Table 3

Results of meta-analyses of effects of psychosocial intervention on psychological outcomes and pregnancy rates among infertile couples

Sample sizeHeterogeneity*Global ESFail-safe numbers‡Criterion§
KNQdfp ValueI2Hedges g†95% CIp Value
Main effects
Pregnancy
 Pregnancy, women10132422.090.00959.02.01 (RR)1.48 to 2.73<0.00113060
Adjusted for publication bias(13)1.57 (RR)1.10 to 2.25<0.05
 Psych. combined, women+men352746259.234<0.00186.90.590.38 to 0.80<0.0011552185
Adjusted for publication bias(42)¶0.310.07 to 0.56<0.05
 Psych. combined, women282076130.827<0.00176.40.510.32 to 0.70<0.001798150
Adjusted for publication bias(34)¶0.300.09 to 0.51<0.05
 Psych. combined, men73478.960.17832.80.340.08 to 0.590.0101245
 Between-group** (women vs men)3521101.21NS
Infertility distress
 Infertility distress, women+men1061521.490.0158.00.24−0.02 to 0.50NS
 Infertility distress, women637117.850.00371.80.37−0.06 to 0.79NS
Depressive symptoms
 Depression symptom, women+men211558367.520<0.00194.61.000.54 to 1.45<0.0011022115
Adjusted for publication bias(25)¶0.310.20 to 0.84NS
 Depressive symptom, women17992107.716<0.00185.10.730.41 to 1.06<0.00139395
Adjusted for publication bias(23)¶0.290.07 to 0.65NS
 Depressive symptom, men52431.940.7490.000.13−0.11 to 0.37NS
 Between-group** (women vs men)2212358.51<0.004
Anxiety
 Anxiety, women+men252159144.424<0.00183.40.510.31 to 0.71<0.001760135
Adjusted for publication bias(29)¶0.310.07 to 0.54<0.05
 Anxiety, women231737114.322<0.00180.80.530.32 to 0.73<0.001631125
Adjusted for publication bias(27)¶0.320.08 to 0.57<0.05
 Anxiety, men52468.740.07053.80.32−0.04 to 0.67NS
 Between-group** (women vs men)2819831.01NS
Marital function
 Marital function, women+men563314.640.00672.60.09−0.23 to 0.41NS
 Marital function, women458714.530.00279.30.08−0.30 to 0.46NS
Moderator analyses
Pregnancy (women)
 Study design††
  RCT685610.850.05753.51.67 (RR)1.17 to 2.40<0.052240
  NRCT44687.930.04862.12.80 (RR)1.55 to 5.06<0.0013130
  Adjusted for publication bias(6)¶1.93 (RR)1.07 to 3.49<0.05
  Between-group**1013242.11NS
 Intervention format
  Group569110.940.02763.42.03 (RR)1.29 to 3.20<0.012835
  Individual44332.230.5310.01.65 (RR)1.26 to 2.17<0.001830
  Between-group**911240.51NS
Psychological outcomes combined (women+men)
 Study design††
  RCT202185232.419<0.00191.80.700.36 to 1.03<0.001642110
  Adjusted for publication bias(24)¶0.26−0.10 to 0.68NS
  NRCT845014.970.03753.10.28−0.00 to 0.57NS
  UCT72156.060.4240.00.550.40 to 0.70<0.0019045
  Adjusted for publication bias(10)¶0.510.36 to 0.66<0.05
  Between-group**3528503.92NS
 Intervention types
  CBT747539.06<0.00184.60.840.33 to 1.350.00110745
  Adjusted for publication bias(10)¶0.37−0.19 to 0.93NS
  MBI984157.78<0.00186.10.610.17 to 0.65<0.00115855
  Adjusted for publication bias(10)¶0.420.01 to 0.84<0.05
  Other191430149.29<0.00187.90.500.18 to 0.810.002246105
  Adjusted for publication bias(24)¶0.17−0.20 to 0.54NS
  Between-group**3527461.32NS
 Intervention format
  Group20148487.219<0.00178.20.760.55 to 0.98<0.001959110
  Adjusted for publication bias(26)¶0.500.25 to 0.75<0.05
  Individual983417.780.02354.90.13−0.08 to 0.35NS
  Couples328492.32<0.00197.81.07−1.02 to 3.16NS
  Online32481.220.5410.000.03−0.22 to 0.28NS
  Between-group**35285024.53<0.001 
  • *Q statistic: p values<0.1 taken to suggest heterogeneity. I2 statistic: 0% (no heterogeneity), 25% (low heterogeneity), 50% (moderate heterogeneity) and 75% (high heterogeneity).

  • †ESR=Hedges g. Standardised mean difference, adjusting for small sample bias. A positive value indicates an ES in the hypothesised direction, that is, reduced pain or relatively smaller increase in pain in the intervention group. All ES were combined using a random effects model. To ensure independency, if a study reported results for more than one pain measure, the ES were combined (mean), ensuring that only one ES per study was used in the calculation.

  • ‡Fail-safe number=number of non-significant studies that would bring the p value to non-significant (p>0.05).

  • §A fail-safe number exceeding the criterion (5×k+10) indicates a robust result.98

  • ¶If analyses indicated the possibility of publication bias, missing studies were imputed and an adjusted ESR was calculated (italics); (K) indicates the number of published studies+number of imputed studies.

  • **Meta-ANOVA (between-study comparisons).

  • ††RCT, NRCT and UCT.

  • ANOVA, analysis of variance; CBT, cognitive–behavioural therapy; ES, effect size; MBI, mind/body intervention; NRCT, non-randomised controlled trial; NS, not significant; Psych, psychological outcomes; RCT, randomised controlled trial; RR, risk ratio; UCT, uncontrolled trial (pre–post).