Evaluating the Efficacy of Expressive Writing on Infertility-Related Trauma, Grief, and Quality of Life: A Randomized Controlled Trial

Abstract

Infertility carries substantial psychological burden, yet psychosocial support remains limited, particularly outside active treatment. Meta-analytic effect sizes for expressive writing on quality of life in infertile populations remain negligible to small (g = 0.00 to 0.05). No study has evaluated structured expressive writing among women experiencing infertility outside treatment settings. INSPIRE is a single-blinded randomized controlled trial among women trying to conceive for over two years, not undergoing stimulated or medicated fertility treatment, with moderate to high infertility-related distress. Exclusions included active suicidal ideation, current psychotherapy, and recent pregnancy loss. Participants were randomized 1:1 via blocked randomization to structured expressive writing or matched neutral journaling delivered over four consecutive days via hybrid Zoom and REDCap. Recruitment used paid social media. The primary outcome is change in FertiQoL. Secondary outcomes include a five-item distress composite assessed at baseline, post-intervention, and four-week follow-up. Models adjusted for baseline FertiQoL. Twenty-nine participants (15 control, 14 intervention; mean age 39.7 years, 72.4% US-based, trying to conceive over two years) were analyzed from a target of 220. Baseline FertiQoL was comparable between groups. Adjusted between-group difference in FertiQoL Overall was 5.55 points (95% CI: -1.56, 12.67) at follow-up. The Emotional subscale showed an 11.30-point improvement at follow-up (95% CI: 0.89, 21.71; d = 0.59), a clinically meaningful effect exceeding prior benchmarks. The distress composite difference was -1.86 (95% CI: -3.75, 0.03) at follow-up. Emotional intensity was consistently higher in the intervention group at baseline and across all writing sessions, with greater Day 4 relief. These preliminary findings require confirmation in the fully powered sample. Preliminary findings suggest structured expressive writing may improve fertility-related quality of life, with clinically meaningful effect sizes. If confirmed, this intervention may offer scalable psychosocial support for individuals experiencing infertility outside active treatment.