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Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: a systematic review and meta-analysis
Open accessAbstract
Objective: To evaluate the evidence on the efficacy of psychosocial interventions for improving pregnancy rates and reducing distress for couples in treatment with assisted reproductive technology (ART). Design: Systematic review and meta-analysis. Data sources: PsycINFO, PubMed, EMBASE, CINAHL, Web of Science and The Cochrane Library between 1978 and April 2014. Study selection: Studies were considered eligible if they evaluated the effect of any psychosocial intervention on clinical pregnancy and/or distress in infertile participants, used a quantitative approach and were published in English. Data extraction: Study characteristics and results were extracted and the methodological quality was assessed. Effect sizes (ES; Hedges g) were pooled using a random effects model. Heterogeneity was assessed using the Q statistic and I 2 , and publication bias was evaluated using Egger’s method. Possible moderators and mediators were explored with meta-analyses of variances (ANOVAs) and meta-regression. Results: We identified 39 eligible studies (total N=2746 men and women) assessing the effects of psychological treatment on pregnancy rates and/or adverse psychological outcomes, including depressive symptoms, anxiety, infertility stress and marital function. Statistically significant and robust overall effects of psychosocial intervention were found for both clinical pregnancy (risk ratio=2.01; CI 1.48 to 2.73; p<0.001) and combined psychological outcomes (Hedges g=0.59; CI 0.38 to 0.80; p=0.001). The pooled ES for psychological outcomes were generally larger for women (g: 0.51 to 0.73) than men (0.13 to 0.34), but the difference only reached statistical significance for depressive symptoms (p=0.004). Meta-regression indicated that larger reductions in anxiety were associated with greater improvement in pregnancy rates (Slope 0.19; p=0.004). No clear-cut differences were found between effects of cognitive–behavioural therapy (CBT; g=0.84), mind–body interventions (0.61) and other intervention types (0.50). Conclusions: The present meta-analysis suggests that psychosocial interventions for couples in treatment for infertility, in particular CBT, could be efficacious, both in reducing psychological distress and in improving clinical pregnancy rates.
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“Furthermore, the overall effect size associated with randomised controlled trials of psychological interventions on combined psychological outcomes was non-significant and efficacy was not found to differ according to intervention type.”
From Infertility-related distress and clinical targets for psychotherapy: A qualitative study (2021) · cites this paper as [15]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Although mindfulness approaches have proven to be of limited efficacy for infertility-related distress, one mindfulness-based approach that has yet to be applied to infertility is loving-kindness meditation (LKM),41 which seems to map on well to both shame/self-blame and severed relationships with others.”
From Infertility-related distress and clinical targets for psychotherapy: A qualitative study (2021) · cites this paper as [15]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Though CBT has been applied to infertility in a number of studies, with limited results, there are a number of CBT-based techniques that have yet to be used but that may address some of the specific infertility-related psychological challenges raised in this study.”
From Infertility-related distress and clinical targets for psychotherapy: A qualitative study (2021) · cites this paper as [15]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“While cognitive restructuring, progressive muscle relaxation, and mindfulness meditation are the most-used and tested approaches to date for the treatment of infertility-related distress, their efficacy in this population is limited.15”
From Infertility-related distress and clinical targets for psychotherapy: A qualitative study (2021) · cites this paper as [15]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Though they were found to result in small reductions in anxiety, they were not found to improve depressive symptoms, infertility distress or marital functioning when adjusting for publication bias.”
From Infertility-related distress and clinical targets for psychotherapy: A qualitative study (2021) · cites this paper as [15]
In the citing paper
“Bai et al. [45] used the effect size d = 0.59 (medium effect [41]) for the calculation of the power analysis, which was determined in the meta-analysis by Frederiksen et al. [19].”
In the citing paper
“Furthermore, Frederiksen et al. [19] made some miscalculations in their meta-analysis [62].”
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“, negative emotions, such as stress, may reduce chances of getting pregnant [22]), making understanding the emotional impact critical.”
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“treatment and pregnancy of infertile women (21),”
Hosseinpanahi, M., Mirghafourvand, M., Farshbaf-Khalili, A., Esmaeilpour, K., Rezaei, M., & Malakouti, J. (2020) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_512_20 · Cited by 29
“Reports indicated positive effects of psychological intervention on the rate of fertility and psychological consequences of infertility, such as anxiety, depression, stress, and marital relationship.[28] In a meta‐analytical study (2014), 1821 patients with mental disorders and physical problems have been examined.”
BackgroundStress and Quality of Life for Taiwanese Women Who Underwent Infertility Treatment
Cheng, C., Stevenson, E. L., Yang, C., & Liou, S. (2018) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1016/j.jogn.2018.03.005 · Cited by 29
Zhu, H., Shi, L., Wang, R., Cui, L., Wang, J., Tang, M., Qian, H., Wei, M., Wang, L., Zhou, H., et al. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.889845 · Cited by 39
Renzi, A., Solano, L., Trani, M. D., Ginobbi, F., Minutolo, E., & Tambelli, R. (2019) · Psychology and Health · doi:10.1080/08870446.2019.1667500 · Cited by 28
Application of Mindfulness-Based Psychological Interventions in Infertility
Patel, A., Sharma, P. V. N., & Kumar, P. (2020) · Journal of Human Reproductive Sciences · doi:10.4103/jhrs.jhrs_51_19 · Cited by 26
“The main conclusions which emerge from the present body of literature[31,15-22,25,26,27,39,41,42] are as following: a.”
BackgroundInfluentialThe impact of infertility on the mental health of women undergoing in vitro fertilization treatment
Moutzouroulia, A., Asimakopoulou, Z., Tzavara, C. K., Asimakopoulos, K., Adonakis, G., & Kaponis, A. I. (2025) · Sexual & Reproductive Healthcare · doi:10.1016/j.srhc.2025.101072 · Cited by 26
Online peer support communities in the infertility journey: A systematic mixed-studies review
Lin, J. W., & Shorey, S. (2023) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2023.104454 · Cited by 30
Pinto, P. R., Paredes, A. C., & Almeida, A. (2018) · Pain Medicine · doi:10.1093/pm/pny309 · Cited by 26
Sahraian, K., Abdollahpour Ranjbar, H., Namavar Jahromi, B., Cheung, H. N., Ciarrochi, J., & Habibi Asgarabad, M. (2024) · BMC Psychiatry · doi:10.1186/s12888-023-05411-6 · Cited by 27
Hamzehgardeshi, Z., Yazdani, F., Elyasi, F., Moosazadeh, M., Peyvandi, S., Gelehkolaee, K. S., & Shahidi, M. (2019) · International Journal of Reproductive BioMedicine (IJRM) · doi:10.18502/ijrm.v17i1.3821 · Cited by 25
“Frederiksen showed in a meta-analysis study that, like cognitive behavioral therapies, mental interventions for couples seeking fertility treatment could be useful in reducing mental stress and improving fertility treatment (31).”
BackgroundEvaluations of psychosocial cancer support services: A scoping review
Lingens, S. P., Schulz, H., & Bleich, C. (2021) · PLoS ONE · doi:10.1371/journal.pone.0251126 · Cited by 25
“Primarily, our results reveal the lack of high-quality research on the evaluation of psychosocial cancer support services—specifically in form of RCTs.”
BackgroundRoozitalab, S., Rahimzadeh, M., Mirmajidi, S. R., Ataee, M., & Saeieh, S. E. (2021) · Journal of Reproduction & Infertility · doi:10.18502/jri.v22i4.7654 · Cited by 25
“The results of various studies have revealed that the lack of psychological intervention increased the symptoms of PTSD (27, 28).”
BackgroundZaake, D., Kayiira, A., & Namagembe, I. (2019) · Fertility Research and Practice · doi:10.1186/s40738-019-0058-8 · Cited by 24
Towards a more pragmatic and wiser approach to infertility care
The Annual Capri Workshop Group, Bhattacharya, S., Evers, J. L. H., Gameiro, S., Negri, E., Somigliana, E., Vercellini, P., Wellings, K., Baird, D. T., Crosignani, P., et al. (2019) · Human Reproduction · doi:10.1093/humrep/dez101 · Cited by 25
Sõritsa, D., Mäestu, E., Nuut, M., Mäestu, J., Migueles, J. H., Läänelaid, S., Ehrenberg, A., Sekavin, A., Sõritsa, A., Salumets, A., et al. (2020) · Journal of Assisted Reproduction and Genetics · doi:10.1007/s10815-020-01864-w · Cited by 27
“In our study, the regression coefficient for oocytes and embryos of the described models were 1.8 (P = 0.03) and 1.2 (P = 0.03), respectively (these values were rounded to the closest entire number in the figure for simplicity) hormones via the hypothalamic-pituitary-ovarian-axis [28]; (2) PA can impact reproductive f…”
BackgroundInfluentialVatanparast, M., Ardekani, S. M. Y., Anvari, M., Kalantari, A., Yaghmaie, F., & Royani, Z. (2020) · Journal of Reproductive and Infant Psychology · doi:10.1080/02646838.2020.1843613 · Cited by 24
“couples during the period of diagnosis when an infertile couple starts treatment, which may improve the ART outcome, as mentioned in previous studies (Cousineau & Domar, 2007; Frederiksen et al., 2015).”
BackgroundMethodInfluentialDepressive symptoms, anxiety, and quality of life of Japanese women at initiation of ART treatment
Kato, T., Sampei, M., Saito, K., Morisaki, N., & Urayama, K. Y. (2021) · Scientific Reports · doi:10.1038/s41598-021-87057-6 · Cited by 24
Stress and Anxiety Levels in Couples who Undergo Fertility Treatment: a Review of Systematic Reviews
Paraskevi, L., Sarantaki, A., & Gourounti, K. (2021) · Materia Socio Medica · doi:10.5455/msm.2021.33.60-64 · Cited by 29
“Also, they investigate the possibility of better treatment outcomes as a result of providing a comparison of outcomes between couples who participated in an interventional group and those who did not (1, 3, 4, 5, 13).”
BackgroundMethodInfluentialReproductive problems and intensity of anxiety and depression in women treated for infertility
Wdowiak, A., Makara‐Studzińska, M., Raczkiewicz, D., & CYRANKA, K. M. (2022) · Psychiatria Polska · doi:10.12740/pp/125885 · Cited by 24
Tabatabaei, F., Tahernia, H., Ghaedi, A., Bazrgar, A., & Khanzadeh, S. (2023) · BMC Women s Health · doi:10.1186/s12905-023-02692-7 · Cited by 26
“These challenges encompass issues like anxiety and depressive disorders, and tendencies toward self-blame [11, 12].”
BackgroundCreating a collaborative model of mental health counseling for the future
Domar, A. D. (2015) · Fertility and Sterility · doi:10.1016/j.fertnstert.2015.05.026 · Cited by 23
Kremer, F., Ditzen, B., & Wischmann, T. (2023) · PLoS ONE · doi:10.1371/journal.pone.0282065 · Cited by 22
RetractedGalhardo, A., Cunha, M., & Pinto‐Gouveia, J. (2019) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2362 · Cited by 23
Bright, K. S., Dube, L., Hayden, A., & Gordon, J. L. (2020) · BMJ Open · doi:10.1136/bmjopen-2019-036030 · Cited by 22
Boedt, T., Dancet, E. A. F., Fong, S. L., Peeraer, K., Neubourg, D. D., Pelckmans, S., van de Vijver, A., Seghers, J., der Gucht, K. V., CALSTER, B. V., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-029665 · Cited by 26
“18 A meta-analysis of interventional studies recently concluded that psychosocial interventions for couples undergoing IVF are effective, both in reducing emotional distress and in improving IVF-pregnancy rates.(19) Psychosocial interventions focussing on mindfulness are promising as it has recently been shown to resu…”
BackgroundGolshani, F., Mirghafourvand, M., Hasanpour, S., & Seiiedi Biarag, L. (2020) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs.96715 · Cited by 21
“(2015) in a review and meta-analysis showed that the psychological interventions, especially CBT, are effective in improving infertility and also in reducing psychological depression and improving clinical pregnancy (30).”
BackgroundWillis, M. D., Wesselink, A. K., Hystad, P., Jimenez, M. P., Coleman, C. M., Kirwa, K., Hatch, E. E., & Wise, L. A. (2023) · Environmental Health Perspectives · doi:10.1289/ehp10648 · Cited by 22
Obst, K. L., Oxlad, M., Turnbull, D. A., & McPherson, N. O. (2023) · American Journal of Men s Health · doi:10.1177/15579883231209210 · Cited by 21
“Traditionally, fertility has been viewed as a “women’s problem” given that women undertake most treatments and procedures associated with infertility and pregnancy (Culley et al., 2013; Frederiksen et al., 2015; Wischmann & Thorn, 2013).”
BackgroundChen, S., Wang, T., Zhang, S., Zhao, L., & Chen, L. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.03.016 · Cited by 22
“%) evaluated the association of infertility treatment with the risk of perinatal depressive symptoms, as the rests evaluated the association of ART with the risk of perinatal depressive symptoms.”
BackgroundInfluentialPatient perspectives and experiences with in vitro fertilization and genetic testing options
Rothwell, E., Lamb, B., Johnson, E. P., Gurtcheff, S. E., Riches, N. O., Fagan, M. B., Sabatello, M., & Johnstone, E. B. (2020) · Therapeutic Advances in Reproductive Health · doi:10.1177/2633494119899942 · Cited by 21
Kruglova, K., O’Connell, S. B. L., Dawadi, S., Gelgoot, E. N., Miner, S. A., Robins, S., Schinazi, J., & Zelkowitz, P. (2021) · JMIR Formative Research · doi:10.2196/28136 · Cited by 20
Margan, R., Margan, M.-M., Fira-Mlădinescu, C., Putnoky, S., Sas, I. T., Bagiu, R. V., Popa, Z. L., Bernad, E. S., Ciucă, I. M., Bratosin, F., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19063256 · Cited by 20
“the detrimental consequences of hazardous sexual conduct or an imbalanced lifestyle on fertility [24,25].”
BackgroundRodino, I. S., Gignac, G. E., & Sanders, K. A. (2018) · Reproductive Biomedicine & Society Online · doi:10.1016/j.rbms.2018.03.002 · Cited by 20
“Moreover, psychological interventions in patients undergoing fertility treatment have shown a positive effect on patient psychological well-being, fertility treatment retention rates and subsequent pregnancy rates, highlighting the beneficial effects of addressing patient vulnerabilities with adjunct psychological car…”
Background
Metadata
- Authors
- Frederiksen, Y., Farver-Vestergaard, I., Skovgård, N. G., Ingerslev, H. J., & Zachariae, R.
- Affiliations
- Aarhus University (DK)
- Aarhus University Hospital (DK)
- Corresponding author
- Frederiksen, Yoon
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2015-01
- Volume
- 5
- Issue
- 1
- Pages
- e006592
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC4316425
- OpenAlex
- W2103859384
- Cited by
- 380
- References
- 112
- Citations by year
- 2026: 27 · 2025: 34 · 2024: 46 · 2023: 43 · 2022: 35 · 2021: 50 · 2020: 35 · 2019: 37 · 2018: 29 · 2017: 20 · 2016: 18 · 2015: 6
- FWCI
- 3.69
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Aarhus Universitet
- 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
- psychosocial interventions, infertility, assisted reproduction, clinical pregnancy rate, psychological distress, depressive symptoms, anxiety, infertility stress, couples, cognitive behavioral therapy, mind-body interventions
- MeSH terms
- Mental Disorders, Female, Humans, Infertility, Male, Pregnancy, Pregnancy Outcome, Psychotherapy, Treatment Outcome, Pregnancy Rate, Reproductive Techniques, Assisted
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