Pregnancy rate more than doubled with online program for infertile women

By Dr. Liji Thomas, MDMar 18 2020

A new study published in March 2020 in the journal PLOS ONE reports that the online version of a well-respected program that counsels infertile women achieved the same level of success as the person-to-person equivalent. This was true about both the reduction in emotional distress and the increase in pregnancy rates.

An internet-based mind/body intervention to mitigate distress in women experiencing infertility: A randomized pilot trial. Image Credit: Valeria Aksakova / Shutterstock

Infertility and psychological burden

Infertility has been shown to produce significant emotional distress, anxiety, and depression. These may be due to feelings of shame, guilt, and low self-esteem, which cause a poor quality of life. It is estimated that 30% to 40% of infertility patients suffer from significant depression and anxiety.

The medications used in the treatment of infertility are also linked to similar symptoms, which makes it harder to distinguish between primary symptoms and those occurring as a result of the medication. Secondly, patients experience more significant depression and anxiety as they are treated for a longer time and with more intensive and costly interventions.

On the other hand, it is also true that depressed women are less likely to be treated for infertility, and the chances of dropping out after a single treatment cycle are higher. Finally, research has shown that even when the outcome is likely to be favorable, and even when patients can afford such treatment, the biggest reason to discontinue is psychological distress.

Personal counseling of infertile women by specialized staff has been shown to reduce anxiety, stress, and depression while improving pregnancy success rates. However, many such women do not exploit this resource for a variety of reasons, including doubt about its effectiveness, the cost, the perceived shame of infertility, difficulties with travel, and other problems with getting appointments. As a result, not only do these women being treated for infertility not take help from counselors, but they often decide to stop trying to have a child one day.

The program

The current study focused on the online program called the MindBody Program for Fertility, which was developed by Harvard scientists at the Domar Center. This program was developed over three years, based on the in-person version used earlier. The researchers collaborated with gynecological and reproductive biologist Alice Domar at Harvard.

The online program provides all the content on the in-person version, with ten instruction modules lasting one hour each. Each module may use audio, visual, and text material. The module contains matter on how stress and lifestyle affect fertility, relaxation techniques of a wide range from hatha yoga to deep breathing; mindfulness; cognitive behavioral therapy, techniques to express one’s emotions effectively, while coping with negative emotions, training in assertiveness, and in setting goals.

Women doing the online program can also get feedback from a trained therapist after homework assignments. They could count on the availability of the remote therapist until the program was complete.

The study findings

The study looked at 71 women with infertility, of whom approximately half took the online program, and the other half were on a waitlist for it. Both underwent a pre- and post-program evaluation.

Women who went through this program immediately reported less depression and anxiety, with the quantum ranging from medium to large. They also had significant stress reduction in relation to their sexual and social issues.

Not only were these gains perceptible in contrast to the control group, but they had a 2.5-fold chance of pregnancy compared to the latter. In absolute terms, the group that took the program reported pregnancy in 53% of cases compared to 20% in the other group. Not only so, but the waiting period until pregnancy occurred was also 79 days, on average, compared to a mean of 97 days in the control group.

These advantages are comparable to the benefits of the in-person program. Both sets of evaluations proved that the women in this situation were willing to take and satisfied with the online program.

Study author Jessica Clifton says, “Offering this highly effective program online removes the barriers to counseling that prevent so many women undergoing fertility treatment from getting the help they need. It could enable women across the country, no matter where they live or what their circumstances, to reduce their distress and increase their chances of conceiving.”

The implications

The researcher sums up: “The results suggest we could change the way reproductive medicine is provided. Medical practices could implement quick and easy screening to identify distressed patients. We could then offer a convenient, effective, and affordable internet-based intervention for these patients that would measurably reduce their distress and help them achieve their dream of conceiving a child.”