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.
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Currently available psychological interventions for infertility have only small effects on infertility-related distress.
“The most recent meta-analysis of psychological interventions for infertility identified 58 randomized controlled trials and found that such interventions have only small effects on infertility-related distress [10].”
From Acceptance and commitment therapy adapted for women with infertility: a pilot study of the Infertility ACTion program. (2024) · cites this paper as [10]
Efficacy of psychological interventions for infertility does not differ according to intervention type or format.
“Efficacy did not differ according to intervention type or format.”
From Acceptance and commitment therapy adapted for women with infertility: a pilot study of the Infertility ACTion program. (2024) · cites this paper as [10]
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“The most recent meta-analysis of psychological interventions for infertility identified 58 randomized controlled trials and found that such interventions have only small effects on infertility-related distress [10].”
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- Authors
- Dube, L., Bright, K., Hayden, K. A., & Gordon, J. L.
- Affiliations
- University of Regina (CA)
- Alberta Health Services (CA)
- Department of Libraries and Cultural Resources, University of Calgary , Calgary, Alberta, Canada
- Corresponding author
- Gordon, Jennifer L
- Venue
- Human Reproduction Update
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-10-03
- Volume
- 29
- Issue
- 1
- Pages
- 71-94
- ISSN
- 1355-4786 (ISSN-L)
- 1460-2369
- OpenAlex
- W4300687628
- Cited by
- 75
- References
- 101
- Citations by year
- 2026: 25 · 2025: 23 · 2024: 19 · 2023: 7 · 2022: 1
- FWCI
- 2.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction Update (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Saskatchewan Health Research Foundation Patient-Oriented Research
- Postdoctoral Fellowship through the University of Calgary
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Assisted Reproductive Technology and Twin Pregnancy
- Keywords
- infertility, psychological intervention, depression, anxiety, pregnancy rate, couples, marital satisfaction, well-being, treatment moderators, Middle East, treatment duration, treatment options, gender differences, quality of evidence, randomized controlled trials, meta-regression, subgroup analysis, subgroup heterogeneity, subgroup size
- MeSH terms
- Psychosocial Intervention, Anxiety, Female, Humans, Infertility, Mental Health, Pregnancy, Pregnancy Rate
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