Abstract
Background. Recurrent implantation failure (RIF) is a psychological challenge in assisted reproductive treatments, with more than 55% of patients experiencing anxiety. Anxiety activates the hypothalamic–pituitary–adrenal axis and increases catecholamine levels, potentially impairing endometrial receptivity and contributing to pelvic floor muscle tension. This review aimed to investigate the role of spirituality and spiritual coping in reducing anxiety and improving endometrial receptivity. Following PRISMA guidelines, PubMed, Scopus, Web of Science, Cochrane Library, and Embase were searched up to 2026, and study quality was assessed using the JBI critical appraisal checklists. Seven studies of moderate to high quality were included. Spiritual experiences were inversely associated with infertility-related stress and feelings of failure. Spiritual intelligence and spiritual well-being were associated with greater resilience and lower psychological distress, whereas religious internalization accompanied by guilt was associated with increased anxiety. Positive spiritual coping may improve psychological adjustment. Spirituality-sensitive support, integrated into routine care, may provide a holistic approach to managing recurrent implantation failure.
Methods. Following PRISMA guidelines, electronic databases (PubMed, Scopus, Web of Science, Cochrane Library, and Embase) were searched up to 2026. Studies assessing spirituality, anxiety, and implantation/ART outcomes were screened. Methodological quality was evaluated using Joanna Briggs Institute (JBI) Critical Appraisal Checklists.
Results. Seven high-to-moderate quality studies (translational, cohort, cross-sectional, and qualitative) were analyzed. Maternal anxiety directly impaired endometrial receptivity via adrenergic receptor (ADRA2C) dysfunction. Daily spiritual experiences were inversely correlated with infertility stress (r = -0.665) and defeat feelings (r = -0.731), accounting for 47% and 53.3% of their variance, respectively (p < 0.001). Spiritual intelligence dimensions—Personal Meaning Production (β = 2.64) and Conscious State Expansion (β = 0.85)—were primary predictors of psychological resilience. Spiritual health significantly reduced psychological distress both directly and indirectly via perceived social support (p < 0.05). Conversely, guilt-driven religious introjection exacerbated anxiety. Conclusion. Positive spiritual coping and spiritual intelligence act as effective neuroendocrine and psychological buffers, dampening HPA hyperactivity and improving pelvic floor and uterine perfusion. Incorporating spiritually sensitive counseling into pelvic physiotherapy and ART protocols represents a holistic paradigm for RIF management.