Hämmerli Katja, Znoj Hansjörg, Barth Jürgen
Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland.
Hum Reprod Update. 2009 May-Jun;15(3):279-95. doi: 10.1093/humupd/dmp002. Epub 2009 Feb 5.
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).
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.
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.
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.
针对不孕患者的心理干预旨在改善心理健康状况并提高妊娠率。本荟萃分析的目的是检验心理干预是否能改善不孕患者的心理健康状况和妊娠率。因此，我们汇总了在辅助生殖治疗（ART）引入后开展的有关心理干预的对照研究。
检索了Medline、PsycINFO、PSYNDEX、科学引文索引和考克兰图书馆数据库，以识别1978年至2007年间发表的相关文章（共384篇）。纳入的研究为针对不孕患者（包括男性和女性）的前瞻性干预研究，这些研究中的心理干预独立于实际医疗治疗。结局指标为心理健康状况和妊娠率。最终共有21项对照研究纳入荟萃分析，以比较心理干预的效果。计算了心理测量指标的效应量（ES）和妊娠率的风险比（RR）。
对照研究的结果表明，心理干预对心理健康状况无显著影响（抑郁：ES 0.02，99%置信区间：-0.19，0.24；焦虑：ES 0.16，99%置信区间：-0.10，0.42；心理困扰：ES 0.08，99%置信区间：-0.10，0.51）。然而，有证据表明心理干预对妊娠率有积极影响（RR 1.42，99%置信区间：1.02，1.96）。关于妊娠率，仅在未接受ART的夫妇中发现心理干预有显著效果。
尽管心理干预对心理健康测量指标没有临床效果，但发现其能提高部分患者的妊娠几率。心理干预是一种有吸引力的治疗选择，特别是对于未接受医疗治疗的不孕患者。
