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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.
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“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.
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“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]
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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].”
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“Furthermore, Frederiksen et al. [19] made some miscalculations in their meta-analysis [62].”
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Cited by
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The relationship between stress and infertility
Rooney, K. L., & Domar, A. D. (2018) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2018.20.1/klrooney · Cited by 626
Recurrent implantation failure: A comprehensive summary from etiology to treatment
Ma, J., Gao, W., & Li, D. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.1061766 · Cited by 212
Pasch, L. A., Holley, S. R., Bleil, M. E., Shehab, D., Katz, P., & Adler, N. E. (2016) · Fertility and Sterility · doi:10.1016/j.fertnstert.2016.03.006 · Cited by 180
Lifestyle and fertility: the influence of stress and quality of life on female fertility
Palomba, S., Daolio, J., Romeo, S., Battaglia, F. A., Marci, R., & Sala, G. B. L. (2018) · Reproductive Biology and Endocrinology · doi:10.1186/s12958-018-0434-y · Cited by 183
Aging and the environment affect gamete and embryo potential: can we intervene?
Meldrum, D. R., Casper, R. F., Diez-Juan, A., Simon, C., Domar, A. D., & Frydman, R. (2016) · Fertility and Sterility · doi:10.1016/j.fertnstert.2016.01.013 · Cited by 159
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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