Efficacy of psychological interventions for mental health and pregnancy rates among individuals with infertility: a systematic review and meta-analysis

Abstract

BACKGROUND Depression and anxiety are highly prevalent among individuals struggling with infertility. Thus, numerous psychological interventions have been adapted to infertility, with the aim of relieving distress as well as increasing pregnancy rates. OBJECTIVE AND RATIONALE This systematic review and meta-analysis aimed to identify all randomized controlled trials (RCTs) evaluating the effect of psychological interventions on infertility-related distress and pregnancy rates among individuals and/or couples with infertility and to analyse their overall effect. It also sought to examine potential treatment moderators, including intervention length, format and therapeutic approach. SEARCH METHODS An electronic search of 11 databases, including MEDLINE, EMBASE, PsycINFO and Cochrane Central Register of Controlled Trials, was performed for studies published until January 2022. The inclusion criteria were RCTs conducted on humans and published in English. Psychological outcomes of interest included anxiety, depression, infertility-related distress, wellbeing and marital satisfaction. The Cochrane Risk of Bias tool was used to assess study quality, and the Grading of Recommendations Assessment, Development and Evaluation was used to assess the overall quality of the research evidence. OUTCOMES There were 58 RCTs in total, including 54 which included psychological outcomes and 21 which assessed pregnancy rates. Studies originated from all regions of the world, but nearly half of the studies were from the Middle East. Although a beneficial effect on combined psychological outcomes was found (Hedge’s g = 0.82, P < 0.0001), it was moderated by region (P < 0.00001) such that studies from the Middle East exhibited large effects (g = 1.40, P < 0.0001), while the effects were small among studies conducted elsewhere (g = 0.23, P < 0.0001). Statistically adjusting for study region in a meta-regression, neither intervention length, therapeutic approach, therapy format, nor participant gender (P > 0.05) moderated the effect of treatment. A beneficial treatment effect on pregnancy (RR (95% CI) = 1.25 (1.07–1.47), P = 0.005) was not moderated by region, treatment length, approach or format (P > 0.05). Largely due to the lack of high quality RCTs, the quality of the available evidence was rated as low to moderate. WIDER IMPLICATIONS This is the first meta-analysis of RCTs testing the effect of psychological interventions on infertility-related distress and pregnancy rates. These findings suggest that in most regions of the world, psychological interventions are associated with small reductions in distress and modest effects on conception, suggesting the need for more effective interventions. These findings must be considered in light of the fact that the majority of the included RCTs were deemed to be at high risk of bias. Rigorously conducted trials are needed.

Effectiveness of psychosocial interventions for infertile women: A systematic review and meta-analysis with a focus on a method-critical evaluation

“…The systematic review and meta-analysis of Dube et al [ 23 ] (which has been published exactly at the time of completion of this review) showed that psychosocial interventions for women had a 25% higher probability of becoming pregnant than those who did not receive treatment. Art/music therapy, yoga, acupuncture and massage therapy were excluded as psychosocial interventions because they were not considered psychologically based.…”

“…Katyal et al [ 24 ] found an improvement in pregnancy rates in their meta-analysis. This increased when only long-duration interventions were considered, which excluded music therapy interventions (comparable with [ 23 ], see below).…”

“…Our analysis regarding pregnancy rates also includes one study conducted in the Middle East. Anxiety and depression scores were slightly but statistically significantly improved by the interventions in the analysis of Dube et al [ 23 ]. Our review also showed an improvement in anxiety in women with fertility disorders.…”

“…Regarding the effectiveness of psychosocial interventions for fertility disorders on the quality of life of affected individuals (especially anxiety and depression), the findings are also inconsistent. Two recent reviews [ 23 , 24 ] published during our data collection showed an improvement in pregnancy rates through psychosocial interventions (RR = 1,12 [ 24 ]; RR = 1,25 [ 23 ]). Both author teams included RCTs only.…”

“…The aim of this systematic review and meta-analysis–which has been undertaken without prior knowledge of Katyal et al [ 24 ] and Dube et al [ 23 ]—is to investigate the effects of psychosocial interventions on the psychological factors anxiety and depression as well as on pregnancy rates of women undergoing ART treatment compared to women undergoing ART treatment only and not receiving psychosocial interventions (treatment as usual). In this meta-analysis, the attention is exclusively on the psychosocial aspects and not on medical content.…”