{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T14:02:04Z","timestamp":1782741724406,"version":"3.54.5"},"reference-count":49,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"unspecified","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,9]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Infertility treatment represents a major reproductive health issue globally, affecting 8%\u201312% of couples, with heightened prevalence and psychosocial burdens in pronatalist contexts like Iran where cultural and religious norms intensify stigma, emotional distress, marital strain and financial challenges for men, women and couples. Despite growing qualitative research on these experiences within Iran\u2019s healthcare system, findings remain fragmented, limiting higher-order insights into shared challenges, coping mechanisms and relational dynamics. In addition, socioreligious perspectives on assisted reproductive technologies\u2014particularly gamete donation\u2014and structural factors such as financial access to in vitro fertilisation may critically shape treatment experiences but have not been systematically synthesised. This protocol outlines a systematic review and meta-synthesis of qualitative evidence to integrate these perspectives, generating comprehensive understandings to enhance culturally attuned clinical care and policy responses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Comprehensive searches will be conducted in English databases (PubMed\/Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science, Scopus) and Persian databases (Scientific Information Database and MagIran) from inception to August 2026, without date limits and restricted to Persian or English publications. The Population, Concept, and Context framework will guide the inclusion of primary qualitative studies on infertility treatment experiences (Population: infertile men, women and couples in Iran; Concept: experiences, challenges and coping strategies; Context: Iranian sociocultural and healthcare settings). Studies that are exclusively quantitative, non-Iranian, non-peer-reviewed or inaccessible will be excluded. Two reviewers will independently screen titles, abstracts and full texts using Covidence, appraise quality with the Critical Appraisal Skills Programme checklist (using Cohen\u2019s kappa to assess inter-rater reliability) and extract data using piloted forms. Thematic content analysis will be used to synthesise the findings, with the confidence in the evidence assessed using the Confidence in the Evidence from Reviews of Qualitative Research approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethical approval for this protocol was granted by the Research Ethics Committee of Tabriz University of Medical Sciences (approval number: IR.TBZMED.VCR.REC.1405.024). The committee confirmed that no additional ethical review was required, as the study is restricted to the analysis of published literature and does not involve human participants, primary data collection or clinical procedures. Results will disseminate through open-access journals like BMJ Open, conferences and policy summaries for reproductive health stakeholders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>CRD420261390890.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-116434","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T13:34:13Z","timestamp":1782740053000},"page":"e116434","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Infertility treatment experiences in Iran: protocol for a systematic review and meta-synthesis of qualitative evidence"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6723-6438","authenticated-orcid":false,"given":"Mehrdad","family":"Amir-Behghadami","sequence":"first","affiliation":[{"name":"Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran"},{"name":"Iranian Center of Excellence in Health Management, Department of Health Service Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3850-8972","authenticated-orcid":false,"given":"Solmaz","family":"Ghanbari-Homaie","sequence":"additional","affiliation":[{"name":"Medical Education Research Center, Health Management and Safety Promotion Research Institute, Clinical Research Development Unit of Taleghani Hospital, Tabriz University of Medical Sciences, Tabriz, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"2026062906303111000_16.6.e116434.1","unstructured":"World Health Organization . 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