Impact of Endometriosis on Fertility and Quality of Life among Women of Childbearing Age: A Comparative Hospital-Based Cross-Sectional Study in China and Rwanda

Fabiola Irafasha, Hua Wei, Stephano Lydia Donasiao, Qingsong Zeng, Cunjian Yi
In: Yangtze Medicine · 2026 · vol. 10(01) , pp. 16–34 · doi:10.4236/ym.2026.101003 · W7134898362
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study found that endometriosis significantly impacts fertility and quality of life for women in China and Rwanda, with higher education associated with better QoL but infertility more prevalent in higher-income individuals.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This hospital-based cross-sectional study compared fertility outcomes and quality of life in women aged 18–45 years with surgically confirmed endometriosis in four facilities in China and Rwanda, using the 63-item Endometriosis Impact Questionnaire (EIQ) and regression analyses of predictors of EIQ scores and self-reported infertility. Among 153 participants, 62.8% of sexually active women reported infertility (more common in China than Rwanda), and overall EIQ impact did not differ significantly between countries, although Rwandan participants reported lower impact in fertility, sexual, and lifestyle domains while other domains were similar. After adjustment, education level (secondary/tertiary vs none) was associated with lower EIQ impact scores, and higher income was associated with higher odds of self-reported infertility; IVF/IUI access and satisfaction with care were higher in China. The paper’s main caveat is its cross-sectional, facility-based design with exclusion of several comorbid conditions, which limits causal inference and generalizability. This paper is centrally about endometriosis — it directly compares how endometriosis affects fertility and quality of life in women in China versus Rwanda.

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Abstract

Background: Endometriosis is associated with chronic pelvic pain, dysmenorrhea, and infertility, leading to substantial healthcare costs and diminished quality of life (QoL). While early diagnosis may improve outcomes, little is known about women’s experiences across resource-diverse settings. This study compared the impact of endometriosis on fertility and QoL among women of reproductive age in China and Rwanda. Methods: A cross-sectional study was conducted from January to November 2025 in four hospitals across China and Rwanda. Women aged 18 - 45 years with surgically confirmed endometriosis were enrolled, excluding those with comorbidities affecting infertility or QoL. Data were collected using the validated 63-item Endometriosis Impact Questionnaire (EIQ). Multiple linear regression identified predictors of EIQ scores, and logistic regression assessed factors associated with self-reported infertility, using a 5% significance level. Results: Among 153 participants, 66.7% were from China; median age was 31 years (IQR: 25 - 39), and 47.7% had tertiary education. Median monthly income was higher in China than Rwanda ($674.8 vs $103.5; p β = 4.5; p = 0.484), whereas secondary (β = –13.6; p = 0.049) and tertiary education (β = –17.0; p = 0.022) were associated with lower impact scores. Higher income was associated with reported infertility (aOR = 1.002; p = 0.034). Surgical management was common in both countries, but IVF and IUI were accessed only in China, where satisfaction with care was higher (median 4 vs 2). Conclusion: Endometriosis substantially impairs the QoL of women in both China and Rwanda, with no differences in overall impact between the two settings. However, domain-specific variations were observed, and higher education was associated with better QoL outcomes. Infertility was common, particularly among women with higher incomes, and advanced fertility treatments were accessible only in China, where satisfaction with care was also higher. These findings highlight the need to strengthen diagnostic capacity, expand fertility services, and improve comprehensive endometriosis care, especially in resource-limited settings.

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Condition tags

endometriosischronic_pelvic_paindysmenorrheainfertility

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last seen: 2026-06-10T17:14:06.276822+00:00
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