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Abstract Study question How does infertility affect quality of life in people with chronic kidney disease (CKD) compared to the general population using the FertiQOL questionnnaire? Summary answer Scores were similar in both groups however CKD patients with prior fertility treatment experienced significantly greater emotional burden and negative social impact compared to controls. What is known already Infertility is known to affect quality of life (QoL) and mental health in otherwise healthy couples. Parenthood and pregnancy are key life events for many people, including those with CKD. However, neither are typically integrated into QoL assessments for women with CKD, who often have complex emotional needs when considering pregnancy. Despite the increasing prevalence of CKD for women of childbearing age, there is very limited research investigating the impact of infertility on quality of life. FertiQOL is a validated instrument to measure QoL in individuals experiencing fertility problems with six domains: emotional, mind-body, relational, social, environment and tolerability. Study design, size, duration A prospective observational multi-centre cohort study investigated women with CKD and controls (healthy volunteers) over 12 months (October 2022–2023), recruiting 107 participants. Women with CKD were enrolled from four tertiary hospital sites, while controls included healthy women undergoing treatment for male factor infertility and hospital or university staff. Fertility issues in controls were excluded via detailed history, hormonal profiling, and ultrasound. Ethical approval was obtained from the Health Research Authority, with written informed consent provided. Participants/materials, setting, methods Prior fertility treatment, active attempts to conceive, age, body mass index, ethnicity and medical history (gynaecological, obstetric and kidney disease) were recorded. All participants completed the FertiQOL survey; A validated instrument measuring quality of life in individuals experiencing fertility problems divided into 6 domains with raw and scaled (out of 100) scores. Difference between groups was assessed using Mann Whitney-U test. Linear regression models were performed on significant associations adjusting for age, BMI and parity. Main results and the role of chance A total of 73(68.2%) women with CKD and 34(31.8%) controls were recruited. Women with CKD were older than controls(35.1 ± 6.7vs. 31.2 ± 4.6 years) and were less likely to be nulliparous(46.1%vs. 73.5%) or desire pregnancy (73.5% vs. 100%). Both groups were comparable for BMI, ethnicity, attempts to conceive, and prior fertility treatment. FertiQoL raw and scaled total scores were similar between groups. The CKD total median raw score of 66.2(IQR 54.8–77.8) compared to the control group score of 60.4(IQR 55.4–72.2). This suggests infertility affects the QoL in women with CKD as much as in the general population. However, women with CKD had significantly lower scores in the raw environmental domain(CKD = 12.0; Controls = 16.0, p = 0.02). This assesses external factors that affect access to and experience of fertility treatment such as treatment availability, quality of care and financial burden of fertility services. Among participants who had undergone fertility treatment (n = 20), those with CKD had lower total scaled FertiQoL scores(51.0 vs. 63.5, p = 0.047) and significantly lower emotional(37.5 vs. 54.2, p = 0.04) and social(54.2 vs. 79.2, p = 0.007) scaled scores. The emotional domain reflects feelings like sadness, jealousy and resentment; the social domain evaluates social inclusion, stigma and impact of infertility on relationships. Limitations, reasons for caution Limitations include the two groups were not matched for age or parity. However linear regression modelling adjusting for age, BMI and parity did not impact significant differences. A proportion of controls had partners with male factor infertility which may limit generalisability to the wider healthy population. Wider implications of the findings This is the first study examining infertility’s impact on quality of life in women with CKD. Fertility treatment caused more pronounced emotional and social effects, highlighting the need for tailored, holistic support to address the unique challenges faced by this growing population. Infertility affects their quality of life significantly. Trial registration number Yes