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Review
. 2011 Feb 23:342:d223.
doi: 10.1136/bmj.d223.

Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies

J Boivin  1 , E Griffiths, C A Venetis
Affiliations
Review

Emotional distress in infertile women and failure of assisted reproductive technologies: meta-analysis of prospective psychosocial studies

J Boivin et al. BMJ. .

Abstract

Objective: To examine whether pretreatment emotional distress in women is associated with achievement of pregnancy after a cycle of assisted reproductive technology.

Design: Meta-analysis of prospective psychosocial studies.

Data sources: PubMed, Medline, Embase, PsycINFO, PsychNET, ISI Web of Knowledge, and ISI Web of Science were searched for articles published from 1985 to March 2010 (inclusive). We also undertook a hand search of reference lists and contacted 29 authors. Eligible studies were prospective studies reporting a test of the association between pretreatment emotional distress (anxiety or depression) and pregnancy in women undergoing a single cycle of assisted reproductive technology. Review methods Two authors independently assessed the studies for eligibility and quality (using criteria adapted from the Newcastle-Ottawa quality scale) and extracted data. Authors contributed additional data not included in original publication.

Results: Fourteen studies with 3583 infertile women undergoing a cycle of fertility treatment were included in the meta-analysis. The effect size used was the standardised mean difference (adjusted for small sample size) in pretreatment anxiety or depression (priority on anxiety where both measured) between women who achieved a pregnancy (defined as a positive pregnancy test, positive fetal heart scan, or live birth) and those who did not. Pretreatment emotional distress was not associated with treatment outcome after a cycle of assisted reproductive technology (standardised mean difference -0.04, 95% confidence interval -0.11 to 0.03 (fixed effects model); heterogeneity I²=14%, P=0.30). Subgroup analyses according to previous experience of assisted reproductive technology, composition of the not pregnant group, and timing of the emotional assessment were not significant. The effect size did not vary according to study quality, but a significant subgroup analysis on timing of the pregnancy test, a contour enhanced funnel plot, and Egger's test indicated the presence of moderate publication bias.

Conclusions: The findings of this meta-analysis should reassure women and doctors that emotional distress caused by fertility problems or other life events co-occurring with treatment will not compromise the chance of becoming pregnant.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work for all three authors; EG and CAV declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; JB received speaker fees from EMD Serono Inc. and Merck & Co. (then Schering Plough), and a research grant from Merck Serono S.A. in the previous three years; no other relationships or activities that could appear to have influenced the submitted work for the three authors.

Figures

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Fig 1 Decision flowchart for identified studies
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Fig 2 Means and standard deviations for pretreatment emotional distress in subsequently pregnant and not pregnant women and forest plot of the standardised mean difference in pretreatment emotional distress between groups
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Fig 3 Contour enhanced funnel plot for meta-analysis of the association between pretreatment emotional distress and achievement of pregnancy in women undergoing a cycle of fertility treatment with an assisted reproductive technology. The red eclipse represents the area where four studies (white circles) were imputed when the trim and fill method was applied
See this image and copyright information in PMC

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