May 2, 2000 -- The depression and anxiety that accompany infertility have long been suspected of contributing to the problem. Now a study from Harvard Medical School suggests that not only is this true, but that group counseling and stress management may dramatically improve the chances of getting pregnant for women undergoing fertility treatments.
The message about psychological interventions is simple -- the earlier, the better, says researcher Alice D. Domar, PhD.
"We can't say at this point that psychological counseling definitely has an impact on the success of infertility treatments, but the findings are intriguing," Domar tells WebMD. "Group therapy is noninvasive, so why not try it? That is what I would tell my sister or best friend. It's not going to hurt, and it may very well help."
Domar and colleagues at Harvard's Beth Israel Deaconess Medical Center compared women undergoing two types of psychological intervention -- a stress-management program and group counseling -- with women who received no psychological counseling. All 184 women in the study had been trying to get pregnant for no more than two years, and about half were receiving some type of fertility treatment, either drug therapy, intrauterine insemination, or in vitro fertilization. The study appears in the April issue of Fertility and Sterility.
The stress management group participated in a version of a program offered at Harvard's Mind/Body Center for Women's Health. The 10-week course stressed relaxation techniques, including meditation, progressive muscle relaxation, imagery, and yoga. The group in counseling also met for 10 weeks, two hours each week, to discuss issues related to their infertility and treatment.
The decision to include only women with two years or less of infertility was made in an effort to rule out the depression commonly seen in those who have been trying to get pregnant for longer periods.
"We published a study a few years ago which found that depression levels peaked between the second and third year of infertility," Domar says. "So one of the goals of this study was to see if we could prevent this peak."
Participants in all three groups had similar ages and backgrounds and were receiving similar fertility treatments. All women who remained in the study were followed for a year. During that time, 55% of the women who had received stress-management therapy became pregnant, as did 54% of those who received group therapy. Only 20% of the women in the group that received no psychological intervention became pregnant, but 60% of this group had dropped out of the study before its completion.
This high dropout rate is not surprising, Catherine Racowsky, MD, director of the Assisted Reproduction Laboratory at Boston's Brigham and Women's Hospital, tells WebMD. Women with fertility problems often want to use all the treatments that might help them, says Racowsky, who was not involved in the study. "Obviously, those who are put in a control group are not going to be happy about it and they are going to look around for something else," she says.
Racowsky and Domar agree that more study is needed to establish a definite link between psychological counseling and pregnancy in infertile women. The Harvard researchers hope to receive funding from the National Institutes of Mental Health to conduct a study of psychological intervention in women undergoing in vitro fertilization.
"I think the message from this study is that women who want to give themselves the best chance for conception and the best chance to feel OK as they go through infertility treatment should definitely consider a group," Domar says.