Psychological and educational interventions for subfertile men and women

摘要: Background Approximately one-fifth of all subfertile couples seeking fertility treatment show clinically relevant levels anxiety, depression, or distress. Psychological and educational interventions are frequently offered to couples, but their effectiveness, both in improving mental health pregnancy rates, is unclear. Objectives To assess the effectiveness psychological for on outcomes. Search methods We searched (from inception 2 April 2015) Cochrane Gynaecology Fertility Group Specialised Register Controlled Trials, Central Trials (CENTRAL; Issue 2, 2015), MEDLINE, EMBASE, PsycINFO, EBSCO CINAHL, DARE, Web Science, OpenGrey, LILACS, PubMed, ongoing trials registers. We handsearched reference lists contacted experts field. Selection criteria We included published unpublished randomised controlled (RCTs), cluster trials, cross-over (first phase) evaluating outcomes couples. Data collection analysis Two review authors independently assessed trial risk bias extracted data. study additional information. Our primary were measures (anxiety depression) rates (live birth pregnancy). overall quality evidence using GRADE criteria. As we did not consider studies be sufficiently similar permit meaningful pooling, summarised results individual by presenting median interquartile range (IQR) effects as well minimum maximum values. calculated standardised mean differences (SMDs) continuous variables odds ratios (ORs) dichotomous outcomes. Main results We 39 involving 4925 participants undergoing assisted reproductive technology. Studies heterogeneous with respect a number factors, including nature duration interventions, participants, comparator groups. As result, judged that pooling would result estimate effect. There substantial methodological weaknesses studies, which at high one more assessment domains. was concern about attrition (24 studies), performance (27 studies) (18 detection (26 studies). therefore considered study-specific estimates intervention unreliable. Thirty-three reported outcome health. Only two live birth, these had attrition. One pregnancy, again have combined outcome. Psychological outcomes Studies utilised variety anxiety depression. In cases low score denoted benefit from intervention. SMDs follows: versus attentional control usual care: = -0.30 (-0.84 0.00), value -5.13; 0.84, 17 RCTs, 2042 participants; 0.03, -0.38; 0.23, 4 330 participants. SMDs depression -0.45 (-0.68 -0.08), -3.01; 1.23, 12 1160 -0.33, -0.46; 0.17, 3 304 participants. Fertility outcomes When compared care, ORs ranged 1.13 10.05. No this outcome. Authors' conclusions The distress, uncertain due very evidence. Existing subfertility generally poorly designed executed, resulting serious inconsistency findings. need employing appropriate techniques investigate benefits treatments population. particular, groups should employed, receiving mimics amount time attention received group thought specific effect upon order distinguish between therapeutic non-specific interventions. Where cannot minimised, statistical handling drop-out must applied. Failure address issues design has resulted do provide valid basis answering questions