Human Reproduction Update Advance Access originally published online on February 5, 2009
Human Reproduction Update 2009 15(3):279-295; doi:10.1093/humupd/dmp002
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The efficacy of psychological interventions for infertile patients: a meta-analysis examining mental health and pregnancy rate
1 Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland 2 Institute of Social und Preventive Medicine (ISPM), Division of Social and Behavioural Health Research, University of Bern, Switzerland
3 Correspondence address. E-mail: katja.haemmerli{at}ptp.unibe.ch
BACKGROUND: Psychological interventions for infertile patients seek to improve mental health and increase pregnancy rates. The aim of the present meta-analysis was to examine if psychological interventions improve mental health and pregnancy rate among infertile patients. Thus, controlled studies were pooled investigating psychological interventions following the introduction of assisted reproductive treatments (ART).
METHODS: The databases of Medline, PsycINFO, PSYNDEX, Web of Science and the Cochrane Library were searched to identify relevant articles published between 1978 and 2007 (384 articles). Included were prospective intervention studies on infertile patients (women and men) receiving psychological interventions independent of actual medical treatment. The outcome measures were mental health and pregnancy rate. A total of 21 controlled studies were ultimately included in a meta-analysis comparing the efficacy of psychological interventions. Effect sizes (ES) were calculated for psychological measures and risk ratios (RR) for pregnancy rate.
RESULTS: The findings from controlled studies indicated no significant effect for psychological interventions regarding mental health (depression: ES 0.02, 99% CI: –0.19, 0.24; anxiety: ES 0.16, 99% CI: –0.10, 0.42; mental distress: ES 0.08, 99% CI: –0.10, 0.51). Nevertheless, there was evidence for the positive impact of psychological interventions on pregnancy rates (RR 1.42, 99% CI: 1.02, 1.96). Concerning pregnancy rates, significant effects for psychological interventions were only found for couples not receiving ART.
CONCLUSIONS: Despite the absence of clinical effects on mental health measures, psychological interventions were found to improve some patients’ chances of becoming pregnant. Psychological interventions represent an attractive treatment option, in particular, for infertile patients who are not receiving medical treatment.
Key words: assisted reproductive treatment / infertility / meta-analysis / psychological intervention / pregnancy
Received on January 9, 2008; revised December 16, 2008; accepted on January 3, 2009