Institute of Medical Psychology, Centre for Psychosocial Medicine, University Hospital, Heidelberg, Germany.
PLoS One. 2023 Feb 28;18(2):e0282065. doi: 10.1371/journal.pone.0282065. eCollection 2023.
Approximately seven to nine percent of couples of reproductive age do not get pregnant despite regular and unprotected sexual intercourse. Various psychosocial interventions for women and men with fertility disorders are repeatedly found in the literature. The effects of these interventions on outcomes such as anxiety and depression, as well as on the probability of pregnancy, do not currently allow for reliable generalisable statements. This review includes studies published since 2015 performing a method-critical evaluation of the studies. Furthermore, we suggest how interventions could be implemented in the future to improve anxiety, depression, and pregnancy rates.
The project was registered with Prospero (CRD42021242683 13 April 2021). The literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases were searched and 479 potential studies were discovered. After reviewing the full texts, ten studies were included for the synthesis. Not all studies reported the three outcomes: four studies each for depression, three for anxiety and nine studies for pregnancy rates were included in the meta-analysis, which was conducted using the Comprehensive meta-analysis (CMA) software.
Psychosocial interventions do not significantly change women's anxiety (Hedges' g -0,006; CI: -0,667 to 0,655; p = 0,985), but they have a significant impact on depression in infertile women (Hedges' g -0,893; CI: -1,644 to -0,145; p = 0,026). Implementations of psychosocial interventions during assisted reproductive technology (ART) treatment do not increase pregnancy rates (odds ratio 1,337; 95% CI 0,983 to 1,820; p = 0,064). The methodological critical evaluation indicates heterogeneous study design and samples. The results of the studies were determined with different methods and make comparability difficult. All these factors do not allow for a uniform conclusion.
Study design (duration and timing of intervention, type of intervention, type of data collection) and samples (age of women, reason for infertility, duration of infertility) are very heterogeneous. The results of the studies were determined with different methods and make comparability difficult. All these factors do not allow for a uniform conclusion.
In order to be able to better compare psychosocial interventions and their influence on ART treatment and thus also to achieve valid results, a standardised procedure to the mentioned factors is necessary.
尽管有规律且未采取避孕措施的性行为，大约有 7%至 9%的育龄夫妇未能怀孕。在文献中反复发现针对生育障碍的女性和男性的各种心理社会干预措施。这些干预措施对焦虑和抑郁等结果以及怀孕概率的影响目前还无法做出可靠的普遍适用的结论。本综述包括自 2015 年以来发表的研究，对这些研究进行了方法批判性评估。此外，我们还提出了如何在未来实施干预措施以提高焦虑、抑郁和怀孕率。
该项目在 Prospero（CRD42021242683 号，2021 年 4 月 13 日）进行了注册。文献检索按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。对六个数据库进行了检索，发现了 479 项潜在的研究。在审查全文后，有 10 项研究被纳入综述。并非所有研究都报告了三个结果：四项研究分别报告了抑郁，三项研究报告了焦虑，九项研究报告了怀孕率，这些研究被纳入综合荟萃分析（CMA）软件进行荟萃分析。
心理社会干预措施并不能显著改变女性的焦虑（Hedges' g -0.006；CI：-0.667 至 0.655；p = 0.985），但它们对不孕女性的抑郁有显著影响（Hedges' g -0.893；CI：-1.644 至-0.145；p = 0.026）。在辅助生殖技术（ART）治疗期间实施心理社会干预措施并不会增加怀孕率（比值比 1.337；95%CI 0.983 至 1.820；p = 0.064）。方法批判性评估表明研究设计和样本存在异质性。研究结果采用不同的方法确定，这使得可比性变得困难。所有这些因素都不允许得出统一的结论。
研究设计（干预的持续时间和时间、干预类型、数据收集类型）和样本（女性年龄、不孕原因、不孕持续时间）非常不同。研究结果采用不同的方法确定，这使得可比性变得困难。所有这些因素都不允许得出统一的结论。
为了能够更好地比较心理社会干预措施及其对 ART 治疗的影响，从而获得有效的结果，有必要对上述因素进行标准化处理。
