Psychological Intervention Improves Pregnancy Rates in Infertile Women

(Reuters Health) - Group support and group cognitive behavioral therapy can significantly increase pregnancy rates in infertile women, according to a report by Dr. Alice D. Domar and colleagues from Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, Massachusetts, examined the pregnancy rates of 184 infertile women randomized into a 10-week cognitive-behavioral group, a standard support group, or a routine care control group. The women had been attempting for 1 to 2 years to become pregnant.

The women in the three groups did not differ in age, educational level, months of infertility, or type of treatment for their infertility, according to the report. "The cognitive-behavioral participants had significantly different viable pregnancy rates than the control women," the authors report, "and support participants had significantly different viable pregnancy rates than the control women."

A large number of dropouts in the control group (mostly crossing over to the other groups) hampered statistical comparison of pregnancy rates. Nevertheless, the investigators report, 55% of the women in the cognitive-behavioral group and 54% of those in the support group developed viable pregnancies, compared with only 20% of the women in the control group. Furthermore, the report indicates, 42% of the women in the cognitive-behavioral group became pregnant without medical help, compared with 11% of the support group and 20% of the control group. "We can't make statistical conclusions about these trends, simply because of dropouts and the unequal distributions of women in the three groups," Dr. Domar told Reuters Health. "But there's certainly the suggestion that cognitive-behavioral group therapy can spare some of the women the cost and discomfort of medical interventions."

"As more women in the control group failed to become pregnant, they began to develop the sort of depression we see in women who have gone for 2 or 3 years without getting pregnant," Dr. Domar said. "At that point, they left the study to join a Resolve support group, our clinical mind/body program, or other forms of treatment."

"The results of this study suggest that psychological interventions may affect pregnancy rates at an earlier point [than entry into IVF programs] and should perhaps be implemented in conjunction with initial medical treatment," the authors conclude in the journal.

"However it works, group psychological intervention could prove to be a cost-effective first step for women who have tried for a while to get pregnant. Our results suggest that a significant number of women would be able to get pregnant without undergoing the costly and invasive options offered by advanced reproductive technology," Dr. Domar said.

Fertil Steril 2000;73:805-811.