Online Program Quadruples Pregnancy Rate for Infertile Women

Jessica Clifton, PhD

An online clinical program was efficient in reducing stress and promoting pregnancy in women being treated for infertility, according to new study findings.

Lead study author Jessica Clifton, PhD, and a team of investigators sought to determine if an internet-based mind and body program would lead to patients experiencing infertility being willing to be recruited and being ready to engage in a fertility-specific intervention. The team found that women who participated in the program, the Mind/Body Program for Fertility, were more than two-times more likely to become pregnant and experienced medium to large decreases in depression and anxiety compared with a control group.

Offering the program removes barriers to counseling that may otherwise prevent women in fertility treatment from getting help, Clifton said in a statement.

“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,” she added.

The internet-based intervention mirrored the 10-week, face-to-face program, which included information and exercises structured into 10 modules designed to take <1 hour each to complete. Modules had text; audio; video; interactive elements; and electronic downloads. Therapist feedback was provided after each module and to answer questions.

The patients who were assigned to this group were asked to complete the self-guided program. Strategies and skills taught included:

• Knowledge about the relationship between stress, lifestyle, and fertility
• Relaxation techniques
• Mindfulness
• Cognitive restructuring
• Stress reduction strategies
• Listening and communication skills
• Strategies for emotional expression and coping with anger
• Assertiveness training and goal-setting skills

After each module, homework was assigned to track health-related information, time participating in relaxation exercises, and cognitive behavioral therapy tools.

Clifton, a faculty scientist from the Department of Psychological Sciences at the University of Vermont, and colleagues recruited women with infertility issues who were >18 years old and never gave birth; had access to the internet; spoke English; had no psychotropic medication changes in the last month; had not participated in a Mind/Body Program for Fertility; and had no suicidal ideation or intent, a psychotic or eating disorder, or substance abuse or dependence.

Eligible patients were randomized to the internet-based intervention or a quasi-controlled wait-list condition. Each patient was emailed a mid-assessment at five-weeks and a post-assessment at either 10-weeks (control group) or at the end of the online program (intervention group).

If a participant completed the mid-assessment, they were considered retained. Those in the intervention group who completed >5 out of 10 modules were considered to have adhered to the program.

Participants rated their ability to complete each module and the helpfulness after completion. During post-assessment, each participant was given the Client Satisfaction Inventory Short-Form, which assessed the satisfaction with the treatment’s effects.

To assess psychological distress, participants completed online self-report assessments at 3 timepoints, which included 2 primary measures: The Beck Anxiety Inventory and the Beck Depression Inventory-II.

Individuals reported pregnancy rates throughout the study period.

Overall, 71 patients were randomized. Time between pre- and post-assessment differed significantly between the intervention (233.97) and wait-list groups (90.73).

On average, participants in the intervention group completed 4 modules and waited on average 21 days to complete the first module.

Women who participated in the program had a significant reduction in distress (anxiety, P=.003; depression, P=.007; stress, P=.041; fertility-social, P=.018; fertility-sexual, P=.006) compared to the wait-list group.

What’s more, the odds of becoming pregnant was 4.47-times higher for the intervention group participants than the wait-list group (95% CI, 1.56-12.85; P=.005).

The findings suggested that the program was feasible and acceptable for women seeking infertility treatment.

The study, “An internet-based mind/body intervention to mitigate distress in women experiencing infertility: A randomized pilot trial,” was published online in the journal PLOS ONE.