Basirat Zahra, Kheirkhah Farzan, Faramarzi Mahbobeh, Esmaeilzadeh Sedigheh, Khafri Sorraya, Tajali Zahra
Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran.
Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
Int J Fertil Steril. 2022 Aug 21;16(3):211-219. doi: 10.22074/ijfs.2021.529258.1124.
Recurrent pregnancy loss (RPL) and infertility are associated with significant psychiatric complications.
The study aimed to investigate the effectiveness of cognitive behavioral therapy (CBT) and sertraline
in the treatment of in depression, anxiety, and infertility stress of depressed infertile women with RPL in comparison
with usual care.
Materials and Methods: A triple-arm randomized controlled trial was carried out on the 60 depressed infertile
women with RPL, a population of Infertility Center of Babol city, Iran, who were randomly assigned into three
groups: pharmacotherapy with sertraline (n=20), psychotherapy with CBT (n=20), and a usual care as control
group (n=20). The participants of psychotherapy received CBT sessions (90 minutes each) over 10 weeks. The
participants in the pharmacotherapy group took 50 mg/day sertraline daily for 22 weeks. Outcomes were assessed
using the Beck Depression Inventory (BDI-II), fertility problem inventory (FPI), and State-Trait Anxiety
Inventory Form Y (STAI-Y) at the beginning of the trial, 10-weeks post-trial, and three months of follow-up.
Using statistical package for the social sciences (SPSS) software, data were analyzed.
Results: CBT considerably reduced the depression symptoms more than sertraline with a moderate effect size
at the post-trial (g=0.11, 95% CI: -0.03 to -0.50). Sertraline showed reduced the scores of state-anxiety more
considerably in comparison with control group by a large effect size of post-trial (g=-1.04, 95% CI: -1.70 to
-0.38). CBT reduced the total scores of FPI more considerably than sertraline, with a large, small size at follow
up-trial [95% CI=-0.03(-0.65, -0.58)]. Both CBT and sertraline were superior to the control group in reducing
depression and infertility stress.
Conclusion: Depression and infertility stress diminished under CBT and sertraline in depressed infertile women with
RPL, with a significant advantage of CBT. Sertraline was superior to CBT in reduction of anxiety (registration number:
IRCT201304045931N3).
复发性流产（RPL）和不孕症与严重的精神并发症相关。
本研究旨在调查认知行为疗法（CBT）和舍曲林治疗伴有RPL的抑郁不育女性的抑郁、焦虑和不孕压力的有效性，并与常规护理进行比较。
对伊朗巴博勒市不孕不育中心的60名伴有RPL的抑郁不育女性进行了一项三臂随机对照试验，她们被随机分为三组：舍曲林药物治疗组（n = 20）、CBT心理治疗组（n = 20）和常规护理对照组（n = 20）。心理治疗组的参与者在10周内接受CBT治疗（每次90分钟）。药物治疗组的参与者每天服用50毫克舍曲林，持续22周。在试验开始时、试验后10周和随访3个月时，使用贝克抑郁量表（BDI-II）、生育问题量表（FPI）和状态-特质焦虑量表Y型（STAI-Y）评估结果。使用社会科学统计软件包（SPSS）软件对数据进行分析。
在试验后，CBT比舍曲林更能显著减轻抑郁症状，效应量中等（g = 0.11，95%CI：-0.03至-0.50）。与对照组相比，舍曲林在试验后能更显著地降低状态焦虑得分，效应量较大（g = -1.04，95%CI：-1.70至-0.38）。CBT比舍曲林更能显著降低FPI总分，在随访试验中效应量为大、小[95%CI = -0.03（-0.65，-0.58）]。CBT和舍曲林在减轻抑郁和不孕压力方面均优于对照组。
CBT和舍曲林可减轻伴有RPL的抑郁不育女性的抑郁和不孕压力，CBT具有显著优势。舍曲林在减轻焦虑方面优于CBT（注册号：IRCT201304045931N3）。
