓ ✓ ✓ × × ✓ ✓ - - - Q1 Mohamed El-Helaly et al. (2010) [ 42 ] Case-control ✓ ✓ ✓ × ✓ ✓ ✓ ✓ × ✓ - Q1 Mi-Sun Lee et al. (2009) [ 36 ] Cohort ✓ ✓ ✓ ✓ ✓ ? ✓ ✓ ✓ × ✓ Q1 Vered Barzilai-Pesach et al. (2006) [ 26 ] Cohort ✓ ✓ ✓ × × ? ✓ × ? × ✓ Q2 Clarisa R. Gracia et al. (2005) [ 29 ] Case-control ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ - Q1 E.Sheiner et al. (2003) [ 30 ] Case-control ✓ ✓ ✓ ✓ ✓ × × × ✓ × - Q2 Einat K. Sheiner et al. (2002) [ 43 ] Case-control ✓ ✓ ✓ ✓ ✓ × × × ✓ × - Q2 Pitchaya Tuntiseranee et al. (1999) [ 38 ] Cohort ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ × ✓ Q1 Philip L. Bigelow et al. (1998) [ 41 ] Case-control ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ - Q1 Niels Henrik I Hjollund et al. (1998) [ 35 ] Cohort ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ × ✓ Q1 ✓: Yes ×: No ?: Unclear -: no question The details related to the quality assessment of the reviewed studies ✓: Yes ×: No ?: Unclear -: no question Five out of 8 studies found that job stress can affect fertility. Hjollund et al. conducted a study on 297 Danish couples, including metal workers, office and commercial workers, nurses, and daycare workers. In this study, the association between job strain and time to pregnancy was investigated. Based on the results, Occupational stress may influence the likelihood of conception in each menstrual cycle in women [OR = 0.9 (95% CI: 0.5–1.5)] [ 35 ]. Lee et al. performed a study on 322 couples in South Korea to examine the association of stress at work with time to pregnancy. The results showed that work-related paternal stress, quantified by the effort-reward imbalance model, can lead to a decrease in the number of conceptions during the initial menstrual cycle [OR = 0.47 (95%CI:0.22–0.99)] [ 36 ]. McKinnon et al. carried out a study on 1818 couples in North America and evaluated the relationship between work hours, shift work, and job latitude with fertility. They concluded that employment status and non-day shift work could slightly reduce fecundability ( P  < 0.05) [ 37 ]. El Helali et al. conducted a study in Egypt on 522 infertile and fertile men to investigate the relationship between workplace exposures and male infertility. The results of this study indicated that shift work [OR = 3.60 (95%CI: 1.12–11.57)] and job-related stress [OR = 3.76 (95%CI: 1.96–7.52)] could substantially elevate the risk of infertility among men [ 42 ]. In the study of Gracia et al. on 1348 infertile and fertile men in the United States, the relationship between occupational exposures and infertility was examined, and the findings revealed that there were no significant correlations between infertility and factors such as shift work or occupational stress ( P  > 0.05) [ 29 ]. Sheiner et al. performed a study on 64 people in Israel to survey the relationship between occupational psychological stress and female fertility. They observed that there is not a notable relationship between levels of burnout, job stress, and job satisfaction and the fertility status of women ( P  > 0.05) [ 30 ]. Sheiner et al. carried out a study in Israel on 202 persons to investigate the potential association between male infertility and occupational psychological stress. They identified industry and construction jobs [OR = 2.2 (95%CI:1.2–2.7)] and cognitive weariness [OR = 1.8 (95%CI: 1.03–4.6)] as separate risk factors for male infertility issues [ 43 ]. Tuntiseranee et al. conducted a study on 1797 females in Thailand to evaluate socioeconomic and work-related determinants of pregnancy outcomes. They found that Karasek’s model of psychological job demands has a slight correlation with the incidence of small infants for gestational age ( P  < 0.05) [ 38 ]. Three out of 3 studies indicated that job stress can influence fertility intention. Begal and Mills investigated the effect of psychological job control, job pressure, and work-family conflict on fertility intentions using data from 1533 employed women from 23 countries. The results of this study showed that women with high control in their workplace are considerably more likely to plan for a second child ( P  < 0.05). Conversely, high job strain significantly reduces the fertility intention of mothers to have more children ( P  < 0.05) [ 24 ]. Eguchi et al. conducted a study in Japan on 103 dual-earner couples with managerial and non-managerial jobs to evaluate the effect of workplace psychosocial factors on having additional children. Based on the results, men employed in jobs with high demands and high control (active job group) showed a greater likelihood of having more children [OR = 9.07 (95%CI: 1.27–64.85)]. Conversely, no significant relationships were found between workplace psychosocial factors and the likelihood of having more children among women ( P  > 0.05) [ 28 ]. Maeda et al. carried out a study in Japan on 271 women to evaluate the job conditions affecting fertility-related quality of life. They found that the quality of life related to fertility was notably linked to various occupational factors, such as the self-employment status of the participants (β = 0.11), the demands of their job (β= −0.18), support from colleagues (β = 0.14), and the availability of leave (β = 0.22). Additionally, similar associations were observed with their partner’s ability to take leave (β = 0.11), their working hours (β= −0.11), and the degree of cooperation (β = 0.18) [ 21 ]. Six out of 8 studies revealed that job stress can affect the infertility treatment process. Barzilai-Pesach et al. performed a study in Israel on 75 women with white-collar jobs, including office jobs, service providers, and manual workers, to investigate the relationship between women’s occupational stress and outcomes of infertility treatments. They concluded that women with high job demands have a decrease in fertility rates [RR = 0.6 (95%CI: 0.42–0.96)]. Also, actual workload (full-time versus part-time job) was associated with a decreased probability of successful completion of the pregnancy among expectant mothers [RR = 0.3 (95%CI: 0.11–0.96)] [ 26 ]. Bigelow et al. conducted a study in Canada on 845 sperm samples of working people to examine the association between occupational factors and semen quality. In this study, the increase in stress levels was associated with a decline in the quality of five seminal parameters, including progressive sperm movement, total motile count, sperm morphology, abnormal heads, and coiled tails ( P  < 0.039) [ 41 ]. Ikemoto carried out a study in Japan on 1335 women to analyze severe psychological stressors in women during fertility treatment. They observed that an increase of the stress levels was significantly linked to prolonged infertility exceeding two years [OR = 1.87 (95%CI: 1.08 − 3.25)], absence of childbirth [OR = 2.04 (95%CI: 1.05 − 3.97)], harassment related to infertility at work [OR = 2.07 (95%CI: 1.08 − 3.98)], and reported difficulties for working during fertility treatments [OR = 2.94 (95%CI:1.15 − 7.50)] [ 25 ]. Osman et al. performed a study in Malaysia on 210 infertile men to investigate the effect of work stress and smoking on sperm quality. They found that increased smoking due to job stress can be associated with a higher incidence of abnormal sperm histone-to-protamine ratios ( P  < 0.001) [ 40 ]. Teresa et al. carried out a study on 193 men in the United States to survey the effects of work and life stress on semen quality. In this study, men with experience of two or more stressful life events indicated a decrease in the percentage of motile sperm [b= − 8.22 (95%CI: − 14.31– − 2.13)] and in the percentage of morphologically normal sperm [b = − 1.66 (95%CI: − 3.35 − 0.03)] [ 39 ].

Given the importance of the identification of factors affecting fertility in humans, the present study aimed to summarize the findings of the studies performed on the associations between job stress and fertility, its intention, and the infertility treatment process. The results of most studies showed that job stress can probably affect fertility, its intention, and the infertility treatment process. There are various probable mechanisms to explain these associations. Those include the physiological effects of job stress on fertility, the effect of changed behavioral habits due to job stress on fertility, the psychological effects of job stress on fertility intention, and the effect of job stress on the infertility treatment process. The findings of the research showed that there is a dose-response relationship between work-related stress and the risk of male infertility [ 42 ]. The results of other studies also confirm that there is a significant increase in infertility risk because of work stress [ 43 , 44 ]. These studies show that psychological stress decreases testosterone levels [ 45 ] and negatively affects semen quality in humans and rodents [ 39 ]. Indeed, stress disrupts the homeostasis of the physiological reproductive system [ 46 ]. Some epidemiological studies concluded that psychosocial stress can change semen quality, including sperm concentration, motility, and morphology [ 47 ]. It can be because of the change in neuroendocrine factors affecting spermatogenesis. Stress increases the level of glucocorticoids and decreases testosterone secretion from Leydig cells, which are responsible mechanisms of sperm production [ 48 ]. Furthermore, glucocorticoids can trigger apoptosis in Leydig cells, which results in a decreased cell count [ 49 ]. Also, social stress was associated with changes in the production and secretion of luteinizing hormone and testosterone and decrease of testicular function [ 48 ]. Therefore, stressful situations may inhibit testosterone secretion and spermatogenesis in men [ 50 ]. Furthermore, it has been proposed that stress can increase reactive oxygen species levels in sperm plasma and make oxidative stress. This condition has been demonstrated to adversely affect sperm quality and fertility [ 51 , 52 ]. Based on the results of prior research, various forms of stress may adversely influence women’s menstrual cycles, which potentially lead to infertility. Jeyaseelan et al. observed that there is a correlation between job stress and altered menstrual cycle patterns [ 53 ]. Fenster et al. found that women with high stress experienced a higher likelihood of shorter menstrual cycles [ 54 ]. Chronic stress may disrupt the endocrine system in women, which is frequently associated with menstrual irregularities [ 15 ]. In several studies, the impact of stressful jobs on women’s reproductive health has been demonstrated [ 55 ]. The main consequences reported in these studies include menstrual disorders, infertility, and spontaneous abortions among professionals [ 56 ]. The results of other studies also revealed that high job stress can be associated with alterations in menstrual cycle length and ovulation patterns [ 57 , 58 ]. Additionally, the results of a study on female lawyers indicated that prolonged working hours, as an indicator of job stress, can increase the risk of spontaneous abortions [ 59 ]. In addition, high job stress is related to oxidative stress [ 17 , 18 ]. The findings of a review study performed by Ashok et al. indicated that oxidative stress may play a role in several reproductive disorders, including endometriosis, polycystic ovary syndrome (PCOS), and infertility. However, the mechanisms of these effects remain unclear [ 13 ]. Moreover, Brett et al. concluded that females with high job stress jobs have a greater risk of premature birth. During stress, blood flow to the placenta are reduced, which can lead to premature birth [ 60 ]. In addition to the mentioned mechanism, job stress can change behavioral habits, such as drug consumption, smoking, and alcohol consumption. Osman et al. investigated the relationship between occupational stress, smoking, and sperm quality in men. They found that occupational stress can lead to increased smoking [ 40 ]. Smoking can affect sperm quality and increase the incomplete protamine protein and immature histone protein of DNA in sperm. Because of the importance of the vital role of histone and protamine in DNA integrity, this disorder causes vulnerability in DNA sperm [ 40 ]. The findings of a study carried out by Osman et al. indicated that an abnormal histone-to-protamine ratio increases DNA damage in sperm [ 40 ]. Finelli et al. also revealed the relationship between long-term use of alcohol and a decrease in semen quality. This relationship is primarily attributed to the onset of oxidative stress and the genotoxic effects of alcohol consumption on hormonal regulation and DNA stability, which may influence the health of offspring [ 61 ]. In terms of psychological effects also, stress can indirectly affect fertility through decreased sexual desire and sexual performance [ 62 ]. Indeed, stress can psychologically affect people and reduce their life quality. Sarafis et al. concluded that job stress can be associated with a negative impact on the life quality among nurses [ 19 ]. Also, Maeda et al. observed that reproductive life quality was significantly related to job variables in women [ 21 ]. These consequences may lead to a decrease in the intention of the workers to have children. It can be because of the unpreparedness of people to have children and or concern about the future, which depends on the risk factors of job stress. Some jobs have characteristics to conflict with childbearing. In some occupations, people cannot regulate the balance between work and family, which can affect the intention to become a mother or father [ 24 ]. Eguchi et al. found that work-family conflict has an undesirable effect on fertility intention. As a recommendation, workplace social support can decrease work-family conflict and increase the intention to have additional children [ 28 ]. Also, in this research, the persons with an active job had additional children. It seems that active jobs can reduce the psycho-physiological impact of stressful work situations [ 28 ]. In the infertility treatment process, workplace psychological stress in the people under fertility treatment may reduce pregnancy outcomes and create a vicious cycle of stress and fertility failure [ 27 ]. Klonoff-Cohen et al. concluded that job stress decreases pregnancy achievement after treatments [ 63 ]. This effect can be explained via two paths. In the first path, job stress and work pressure may not allow people to pursue their infertility treatment. In other words, improper working conditions can create the feeling that it is impossible to perform work and fertility treatment [ 25 ]. Based on the results of the research, a large number of infertile people did not intend to go to the fertility clinic in adverse working conditions [ 25 ]. In this situation, a supportive work environment is required to help the person during infertility treatment [ 64 ]. In the second path, job stress can disrupt the infertility treatment process through mentioned physiological changes in infertile people, such as a higher incidence of abnormal sperm histone-to-protamine ratios [ 40 ], decrease in the percentage of motile sperm and morphologically normal sperm [ 39 ], decline in progressive sperm movement, total motile count, sperm morphology, abnormal heads, and coiled tails, and alterations in menstrual cycle patterns [ 39 ]. In the study of Barzilai-Pesach et al. also, it was observed that there is a reverse association between workload and the likelihood of conceiving after fertility treatments among infertile females [ 26 ]. Therefore, chronic and high job stress probably can affect fertility, fertility intention, and infertility treatment process in working people. The lack of significant relationships in some studies also can be because of the low level of examined job stress. Moreover, the studied risk factors of stress are different in various studies, which can obtain different findings. Some of these risk factors include job difficulty, workload, and shift work, time pressure, job control, job demand and social support, environmental and psychological hazards in the workplace, low family income, effort-reward imbalance, individual factors, working hours per week, access to leave, employment status, working hours, physical, environmental, socio-economical and behavioral components at work, burnout, job satisfaction. As a limitation, the effect value of various risk factors of job stress on fertility has not been determined and important risk factors have not been revealed. Moreover, there are some confounders affecting this relationship. It is required that their role is specified in the next studies. Furthermore, job stress perhaps can affect the seeking infertility treatment. However, the information on this relationship was not available in the reviewed studies.

In total, the findings of this study showed that job stress may affect fertility, its intention, and the infertility treatment process in humans. There are some probable mechanisms to explain these relationships. Therefore, it is required that necessary measures are planned and performed to decrease job stress and strain in workplaces. Also, it is suggested that the effectiveness of these measures is evaluated in future research. Moreover, given that job stress has various dimensions and risk factors, the role of each of these factors must be determined in future studies. So, control measures are focused on the important factors. In general, job stress can be greatly reduced by a decrease in job demands and an increase in job control and social support.

Job stress is one of the most common occupational problems, which seriously threatens the health of workers. Based on the results of a study in developed countries, nearly 30% of workers suffer from job stress [ 1 ]. According to McGrath and Altman, job stress is a substantial imbalance between personal abilities and job demands [ 2 ]. It can be associated with severe behavioral, physical, and psychological consequences [ 2 ]. Some occupational risk factors of job stress include job control, workplace conflict, job satisfaction, psychological demands, physical environment, social support, and workload. The International Labor Organization has estimated the cost of occupational stress to be between 1.0 and 3.5% of the gross domestic product (GDP) in each country [ 3 ]. High levels of job stress can directly cause several disorders and diseases, such as depression, anxiety, immunodeficiency disorders, headaches, musculoskeletal pain, and cardiovascular diseases [ 4 ]. Moreover, it can affect the personal and organizational performance of the workers [ 5 ]. Also, job stress influences productivity, absenteeism, job burnout, and job turnover [ 6 ]. The effect of job stress on childbearing is an important but less known consequence. Three important agents for childbearing are fertility, fertility intention, and infertility treatment. Fertility is defined as the actual generation of offspring [ 7 ]. The fertility intentions also refer to the decision or desire to have children [ 8 ]. Infertility treatment also includes measures such as medication and surgery to treat infertile people [ 9 ]. Therefore, to investigate the relationship between job stress and childbearing, it is necessary to examine its effect on the stated agents. In some studies, several probable mechanisms for these associations have been mentioned. Infertility may be created because of physiological effects due to job stress. This stress may potentially influence semen quality among males. Also, it may decrease luteinizing hormone (LH) and testosterone levels, spermatogenesis, and sperm quality [ 10 , 11 ]. Furthermore, acute stress may impair testicular function [ 12 ]. Chronic stress can also be associated with more serious effects. High levels of glucocorticoid due to chronic stress induce apoptosis in all cell types, such as germ cells, Sertoli, and Leydig cells [ 13 , 14 ]. Moreover, some previous studies concluded that stress can negatively affect the menstrual cycle and cause infertility among females [ 15 , 16 ]. In addition, high job stress can lead to an increase in oxidative stress [ 17 , 18 ]. Based on the results of a study, oxidative stress can cause some diseases, such as polycystic ovary syndrome, endometriosis, and infertility [ 13 ]. In addition to physiological consequences, psychological effects due to job stress may affect fertility intentions among the workers. Sarafis et al. observed that job stress can negatively influence the life quality among nurses [ 19 ]. Wu et al. also found that low life quality because of socioeconomic factors can decrease fertility intention [ 20 ]. Moreover, the results of a study performed by Maeda et al. indicated that job stress can affect reproductive life quality among females [ 21 ]. Maierhaba et al. concluded that stress and social support can significantly affect the quality of fertility life among males [ 22 ]. So that it may influence sexual desire and sexual performance of people [ 23 ]. Also, concerns about the future due to job stress are another reason to decrease fertility intention [ 24 ]. Moreover, job stress can influence the infertility treatment process among infertile persons. This effect can be created through two paths. Job stress and work pressure decrease the free time of workers to pursue the infertility treatment process [ 25 ]. On the other hand, the physiological changes due to job stress can disrupt the treatment process [ 26 ]. This connection can be a two-way relationship, which makes a vicious cycle [ 27 ]. Although several mechanisms have been proposed to explain the relationship between job stress and fertility, its intention, and the infertility treatment process among workers, the adverse effect of this stress on these agents still remains controversial [ 25 ]. So contradictory findings have been reported in previous studies. Some studies have demonstrated these associations [ 21 , 25 , 28 ] but some other studies have not confirmed these relations [ 29 , 30 ]. Therefore, as a research gap, a comprehensive study is required to summarize the results of the previous studies. Moreover, the effect of job stress on fertility, its intention, and the infertility treatment process may be different. So, it is unclear which job stress affects childbearing through which of these three agents. through which of these three agents. Therefore, this systematic review study aimed to investigate the effect of job stress on fertility, its intention, and the infertility treatment process among workers.