Exploratory randomized trial on the effect of a brief psychological intervention on emotions, quality of life discontinuation and pregnancy rates in in vitro fertilization patients

Capsule:
A combined cognitive coping and relaxation self help psychological intervention was associated with improved psychological status but not lower treatment discontinuation or higher pregnancy rates.

Authors:
Alice D. Domar, Ph.D., Jill Gross, M.S., Kristin Rooney, B.A., Jacky Boivin, Ph.D.

Volume 104, Issue 2, Pages 440-451

Abstract:

Objective:
To determine whether a brief self-administered cognitive coping and relaxation intervention (CCRI) would lead to decreased treatment termination in in vitro fertilization (IVF) patients compared with routine care (RC).

Design:
Randomized, controlled, prospective study.

Setting:
Private academically affiliated infertility center.

Patient(s):
One hundred sixty-six women about to begin their first IVF cycle.

Intervention(s):
Randomization to the self-administered CCRI or RC control group and then observation for 12 months.

Main Outcome Measure(s):
Treatment discontinuation within 12 months (primary outcome), clinical pregnancy rate and psychological well-being (secondary outcomes).

Result(s):
The 12-month pregnancy rate was similar for the RC and CCRI groups (odds ratio [OR] 1.02; 95% CI, 0.53–1.98). Of the patients who were not pregnant on the first cycle, 15 of 46 (15.2%) patients assigned to RC discontinued compared with 5 of 55 (5.5%) patients assigned to the CCRI (OR 3.11; 95% CI, 0.756–12.80). The CCRI group engaged in statistically significantly more positive reappraisal coping (OR 0.275; 95% CI, 0.16, 0.39) than the RC control group (OR 0.097; 95% CI, −0.03, .23). The CCRI group had an improved Fertility Quality of Life (FertiQoL CORE: OR 4.07; 95% CI, 2.07, 6.06; FertiQoL Emotional: OR 5.95; 95% CI, 2.89, 9.00) compared with the control group (Core OR: 0.67; 95% CI, −1.55, 2.89; Emotional: OR −0.02, 95% CI, −3.36, 3.32). The CCRI group reported less global anxiety (OR 0.275; 95% CI, 0.16, 0.39) than the control group (OR 0.471; 95% CI, −2.40, 3.34). The CCRI reported positive evaluations for the intervention (e.g., ease of use, helpfulness, perceived stress reduction).

Conclusion(s):
Use of the CCRI tool led to improved psychological status but not statistically significantly more treatment cycles or a higher pregnancy rate.

Clinical Trial Registration Number:
NCT01318291.

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