Cultural Perceptions and Emotional Well-Being Among Married Women with Polycystic Ovary Syndrome Experiencing Fertility Difficulties in Southern Punjab, Pakistan: A Cross-Sectional Study.

Background: Polycystic ovary syndrome (PCOS) commonly causes fertility difficulties and is associated with substantial psychological distress, particularly in collectivist societies where motherhood is central to female identity and social status. This cross-sectional study examined the association between specific cultural perceptions of fertility difficulties and emotional well-being among married women with PCOS in rural Southern Punjab, Pakistan. Methodology: From July to September 2025, we recruited 583 married women aged 18-48 years with confirmed PCOS using systematic random sampling from the Gynecology Outpatient Department of DHQ Hospital Muzaffargarh. Data were collected using a structured questionnaire comprising validated scales for cultural perceptions of fertility difficulties (10 items, Cronbach's α = 0.87) and emotional well-being (Urdu DASS-21 Depression and Anxiety subscales plus selected Fertility Problem Inventory items, Cronbach's α = 0.84-0.91). Multiple linear regression models with robust standard errors were used in this study. Results: A higher perceived cultural importance of childbearing (β = 0.39, 95% CI 0.30-0.48, p < 0.001) and societal pressure to conceive soon after marriage (β = 0.36, 95% CI 0.27-0.45, p < 0.001) were significantly associated with increased depression and anxiety. Perceived stigma showed an unexpected negative association with depression (β = -0.15, 95% CI -0.24 to -0.06, p = 0.001), possibly reflecting resilience or the mobilization of social support. Conclusions: Cultural perceptions of fertility difficulties are strongly associated with emotional distress in rural populations. Therefore, culturally sensitive psychological screening and support integrated into reproductive health services are recommended.