To the Editor: We are pleased to see that Bedi et al.1 have published a qualitative systematic review protocol that aims to identify and synthesize evidence on the experiences of adults participating in infertility support groups and, ultimately, to understand its value to those experiencing infertility. Indeed, this theme deserves particular attention considering its prevalence and that it is a sparsely explored area of health.

Infertility is a disease that affects populations worldwide, regardless of sociocultural or economic status, and its extension has raised concerns of international organizations and led to calls for a prioritized intervention as a public health issue.2,3 As such, new advanced resources to diagnose and treat are needed, but also a deeper and broader understanding about the experience of those living with infertility, which affects several dimensions of life.4 The authors'1 interest in qualitative studies acknowledges the need to investigate the complex nature of the condition. Qualitative research facilitates a deeper knowledge about the phenomenon and the human responses towards life and health circumstances. A recent literature review identified a set of human responses and nursing diagnoses of infertile patients as described in the citations or verbatim from the papers included.5 When reading the protocol by Bedi et al.,1 the impact of infertility is based on physical, mental, emotional, financial and psychosocial dimensions, and no clear reference to spiritual dimension or spirituality is provided. Interestingly, the aforementioned review has found that human responses related to spirituality in those living with infertility are critical and also the most frequent responses, regardless of religious affiliation or whether in the diagnostic, treatment or post-treatment stage.5 Transcendence has been considered a major aspect when addressing this nontransitional condition.6

Furthermore, Bedi et al.1 focus the review in the context of support groups, which are known to be made of relationships that may facilitate connectedness, which is a core attribute of the concept of spirituality as described in healthcare literature, and is developed through formal and informal infertility support groups or programs.4,7

We appreciate the commitment of the authors to synthesizing evidence concerning infertility, which often brings deep suffering related to this uncertain path to parenthood.4 Caution is needed when addressing subjective perceptions, because they can only be fully apprehended through a holistic lens that a spiritual overview of a human existence provides. As such, this is a fertile ground for the provision of person-centered infertility care and a particular opportunity for spiritual care by nurses and midwives.8 The experiences of adults participating in infertility support groups include a spiritual dimension, which will naturally emerge in this qualitative systematic review.

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