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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.
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“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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A pszichológiai szűrés és ellátás helye az asszisztált reprodukcióban
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“Evidence from outside of sub-Saharan Africa suggests that psychosocial interventions for infertile couples are effective [22-24].”
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“…individuals’ chances of fulfilling their dream—and, for some, their female role expectation—researchers have found that stress levels in women receiving in-vitro fertilization are equivalent to those of women with cancer, AIDS, and heart disease (Domar et al., 1993; Frederiksen et al., 2015).”
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“…and systematic reviews of the many studies evaluating psychological interventions for women with infertility have inconsistent conclusions (Boivin, 2003; Chow et al., 2016; Frederiksen et al., 2015; Ha¨mmerli et al., 2009; Rooney & Domar, 2018; Verkuijlen et al., 2016; Ying et al., 2016).”
Chua, C. M. S., Huang, Z., Lim, H. K. L., Nantsupawat, A., Wichaikhum, O., Lee, J. J. N., Chee, C. Y. I., & Shorey, S. (2025) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.70533 · Cited by 3
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“Positive associations have been found between psychosocial interventions and reductions in psychological distress (26) and anxiety (27), as well as improvements in marital function (27) and clinical pregnancy rates (25–28).”
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“Infertile women in China often feel inferior and crowded due to the influence of China’s traditional culture.(4) In addition, the heavy economic burden of infertility, complex treatment process and uncertainty of treatment lead to poor mental health.”
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“…psychological assistance may help reduce distress, anxiety and other emotional difficulties, as well as contribute to improving ART pregnancy outcomes (Czamanski-Cohen et al., 2016; Facchinetti et al., 2004; Frederiksen et al., 2015; Karaca et al., 2019; Pasha et al., 2013; Renzi et al., 2020).”
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“As a result, the facilities should be provided so that these individuals receive psychological treatment parallel to infertility medical treatment (16, 17).”
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“Nurses in relation to pregnant women in critical wards of hospital should take actions for reducing the anxiety and fear of women (18).”
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“As was reported by previous studies, infertility can bring people as much emotional strain as a traumatic event (Ashraf et al., 2014; Frederiksen et al., 2015; Khetarpal & Singh, 2012), which is accompanied by feelings of anger, guilt, shame, anxiety, depression, and other negative emotions (Bhat &…”
Fertility treatment: Getting stressed about stress
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“On the other hand, another systematic review and meta-analysis also published in 2015 (5), reported that psycho-social interventions improved psychological outcomes and could improve pregnancy success.”
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“…de consiliere psihologică sau psihoterapie (de exemplu, cognitiv-comportamentală sau terapie de grup) pe durata ciclurilor de fertilizare in vitro comparativ cu eşantionele de control care primesc doar servicii standard de tratament medical (Frederiksen et al ., 2015; Ying, Wu şi Loke, 2016).”
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Papathanasiou, A. (2025) · Women & Health · doi:10.1080/03630242.2025.2529507 · Cited by 2
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“178,179 However, as highlighted in the scoping review above, 176 men are largely absent from these interventions.”
Mindful Self-Compassion for Infertility-Related Distress: A Single-Group Intervention Study
Halleran, M., Balsom, A. A., & Gordon, J. L. (2026) · Journal of Integrative and Complementary Medicine · doi:10.1177/27683605261427699 · Cited by 3
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“world that can threaten individual, marital, and social balance; because infertility is an unexpected tension and severe stigma for infertile couples [1] that can cause profound marital and emotional problems among them [2] and affect different aspects of people’s lives including their emotional and social performance…”
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BackgroundFemale sexual function and fertility
Grill, E. A., Meyers, A. J., & Domar, A. D. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-822288-1.00017-8 · Cited by 2
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“The present study results are consistent with the previous systematic reviews (Boivin, 2003; Hämmerli et al., 2009; Frederiksen et al., 2015) Cognitive behavior therapy is a structured, short-term, psychotherapy aimed at modifying dysfunctional thinking and behaviors as well as solving current…”
Long-term outcomes of erectile function in adult orchidopexy patients
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“38 Mindfulness-based interventions showed a positive effect on pregnancy rates.”
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“14,15 However, while global studies advocate for the inclusion of psychological counselling in infertility treatment protocols, 8,16,17 the specific dynamics of this relationship remain underexplored within the unique cultural context of India.”
BackgroundRelationship between relative fat mass and infertility: A cross-sectional study
Zhao, X., Wu, Y., & Hu, H. (2024) · Medicine · doi:10.1097/md.0000000000039990 · Cited by 2
“[5] Infertility is linked to a number of subsequent chronic illnesses, including cancer, diabetes, and cardiovascular disease, according to research.”
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Hormonal and nonhormonal treatment of male infertility
Davies, R., Jayasena, C. N., & Minhas, S. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-89907-9.00037-5 · Cited by 2
Mental stress in infertility: a tertiary care hospital-based study
Bhattacharya, S., Kyal, A., Mondal, P., Mukhopadhyay, P., Chowdhury, M., & Mitra, D. (2018) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20184161 · Cited by 2
“infertile couples, several psychosocial interventions have been developed to offer support, but these are mostly limited to Western countries.(10) Psychosocial intervention is defined as any intervention that addresses the psychological or social needs of the patient and can be delivered in any format, including group…”
BackgroundSpouses’ Psychological States and Family Relations in Families with Natural and Induced Pregnancies
Bokhan, T. G., Terekhina, O. V., Shabalovskaya, M. V., Leshchinskaia, S. B., Владимировна, С. А., Анатольевна, Н. Е., Selita, F., & Agarkova, L. A. (2018) · Psychology in Russia State of Art · doi:10.11621/pir.2018.0404 · Cited by 2
Kostić, J. O., Mitrović, M., & Panić, D. (2021) · Psychological applications and trends · doi:10.36315/2021inpact005 · Cited by 2
Holley, S. R., & Pasch, L. A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108859486.007 · Cited by 2
Nsed, E. N. E., Boichuk, O. H., & Yaniv, О. V. (2021) · Art of Medicine · doi:10.21802/artm.2020.4.16.71 · Cited by 2
Baghbani, F., Alidousti, K., Parvizi, M. M., Ahmadi, A., Alamdarloo, S. M., Jaladat, A. M., & Atarzadeh, F. (2023) · Research Square · doi:10.21203/rs.3.rs-2763633/v1 · Cited by 2
Küçükkelepçe, D. Ş., & ÜNVER, H. (2021) · Medical Records · doi:10.37990/medr.1014220 · Cited by 1
Factors that affect career success of nurses who practice in assisted reproductive technology
Li, W., Honggui, W., Hong, P., & Hong, L. (2023) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.6388.3927 · Cited by 1
An Integrative Review of Psychosocial Intervention Programs for Infertile Females
Shin, Y., & Nam, S. (2023) · Korean Journal of Stress Research · doi:10.17547/kjsr.2023.31.4.158 · Cited by 1
New therapeutic approaches for improving the outcomes of assisted reproductive technologies
Levakov, S. A., Александровна, Г. Т., & Rudyakova, E. A. (2024) · V F Snegirev Archives of Obstetrics and Gynecology · doi:10.17816/aog628310 · Cited by 1
Vasudevan, S. R., & Bhuvaneswari, M. (2025) · Human Arenas · doi:10.1007/s42087-024-00470-x · Cited by 1
“Most of the studies show psy-1 chological aids and interventions were highly effective in reducing fertility-related stress and anxiety and have increased pregnancy rates (Boivin, 2003 ; Frederiksen et al., 2015).”
Guo, D.-Y., Chan, C., Leng, L.-L., Zhang, J., Wang, X.-H., & Zhang, C. (2025) · Clinical Social Work Journal · doi:10.1007/s10615-025-00999-6 · Cited by 1
“This exploration can also effect from a meta-study of infertility intervention on psy - chological outcomes (d = 0.59) (Frederiksen et al., 2015 ), with a power of 0.95 at a significance level of 5%, 20 par - ticipants were required in each group for an analysis of variance (ANOVA) with a 2*2…”
InfluentialBokek‐Cohen, Y., Lupo, K. T., Miller, N. D., Wiser, A., & Herzberger, E. H. (2025) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.70324 · Cited by 1
Stucki, P., Meier, M., di Giacopo, S. C. M., Birchler, K., & Leeners, B. (2025) · Frontiers in Reproductive Health · doi:10.3389/frph.2025.1698380 · Cited by 1
Peng, Y., Pu, Y., Wang, Y., Li, S., Wang, Y., & Fang, J. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1798373 · Cited by 1
Fertile ground for social support? Understanding men's use of online infertility support groups
Ryckeghem, L. V., Wallays, A., Oelbrandt, E., & Buffel, V. (2026) · Digital Health · doi:10.1177/20552076261430610 · Cited by 1
di Giacopo, S. C. M., Kalaitzopoulos, D. R., Meier, M., & Leeners, B. (2026) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2026.07.001 · Cited by 1
Sun, H., Gao, X., Zhang, J., & Qin, R. (2026) · Current Urology · doi:10.1097/cu9.0000000000000366 · Cited by 1
Psychosocial aspects of therapeutic donor insemination
Patel, A., Sharma, P., & Kumar, P. (2018) · Journal of Human Reproductive Sciences · doi:10.4103/jhrs.jhrs_108_18 · Cited by 1
ART THERAPY FOR INFERTILITY: A CASE STUDY
Petre, L. M. (2019) · SWS International Scientific Conference on Social Sciences · doi:10.5593/sws.iscss.2019.3/s11.014 · Cited by 1
THE PSYCHOSOCIAL ASPECTS OF INFERTILITY
Kostić, J. (2021) · Facta Universitatis Series Philosophy Sociology Psychology and History · doi:10.22190/fupsph210200io · Cited by 1
Unified Protocol Application in Fertility Problems
Crespo-Delgado, E., Martínez‐Borba, V., Pejó, L. A., & Osma, J. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780197564295.003.0008 · Cited by 1
Chen, D., Wang, A., Zhang, W., Guo, Y., Yao, S., Chen, X., & Zhang, J. (2023) · Journal of Psychosomatic Obstetrics & Gynecology · doi:10.1080/0167482x.2023.2278015 · Cited by 1
“…exhausting [6]. anxiety, depression, and sleep disturbance are common and are caused by high costs, uncertain success and a lack of knowledge [7,8]. especially in china, where confucianism is dominant, most couples hold the traditional idea that having a child is necessary, and thus,…”
BackgroundMethodInfluentialSpoletini, R., Scaravelli, G., Monaco, S., Renzi, A., & Fedele, F. (2024) · PSICOLOGIA DELLA SALUTE · doi:10.3280/pds2024-003006 · Cited by 1
Dias, L. A., Loecker, P. D., Willems, S., D’Hooghe, T., Vriens, J., Peeraer, K., & Dancet, E. A. F. (2025) · Human Reproduction · doi:10.1093/humrep/deaf033 · Cited by 1
Ruiz-Porras, D., Ruiz-Porras, L., & Cruz-Repiso, V. (2019) · Psicología y Salud · doi:10.25009/pys.v30i1.2614 · Cited by 1
Ahmed, H., hafeze, E. E. D. A., & Arief, A. F. (2019) · Assiut Scientific Nursing Journal · doi:10.21608/asnj.2019.76389 · Cited by 1
Kim, M., Park, J., Hong, J.-E., & Ban, M. (2021) · JOURNAL OF THE KOREAN SOCIETY OF MATERNAL AND CHILD HEALTH · doi:10.21896/jksmch.2021.25.3.169 · Cited by 1
“난임 치료를 받는 남녀를 대상으로 한 심리 사회적 중재의 체계적 문헌고찰 연구(Frederiksen et al., 2015)에서도 난임 치료를 받는 부부대상의 중재를 제안하 였으며, 특별히 그룹중재에서 부정적 정서 완화 정도가 높 았음을 제시하였다.”
What is a person with depression who wants to have a baby to do?
Holley, S. R. (2018) · Fertility and Sterility · doi:10.1016/j.fertnstert.2018.02.125 · Cited by 1
Infertility and Assisted Reproduction: Psychosocial Aspects
Geller, P. A., Nelson, A. J., & Hartman, A. R. (2020) · Springer eBooks · doi:10.1007/978-3-030-39903-0_1312 · Cited by 1
Recurrent Pregnancy Loss: immunological risk factors and immunomodulatory treatments
Nørgaard-Pedersen, C. (2023) · VBN Forskningsportal (Aalborg Universitet) · doi:10.54337/aau620097234 · Cited by 1
Park, S. A., & Kim, H. (2026) · medRxiv · doi:10.64898/2026.02.26.26347155 · Cited by 1
Tremellen, K. P. (2021) · Assisted Reproduction Techniques · doi:10.1002/9781119622215.ch67
Women’s Health: Behavioral Medicine Interventions for Women During Childbearing and Menopause
Psaros, C., Remmert, J. E., Amoyal, N. R., & Hicks, R. A. (2016) · Springer eBooks · doi:10.1007/978-3-319-29294-6_12
Recomendaciones para intervención psicológica en receptores de gametos y embriones
Mestre‐Bach, G., Bayonas, A., Tirado, M., Chamorro, S., Molla, V. G., & Brichette, M. (2017) · Medicina Reproductiva y Embriología Clínica · doi:10.1016/j.medre.2016.11.001
The Role of the Mental Health Professional in the ART Clinic Setting
Domar, A. D., & Rooney, K. L. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-801238-3.64904-8
von Wolff, M., Stute, P., & Mosimann, B. (2018) · Gynäkologische Endokrinologie · doi:10.1007/s10304-018-0177-z
Medical Family Therapy in Obstetrics and Gynecology
Lamson, A. L. S., Phelps, K. W., Jones, A. B., & Bagley, R. (2018) · Focused issues in family therapy · doi:10.1007/978-3-319-68834-3_6
von Wolff, M., & Stute, P. (2019) · Gynäkologische Endokrinologie · doi:10.1007/s10304-019-0253-z
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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