Results of meta-analyses of effects of psychosocial intervention on psychological outcomes and pregnancy rates among infertile couples
| Sample size | Heterogeneity* | Global ES | Fail-safe numbers‡ | Criterion§ | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| K | N | Q | df | p Value | I2 | Hedges g† | 95% CI | p Value | |||
| Main effects | |||||||||||
| Pregnancy | |||||||||||
| Pregnancy, women | 10 | 1324 | 22.0 | 9 | 0.009 | 59.0 | 2.01 (RR) | 1.48 to 2.73 | <0.001 | 130 | 60 |
| Adjusted for publication bias | (13) | – | – | – | – | – | 1.57 (RR) | 1.10 to 2.25 | <0.05 | – | – |
| Psych. combined, women+men | 35 | 2746 | 259.2 | 34 | <0.001 | 86.9 | 0.59 | 0.38 to 0.80 | <0.001 | 1552 | 185 |
| Adjusted for publication bias | (42)¶ | – | – | – | – | – | 0.31 | 0.07 to 0.56 | <0.05 | – | – |
| Psych. combined, women | 28 | 2076 | 130.8 | 27 | <0.001 | 76.4 | 0.51 | 0.32 to 0.70 | <0.001 | 798 | 150 |
| Adjusted for publication bias | (34)¶ | – | – | – | – | – | 0.30 | 0.09 to 0.51 | <0.05 | – | – |
| Psych. combined, men | 7 | 347 | 8.9 | 6 | 0.178 | 32.8 | 0.34 | 0.08 to 0.59 | 0.010 | 12 | 45 |
| Between-group** (women vs men) | 35 | 2110 | 1.2 | 1 | NS | – | – | – | – | – | – |
| Infertility distress | |||||||||||
| Infertility distress, women+men | 10 | 615 | 21.4 | 9 | 0.01 | 58.0 | 0.24 | −0.02 to 0.50 | NS | – | – |
| Infertility distress, women | 6 | 371 | 17.8 | 5 | 0.003 | 71.8 | 0.37 | −0.06 to 0.79 | NS | – | – |
| Depressive symptoms | |||||||||||
| Depression symptom, women+men | 21 | 1558 | 367.5 | 20 | <0.001 | 94.6 | 1.00 | 0.54 to 1.45 | <0.001 | 1022 | 115 |
| Adjusted for publication bias | (25)¶ | – | – | – | – | – | 0.31 | −0.20 to 0.84 | NS | − | − |
| Depressive symptom, women | 17 | 992 | 107.7 | 16 | <0.001 | 85.1 | 0.73 | 0.41 to 1.06 | <0.001 | 393 | 95 |
| Adjusted for publication bias | (23)¶ | − | − | − | − | − | 0.29 | −0.07 to 0.65 | NS | − | − |
| Depressive symptom, men | 5 | 243 | 1.9 | 4 | 0.749 | 0.00 | 0.13 | −0.11 to 0.37 | NS | − | − |
| Between-group** (women vs men) | 22 | 1235 | 8.5 | 1 | <0.004 | − | − | − | − | − | − |
| Anxiety | |||||||||||
| Anxiety, women+men | 25 | 2159 | 144.4 | 24 | <0.001 | 83.4 | 0.51 | 0.31 to 0.71 | <0.001 | 760 | 135 |
| Adjusted for publication bias | (29)¶ | − | − | − | − | − | 0.31 | 0.07 to 0.54 | <0.05 | − | − |
| Anxiety, women | 23 | 1737 | 114.3 | 22 | <0.001 | 80.8 | 0.53 | 0.32 to 0.73 | <0.001 | 631 | 125 |
| Adjusted for publication bias | (27)¶ | − | − | − | − | − | 0.32 | 0.08 to 0.57 | <0.05 | − | − |
| Anxiety, men | 5 | 246 | 8.7 | 4 | 0.070 | 53.8 | 0.32 | −0.04 to 0.67 | NS | − | − |
| Between-group** (women vs men) | 28 | 1983 | 1.0 | 1 | NS | − | − | − | − | − | − |
| Marital function | |||||||||||
| Marital function, women+men | 5 | 633 | 14.6 | 4 | 0.006 | 72.6 | 0.09 | −0.23 to 0.41 | NS | − | − |
| Marital function, women | 4 | 587 | 14.5 | 3 | 0.002 | 79.3 | 0.08 | −0.30 to 0.46 | NS | − | − |
| Moderator analyses | |||||||||||
| Pregnancy (women) | |||||||||||
| Study design†† | |||||||||||
| RCT | 6 | 856 | 10.8 | 5 | 0.057 | 53.5 | 1.67 (RR) | 1.17 to 2.40 | <0.05 | 22 | 40 |
| NRCT | 4 | 468 | 7.9 | 3 | 0.048 | 62.1 | 2.80 (RR) | 1.55 to 5.06 | <0.001 | 31 | 30 |
| Adjusted for publication bias | (6)¶ | − | − | − | − | − | 1.93 (RR) | 1.07 to 3.49 | <0.05 | − | − |
| Between-group** | 10 | 1324 | 2.1 | 1 | NS | − | − | − | − | − | − |
| Intervention format | |||||||||||
| Group | 5 | 691 | 10.9 | 4 | 0.027 | 63.4 | 2.03 (RR) | 1.29 to 3.20 | <0.01 | 28 | 35 |
| Individual | 4 | 433 | 2.2 | 3 | 0.531 | 0.0 | 1.65 (RR) | 1.26 to 2.17 | <0.001 | 8 | 30 |
| Between-group** | 9 | 1124 | 0.5 | 1 | NS | − | − | − | − | − | − |
| Psychological outcomes combined (women+men) | |||||||||||
| Study design†† | |||||||||||
| RCT | 20 | 2185 | 232.4 | 19 | <0.001 | 91.8 | 0.70 | 0.36 to 1.03 | <0.001 | 642 | 110 |
| Adjusted for publication bias | (24)¶ | − | − | − | − | − | 0.26 | −0.10 to 0.68 | NS | − | − |
| NRCT | 8 | 450 | 14.9 | 7 | 0.037 | 53.1 | 0.28 | −0.00 to 0.57 | NS | − | − |
| UCT | 7 | 215 | 6.0 | 6 | 0.424 | 0.0 | 0.55 | 0.40 to 0.70 | <0.001 | 90 | 45 |
| Adjusted for publication bias | (10)¶ | − | − | − | − | − | 0.51 | 0.36 to 0.66 | <0.05 | − | − |
| Between-group** | 35 | 2850 | 3.9 | 2 | NS | − | − | − | − | − | − |
| Intervention types | |||||||||||
| CBT | 7 | 475 | 39.0 | 6 | <0.001 | 84.6 | 0.84 | 0.33 to 1.35 | 0.001 | 107 | 45 |
| Adjusted for publication bias | (10)¶ | − | − | − | − | − | 0.37 | −0.19 to 0.93 | NS | − | − |
| MBI | 9 | 841 | 57.7 | 8 | <0.001 | 86.1 | 0.61 | 0.17 to 0.65 | <0.001 | 158 | 55 |
| Adjusted for publication bias | (10)¶ | − | − | − | − | − | 0.42 | 0.01 to 0.84 | <0.05 | − | − |
| Other | 19 | 1430 | 149.2 | 9 | <0.001 | 87.9 | 0.50 | 0.18 to 0.81 | 0.002 | 246 | 105 |
| Adjusted for publication bias | (24)¶ | − | − | − | − | − | 0.17 | −0.20 to 0.54 | NS | − | − |
| Between-group** | 35 | 2746 | 1.3 | 2 | NS | − | − | − | − | − | |
| Intervention format | |||||||||||
| Group | 20 | 1484 | 87.2 | 19 | <0.001 | 78.2 | 0.76 | 0.55 to 0.98 | <0.001 | 959 | 110 |
| Adjusted for publication bias | (26)¶ | − | − | − | − | − | 0.50 | 0.25 to 0.75 | <0.05 | − | − |
| Individual | 9 | 834 | 17.7 | 8 | 0.023 | 54.9 | 0.13 | −0.08 to 0.35 | NS | − | − |
| Couples | 3 | 284 | 92.3 | 2 | <0.001 | 97.8 | 1.07 | −1.02 to 3.16 | NS | − | − |
| Online | 3 | 248 | 1.2 | 2 | 0.541 | 0.00 | 0.03 | −0.22 to 0.28 | NS | − | − |
| Between-group** | 35 | 2850 | 24.5 | 3 | <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).